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Research

St. Mike’s experts respond to the South Asian health crisis

St. Michael’s experts join up with a pioneering philanthropist to explain why all health is global health, and how they’re working to help the GTA’s South Asian community get informed—and vaccinated.

The COVID-19 pandemic has hit some communities and countries harder than others. India is experiencing a huge surge in infections and severe health-care shortfalls, while the South Asian community in the GTA is also heavily affected, with high rates of infection and relatively low rates of vaccination. Many are essential workers, and vaccine confidence and accessibility are concerns. As a physician at St. Michael’s–a leader in research and patient care in the South Asian community–Dr. Seema Marwaha decided to help by founding the South Asian Health Network (SAHN) with philanthropist Sabina Vohra-Miller. The group provides information and assistance to South Asian and other racialized communities. Dr. Prabhat Jha, an epidemiologist at St. Michael’s and the founder of the Centre for Global Health Research, contributes his expertise to the SAHN team. We asked them what they’re doing and why it’s so important right now.

How bad is the current situation in India?

Dr. Jha: It’s a disaster. The number of people sickened is four times what occurred during the last peak in September. And they just have to cope as well as they can on their own, because there might not be medical support within 600 km. The hospitals are swamped, and they can’t vaccinate their way out of it. By June, when we expect this wave to end, only about 20 per cent of the population will be vaccinated, and that’s not enough to protect against another wave.

What is the impact on the South Asian community here?

Dr. Jha: The diaspora is deeply concerned. We’re hearing about so many people getting sick. I have relatives in Delhi, and many are already infected. It’s important to remember that there’s no such thing as local health, it’s all global because variants travel. On top of that, India manufactures a lot of the world’s vaccines, and if it limits exports, it would be bad news. Moreover, if India is not able to open for some time, that would drag down world economic growth and trade. So this isn’t just India. This is a potential disaster for the world.

Dr. Marwaha: At the end of the day, no one is OK until we’re all OK. And when we talk about equitable vaccine distribution, it’s not just within the community, it’s literally across the world.

How did the South Asian Health Network come about?

Dr. Marwaha: Last December there was a lot of public shaming of South Asian communities, with people saying they brought increased infection rates upon themselves because they were “not following the rules.” Sabina and I came together around the idea that societal barriers were likely driving the numbers more than behaviour—as many are essential workers who can’t stay home and isolate. There was also a lot of misinformation circulating in these communities. So we started a group to make people aware of these barriers and try to solve the communication problem.

What does that entail?

Dr. Marwaha: First, it’s identifying the misinformation, figuring out what the barriers are to reaching people and creating content to fill the gaps in the form of videos, infographics and town halls presented in various languages. Then there’s sharing what other people are doing. The third part is distribution. Different communities access information in different ways, so building networks with grassroots community partners, social media channels and ethnic and traditional media is key. We need to have our ear to the ground to find out what people are experiencing, what’s causing them stress, what’s making their neighbourhood a hot zone. Then we need to figure out what they need and use our networks and resources to make everyone understand how these problems affect them too. Sabina’s op ed in the Toronto Star was one example that got a lot of attention.

Sabina Vohra-Miller: We’re partnering with BIPOC organizations across Ontario because they have the trust and the relationships. And when we’re creating materials we make sure we’re addressing the concerns that are coming up and giving them things they can use when they’re having those conversations with their community members. It’s a beautiful partnership.

Dr. Marwaha: We’re also just being present at community meetings to show we’re there to represent them. We need to understand what’s happening on the ground in order to figure out how to get people vaccinated, and that’s what we’re doing. We’re saying maybe you need to have everyone in a household vaccinated at the same time rather than each person booking in different ways at different outlets. And it has to be a place they can walk to or access by public transit. They might not have an OHIP card or a printer to print their consent form. We’re thinking about those things. Because people aren’t intentionally throwing up these structural barriers, they’re just trying to get the job done as quickly as possible, and it’s our job to make them aware of the barriers.

Do each of you have particular roles?

Dr. Marwaha: We can’t be everywhere, so we’re looking at where each of us can best use our skills. This morning I filmed five vaccination education videos for the Ontario Ministry of Health website, which is great for us, and great for St. Mike’s. I didn’t speak Punjabi or Hindi, but just seeing someone who looks like you saying the vaccine is safe is meaningful. Representation really matters.

Vohra-Miller: Vaccine education is something I’m passionate about. I love combatting misinformation, and making infographics and town halls plays into our strategy of making sure we’re getting information out that’s accessible, using a variety of formats and targeting the right media for our audience. Not everyone has a Twitter account or cable TV or a newspaper subscription, so where do they get their information from? We’re trying to make sure we use every possible avenue to reach as many people in those communities as we can.

Dr. Jha: I’ve done some outreach, trying to make sure that media interviews emphasize the key message, which is to get vaccinated. The South Asian community has been identified as one of the more reluctant groups in terms of vaccinations, particularly the AstraZeneca. So I’ve been saying that if there’s any vaccine that comes to you, take it. And I would have no hesitation in getting the AstraZeneca myself, or giving it to my parents.

How much of an issue is vaccine hesitancy?

Vohra-Miller: In the early days there were a lot of questions about the vaccines and people were hesitant. But I think those have mostly been addressed, and the issue now isn’t so much hesitancy as accessibility. At every town hall, people are asking where they can get the vaccine, and when they’ll be eligible. All the questions have to do with accessibility.

Dr. Marwaha: What we’re seeing now is massive demand and inability to navigate a system that wasn’t designed for the South Asian people trying to access it. We’ve become unofficial vaccine navigators for essential workers experiencing barriers due to language or technology or culture. Our role is important. Because we have roots in India and we’re privileged to have medical roles, it’s become a sort of calling.

How does St. Michael’s help?

Dr. Marwaha: The St. Mike’s vaccination outreach team has been incredibly receptive. There were six community housing buildings that were high-risk but just outside the hotspot postal code. We were able to not only advocate to add them to the vaccination list, but we also went there and helped people register for appointments in the lobby. The majority were racialized and living in smaller spaces. St. Michael’s has been really supportive. Serving vulnerable and underserved communities is part of the hospital’s tradition, and the teams are always willing to help. 

What will your work look like post-pandemic?

Dr. Jha: It’s already changed. COVID has turned the world upside down. There’s no distinction between global and local health anymore. I have been trying to accelerate the idea of creating new global vaccine facilities, which would produce vaccines beyond domestic needs and sell them at close to cost. It’s a solution to vaccine nationalism. It will be essential, because infections might now be a once in a decade event. And vaccines are the best response.

Vohra-Miller: Our work won’t end when the pandemic ends. We left COVID out of the group’s name because there were issues that existed before COVID and will exist after it. And we’ll continue using the network to improve the health of this population.

To be informed about upcoming St. Michael’s events focused on the health of the South Asian community, contact Renu Dhir at DhirR@smh.ca.


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