Seite - 35 - in VULNERABLE - The Law, Policy and Ethics of COVID-19

35Have the Post-SARS Reforms Prepared Us for COVID-19? is responsible for providing public health services to Indigenous com- munities, and in terms of First Nations’ own jurisdiction to regulate public health matters. With respect to the former, the poor health status of Indigenous people living in Canada is well documented, as is the federal-provincial wrangling that causes or exacerbates health inequi- ties.11 Indigenous communities also have their own jurisdiction to pass regulations in response to a pandemic, either through bylaw-making powers assigned under the Indian Act,12 a self-government agreement, or an asserted inherent constitutional right to self-government. In sum, the reason Canadian federalism involves so many actors and institutions stems from the constitutional division of power. The key lessons learned from recent pandemic experiences generally revolve around the question of how to facilitate the inter- governmental coordination required to contain disease spread. As noted below, SARS taught us that we needed a more sophisticated institutional armature to facilitate coordination between jurisdictions; H1N1 brought home the realization that too many intermediate orga- nizations in this framework could lead to confusion in determining roles and responsibilities. Some lessons—such as the need to share data as quickly and as comprehensively as possible—seem to have been poorly learned; other lessons (most painfully, that all pandemics are different) highlight the need to build agility and flexibility into decision-making. That long-term care homes rather than hospitals would be the epicentre of many of the biggest outbreaks, for example, was not appreciated soon enough by many jurisdictions: SARS had been limited to hospitals and, as those most vulnerable to H1N1 were younger rather than older cohorts, H1N1 did not force our attention to long-term care homes. But lessons are not just for governments; they are for all those involved in pandemic responses. And, as politi- cal decision makers have learned that they must listen and respond to front line workers, so too must those at the front line understand that pandemics are not simply a moment in time, but rather exist within a specific political context, one that constrains the political choices available to those at the helm. 11. See generally, Constance MacIntosh, “The Intersection of Aboriginal Public Health with Canadian Health Law and Policy” in Tracey Bailey, Timothy Caulfield & Nola Riles, eds, Public  Health  Law  and  Policy  in  Canada, 3rd ed (Toronto: Butterworths, 2013); Yvonne Boyer, Moving  Aboriginal  Health  Forward:  Discarding  Canada’s  Legal  Barriers  (Vancouver: UBC Press, 2015). 12. Indian Act, RSC 1985, c I-5.