What Factors Led to Their Successful Rollout?
ATLANTA — Native Americans, a category including American Indians and Alaska natives, have consistently had the best COVID-19 vaccination rates in the United States since the shots became available in early 2021, according to the national Centers for Disease Control and Prevention.
The CDC’s daily tracker for Oct. 23 showed that 51.1% of American Indians and Alaska Natives were fully vaccinated. This compared with 44.2% of Asians, 40.9%of white Americans, 40% of Hispanics, and 33.8% of African Americans.
While some of the heightened response was linked to the high rate of infections, leaders in the Native American communities suggested the success with vaccination rates is due to several factors: One was the U.S. government’s decision to allow Native American communities to control vaccine distribution; and second, traditional ethnic values including respect for elders, “community first” philosophies, and a willingness to trust science— so long as it’s presented by community members themselves.
The Native American population is especially vulnerable to a pandemic for many reasons, according to an article in The BMJ. On many reservations, multigenerational families live together in crowded situations. Access to good healthcare can be challenging in rural areas and health services for members of federally recognized Native American communities are often underfunded. That population also has higher rates of diabetes, heart disease, asthma, and obesity, making them more vulnerable to serious COVID-19 illness.
A white paper published by Kaiser Family Foundation last April looked at the high rates of cases, deaths, and hospital admissions among Native American populations.
“They are nearly twice as likely to be infected with COVID-19, three times as likely to be hospitalized, and nearly 2½ times as likely to die from the virus as white people,” Latoya Hill, one of the study authors and a senior analyst in Kaiser’s Racial Equity and Health Policy Program, said on KFF.org. “So, it was going to be really important to ensure that they were able to get vaccinated.”
Many tribes and eligible Native-led organizations throughout the country receive vaccine allotments from the Indian Health Service.
The KFF.org site pointed to several factors in the high vaccination rates in Native Americans, noting that tribes:
- Had leadership that prioritized and distributed vaccines based on the preferences and needs of their community;
- Had relatively high levels of supply compared to many state vaccination programs;
- Launched campaigns that used culturally relevant messaging and trusted messengers; and
- Used existing community resources and providers to distribute vaccines.
“The high vaccination rate among AIAN people stands in stark contrast to the gaps in vaccinations for Black and Hispanic people observed to date,” according to the KFF white paper. “The underlying inequities and barriers to health care facing AIAN people similarly could have led to barriers to vaccination. However, experiences suggest that the autonomy provided to Tribes to design and implement vaccine distribution efforts among their communities has contributed to success in vaccinating the population.”
One key factor appeared to be the greater supply of vaccine doses delivered to the HIS. As of April 5, 2021, according to KFF, more than 1.5 million doses had been delivered to IHS, which represents roughly nearly 75,000 per 100,000 people served by the IHS. Only two states and Washington, DC, had higher rates of doses delivered than the IHS, and the rate of doses administered by the IHS lagged behind those states.”
Many tribes had prepared for the vaccine rollout, according to an article in the BMJ. One example was the Lummi Nation, with 5,000 members living in the far northwestern corner of the continental United States.1
Dakotah Lane, a member and medical director of the Lummi, was concerned about the death rate from COVID-19 among his peers: 5.5%, compared with 1% in the surrounding county. He knew that, without preparation, there would be hesitancy within his community.
“Vaccines are a chicken and egg question within marginalized communities,” he told The BMJ. “They say, ‘I don’t want to participate in any research because I’d be a guinea pig.’ And then on the flip side, when a vaccine becomes available, they say, ‘I don’t want the treatment, because how do I know that it works in tribal communities?’”
It was easy to give the elderly community leaders the vaccines first, he said, because of the vaccine research questions, many had already digested information about the virus and the vaccines and noticed that SARS-CoV-2 was hitting older people harder.
The vaccinated elders then recommended it. “In our community, people still listen to our elders,” Lane explained.
A July blog from the journal Health Affairs, meanwhile, suggested that Native American susceptibility to the virus was related to inequalities caused by federal neglect and marginalization. Among those were factors such as lack of access to water and culturally responsive public health information. Both, according to authors Gabriel R. Sanchez, PhD, and Raymond Foxworth, PhD, were “caused by long-standing underinvestment in Native communities, are also associated with COVID-19 spread across tribal lands.”
Sanchez is the director of the Center for Social Policy and a founding member of the Native American Budget and Policy Institute, both at the University of New Mexico. Foxworth is vice president of First Nations Development Institute, a Native American-led community and economic development organization and will be a visiting scholar in the Department of Political Science at the University of New Mexico starting in the fall of 2021.
The blog points out that, in response to their disproportionately high burden of COVID-19, Native Americans had very effective vaccination campaigns through the first months of the rollout. “For example, the Diné Nation (Diné is what Navajo people call themselves), the largest Native nation in the US with lands spanning multiple states, has overcome a severe COVID-19 outbreak that has caused much pain and suffering to achieve early success in vaccination coverage that has outpaced the national average,” Sanchez and Foxworth wrote. “Taking aggressive steps, including having drive-through clinics available in multiple sites across reservation communities and opening access to non-Native residents of counties within reservation boundaries, have helped lead to this success.”
- Silberner J. COVID-19: How Native Americans led the way in the US vaccination effort BMJ 2021; 374 :2168 doi:10.1136/bmj. 2168
