Why vaccinating Quebec's remote Indigenous communities presents a delicate challenge

Remote northern communities can be found near the top of the Quebec government's list of vaccination priorities, just behind CHSLDs, health-care workers, and seniors' homes.

There are excellent reasons for that: vulnerable elderly people and a high prevalence of chronic illness, scant health-care resources, and a system that is more easily overwhelmed. But the challenges are also many.

For one thing, getting a supply of stable vaccine to some areas that areaccessible only by air, and then getting people to the vaccination location, requires plenty of advance planning.

That's why public health officials in Nunavik, which along with the James Bay region hasbeen circled as a specific priority areaby the provincial committee that established the criteria for the rollout,aren't expecting any vaccines in their region before the New Year.

"We want to protect the population from COVID-19 as soon as possible. Atthe same time we want to ...be sure it's done in partnership with the population and not imposed," said Dr. Marie Rochette, the chief public health officer for Nunavik. "Our challenge is to go fast but at the same time to take the time to do things well."

Nunavik has been logging one ortwo new cases every two weeks, Rochette said, and health officials would like to keep it that way. The province has already announced rapid testing for northern-bound travelers in the coming weeks.

'We can't ignore the trauma from the past'

Buy-in from the local population is also important, according to Marjolaine Sioui, the executive director of the First Nations of Quebec and Labrador Health and Social Services Commission.

"We can't ignore trauma from the past," she said. "Whensome of our people went to residential schools and at the timethe First Nations were used ... that's a reality. They were used to testdrugs or test some vitamins and stuff like that. So for them, it stayed with them."

The Quebec and federal governments have been laying the groundwork with organizations like Sioui's and Indigenous leaders in remote communities for some time, but the communications initiative that willprecede vaccination is still being finalized.

It will involvetranslating awareness campaigns into multiple languages, and recording radio ads. And they'll need to be tailored to specific places.

"In some communities, people are feeling some fear towardthe vaccine," Sioui said. "In other communities they say, wow ... I have more elderly than the average. So they really want to get the vaccine to be protected ... you know,'our elders also are more at risk'. Andelders areour knowledge keepers, our language keepers."

Why it makes sense to wait a few weeks

Rochette calls the COVID-19 vaccination campaign "maybe the most complex vaccination program we have seen in Canada so far."

One of the reasons is the first vaccines to be approved, like the Pfizer-BioNTechformulation that won federal approval on Wednesday, can be finicky to handle. Thevaccine must be kept "super-frozen" in a freezer at80 C to60 C or in a thermal container at90 C to60 Cand is only stable for five days once it has been thawed.

"It's not suitable, for the first doses, to use it in remote regions," said Rochette.

Nunavik will, of course, find ways to make do with the Pfizer-BioNTech vaccine if no other candidates are available, but, in any case,it will take time to mass the human resourcesalways in short supply in the north for a large-scale campaign.

"We will need extra human resources," Rochette said. "That's why we have already put in place a group to see who will be able to help for this vaccine, how we will organize all of this. We want to take the time needed to be sure we are quite well organized."