Pandemic Influenza Preparedness and Vulnerable Populations in Tribal Communities

Abstract

American Indian and Alaska Native (AIAN) governments are sovereign entities with inherent authority to establish and administer public health programs within their communities and will be critical partners in national efforts to prepare for pandemic influenza. Within AIAN communities, some subpopulations will be particularly vulnerable during an influenza pandemic because of their underlying health conditions, whereas others will be at increased risk because of limited access to prevention or treatment interventions.We outline potential issues to consider in identifying and providing appropriate services for selected vulnerable populations within tribal communities. We also highlight pandemic influenza preparedness resources available to tribal leaders and their partners in state and local health departments, academia, community-based organizations, and the private sector.

Prevention and Control of Seasonal Influenza with Vaccines

“…These disparities might be attributable in part to the higher prevalence of underlying medical conditions or disparities in medical care among these racial/ethnic groups (92,93). A more recent casecontrol study of risk factors for death from 2009 pandemic influenza that adjusted for factors such as pre-existing medical conditions, barriers to health care access, and delayed receipt of antivirals found that American Indian/Alaska Native status was not independently associated with death (94).…”

The 2009 H1N1 pandemic response in remote First Nation communities of Subarctic Ontario: barriers and improvements from a health care services perspective

“…People living in remote and isolated First Nation communities may face unique challenges during a pandemic which must be addressed by pandemic planners (5). In remote First Nation communities, federal, provincial and First Nation governments share responsibility for the delivery of health care services (4).…”

“…Inadequate social policies and insufficient federal funding have negatively impacted primary health care services, community level surveillance and housing in First Nation communities (6). Although living in an isolated community may initially act as a buffer with respect to exposure to an infectious disease, if a pathogen is introduced into an isolated community, the living conditions (e.g., overcrowded housing, impoverished lifestyle) appears to promote virus transmission (5). Additionally, transportation of supplies and resources may be limited, and can be especially challenging in harsh weather conditions (7).…”

Recommended Mitigation Measures for an Influenza Pandemic in Remote and Isolated First Nations Communities of Ontario, Canada: A Community-Based Participatory Research Approach

“…Although the 2009 H1N1 pandemic (A(H1N1)pdm09) was mild compared to previous pandemics (Gatherer, 2009;Reed et al, 2009;Shen, Ma, & Wang, 2009), Indigenous populations residing in remote and/or isolated areas suffered disproportionately, particularly in Canada, the United States, and Australia (Barker, 2010;Flint et al, 2010;Kermode-Scott, 2009;Kumar et al, 2009;La Ruche et al, 2009;Spence & White, 2010;Trauer, Laurie, McDonnell, Kelso, & Markey, 2011;Zarychanski et al, 2010). The differential health outcomes experienced in such communities during a pandemic may be attributed to a variety of complex challenges that arise from social, economic, environmental, and cultural inequalities (Groom et al, 2009;Richardson, Driedger, Pizzi, Wu, & Moghadas, 2012;Tsuji, 1998). Previous research suggests that differences in the presence of pre-existing co-morbidities, population profiles, access to healthcare services, transmission dynamics, and malnutrition in remote and/or isolated Indigenous communities may result in more severe influenza-related outcomes (La Ruche et al, 2009;Morrison, Buckeridge, Xiao, & Moghadas, 2014;Mostaço-Guidolin, Towers, Buckeridge, & Moghadas, 2013;Spence & White, 2010).…”

“…Recommendations for implementing mitigation measures are inherently complex as it varies according to the pandemic period, setting, availability of resources, severity of the pandemic, and requires reflection on societal values (Aledort et al, 2007;Thompson, Faith, Gibson, & Upshur, 2006). Since marginalized populations best understand how their community perspectives and values impact their ability to comply and implement public health recommendations, directly engaging locally impacted populations can provide valuable insights to guide recommendations for specific mitigation measures (Braunack-Mayer et al, 2010;Groom et al, 2009;Uscher-Pines et al, 2007). Prior to the next pandemic, governments and relevant institutions are recommended to identify populations that have been historically marginalized and engage these populations in the planning process to facilitate the inclusion of ways to address their specific needs during a pandemic outbreak (Uscher-Pines et al, 2007).…”