Behind the Paper: Indigenous perspectives navigating concurrent public health emergencies from the Cedar Project in British Columbia

In this post, we talk to the authors of the recently published paper, Navigating concurrent public health emergencies: Indigenous perspectives from the Cedar Project in British Columbia, by Chenoa Cassidy-Matthews, Ph.D., Jorden Hendry, Margo Pearce, Sherri Pooyak, David Zamar, Jeff Reading, Nadine Caron, Martin Schechter, Patricia Spittal, and Wayne Christian.

What led you to decide on this research question?

With guidance from the Cedar Project Partnership, we shifted our focus to address the evolving needs of urban Indigenous populations during the onset of the COVID-19 pandemic. The Cedar Project had secured funding for a one-year COVID-19 study, and my doctoral research was embedded within that broader grant-funded initiative. Our work began with outreach in the Downtown Eastside (DTES) of Vancouver and in Prince George—areas where many services were reduced or shut down entirely during the early stages of the pandemic, significantly impacting Cedar Project participants and their wider communities. During this time, the research team worked with the frontline staff at the Cedar Project office sites to ensure we were doing our part to support the community with water, food, and harm reduction supplies. Pictured below from left to right: the Cedar Project wagon carrying supplies around the DTES neighbourhood in Vancouver, BC; the contents of a harm reduction kit packaged by members of the research team and frontline staff; and lead author Dr. Chenoa Cassidy-Matthews packaging harm reduction kits for distribution.

Could you talk us through how you designed your study? What was important for your team as you created the study team?

The Cedar Project is a longstanding cohort study, initiated in 2003, led by Drs. Patricia Spittal and Martin Schechter, and guided by the Cedar Project Partnership—an independent group of Indigenous Elders, health and social service experts, scholars, and elected leaders representing Indigenous Peoples living in urban centres across BC. As the pandemic unfolded, it became crucial to design a study that could provide timely insights into the experiences of participants, particularly regarding equitable access to vaccines and harm reduction services. We used a mixed-methods approach to allow qualitative findings to inform our quantitative analyses. Listening to and centering participant voices was essential in designing the study, especially under such rapidly changing conditions.

What challenges did you encounter during your study?

We faced numerous challenges, including shifting public health mandates, inconsistent timelines, and logistical barriers related to conducting research during a global health emergency. Additionally, the pandemic intensified existing inequities, with rising incidents of racism, violence, and social disruption that created heightened fear and instability for Indigenous and racialized communities. This qualitative study allowed us to adapt our data collection strategies and better contextualize the lived realities of Cedar participants—not just in relation to the virus, but to the broader systemic impacts of the pandemic response.

What did you find most striking about your results? How will this research be used?

One of the most powerful elements of this work was the member-checking process. It prompted deep reflection within our team, especially around how to report difficult findings without reinforcing deficit-based narratives. One participant captured this tension by saying, “COVID was really shitty, and it’s okay to say that.” It reminded us that acknowledging harm is part of telling a full, respectful story. We hope these findings will inform future public health preparedness and responses in urban Indigenous contexts, especially around equity, culturally grounded care, and service continuity. Pictured here is second author Jorden Hendry (left) and lead author Dr. Chenoa Cassidy-Matthews (right) during one of the member-checking sessions.

What further research questions need to be addressed in this area?

We are particularly interested in exploring the distinct experiences of Indigenous women and non-binary individuals, who often face intersecting vulnerabilities. Their safety and well-being require specific attention, especially in emergency and crisis contexts where gendered risks are amplified. We are also interested in learning more about the role of cultural arts and ceremony in promoting resilience in the face of public health emergencies. In the photo below is a carving made by one participant during their interview for this study, gifted to the interviewer. This is an example of reciprocity and relationality in Indigenous research, and we would like to amplify this aspect of the research process in future studies.

Why did you choose PLOS Global Public Health as a venue for your article?

We chose PLOS Global Public Health because of its commitment to equity, inclusion, and decolonizing approaches in global health research. The journal provides an open-access platform that elevates diverse perspectives and supports work that is co-led and informed