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Mary Annette Pember
Indian Country Today

The majority of facilities receiving COVID-19 vaccines through the Indian Health Service are providing vaccines to at least some individuals who are not tribal citizens.

People who are not citizens of federally recognized tribes and generally not eligible to receive IHS services are described as non-beneficiaries.

Non-tribal citizens or non-beneficiaries receiving the vaccine at IHS facilities may include tribal employees, teachers, first responders, household members of tribal citizens or all community members, based on local circumstances, according to Joshua Barnett, IHS public affairs specialist.

IHS Chief Medical Officer Rear Adm. Michael Toedt noted during a recent media call that the agency is vaccinating at a rate higher than many states overall.

“IHS today is at a vaccination rate of 32,849 per 100,000 people, which is higher than most states,” he said.

“We have established a goal of administering 1 million doses by the end of March. We are on pace to reach that goal.”

The Cass Lake Hospital received the Pfizer-BioNtech COVID-19 vaccine on Monday, Dec. 14. (Photo courtesy of Vince Rock)

According to Dr. Loretta Christensen, chief medical officer at the Navajo area IHS, about 70 percent of the population on the Navajo reservation has been vaccinated.

There are several explanations for this success. Sovereignty allows tribes to determine vaccine distribution themselves; many are offering the vaccines to anyone 16 or 18 years and older. Existing strategies for COVID-19 testing among often difficult to reach populations allowed tribal health care professionals to quickly pivot to vaccinating.

Three tribes in Minnesota, the White Earth and Red Lake Nations and the Leech Lake Band of Ojibwe, recently began offering COVID-19 vaccinations to non-tribal citizens living on reservations and in select nearby communities.

According to Ed Snetsinger, emergency manager for the White Earth Nation, offering the vaccine to non-Native community members offers a bigger ring of protection for tribal citizens.

“We know that many of our families are made up of both tribal and non-tribal members so it just made sense to us,” Snetsinger, a citizen of the White Earth Nation, said.

“The idea is to be good neighbors during these times of need.”

The fact that both the White Earth and Leech Lake reservations are checker-boarded also influenced decisions to offer vaccines to non-Natives. During the Allotment Era in the late 19th and early 20th centuries, some Native lands were transferred or sold to non-Natives. Although owned by non-Natives, this land remains within reservation boundaries, creating a checker board of tribal and private land ownership.

Portions of three counties overlap the nearly 900,000 acre White Earth reservation. The tribal council made the call to offer the vaccine to non-Native residents of these counties, Mahnomen, Becker and Clearwater, as well as nearby Norman and Polk. Currently, non-Natives over age 45 and others over age 18 who have certain underlying conditions can also receive the vaccine.

The tribe is also vaccinating enrolled citizens 40 years and above at their urban clinics, according to Snetsinger.

Lt. Governor Peggy Flanagan gets her vaccine at the White Earth urban clinic in Minneapolis. (Photo courtesy of White Earth Nation)

Lt. Gov. Peggy Flanagan, White Earth citizen, is shown on the tribe’s Facebook page getting her vaccine at an urban clinic in Minneapolis.

Flanagan wrote in her comment on Facebook, “When it's your turn to get the vaccine, get the vaccine. I had the incredible and emotional opportunity today to receive my first dose of the Moderna vaccine through White Earth Nation's urban clinic. White Earth has done a phenomenal job, vaccinating nearly 90% of elders in Mahnomen County, extending eligibility to Native and non-Native adults in the community, and making sure the urban Indian community has access to vaccine. I am proud to be a White Earth member.”

Indeed, Mahnomen County, located entirely within the White Earth reservation has one of the highest vaccination rates of any county in Minnesota. According to Snetsinger, the vaccination rate for Mahnomen county is 91.4 percent for people age 65 and older. The average vaccination rate per county for the same age group in Minnesota is about 20 percent.

White Earth Home Health department, a tribally run health program, receives its COVID-19 vaccines entirely from the state of Minnesota.

White Earth’s partnership with the state of Minnesota allows the tribe greater flexibility in setting its health care priorities, according to Snetsinger.

“The partnership has been a good fit with our community health care mission,” he said.

Although most community members are embracing the vaccine, Snetsinger notes that people from ages 18-35 are somewhat hesitant.

According to the Washington Post, false claims on social media linking vaccines to infertility and/or claims that the pandemic is a hoax are fueling hesitancy among young adults.

“One of our challenges is encouraging this age group to get vaccinated. Obviously, it’s an individual decision but we hope to improve our rates by offering accurate information via social media and videos,” Snetsinger said.

The Leech Lake Band of Ojibwe is offering non-Natives vaccines through their Indian Health Service facilities.

According to Leech Lake’s Facebook page, the tribe’s IHS health program vaccinated over 1,000 people last week during a single day of their weekly community vaccination clinic in Cass Lake. The Leech Lake News reported that the clinic offers vaccines to all persons 18 and older in select communities in the area.

Non-Natives living on the Red Lake reservation and/or employed by the tribe are eligible to receive the vaccine. Red Lake tribal citizens and enrolled citizens of other tribes over the age of 18 are also eligible. To date, 1,922 Red Lake citizens have received vaccinations.

White Earth, Leech Lake and Red Lake all provide information regarding vaccine availability via tribal Facebook pages.

Vaccination rates could improve even more when IHS soon claims $6 billion from the federal government, its allocation of the $31 billion directed to tribal governments and families as part of the American Rescue Plan.

According to Jillian Curtis, director of IHS office of finance and accounting, some of the $6 billion will be allocated as follows:

  • $2 billion to address lost revenue from Medicare, Medicaid and private insurance.
  • $600 million to support direct healthcare services such as telehealth and electronic health records.
  • $1.5 billion for COVID-19 testing activities.
  • $240 million for public health workforce activities.
  • $600 million for COVID-19 related activities for facilities.
  • $10 million to support the delivery of potable water across Indian Country.
  • $420 million for mental health and substance abuse prevention and treatment. This new funding is in addition to the $366 million IHS received as part of its annual appropriation.

The first step, however, according to Curtis is consultation with tribal leaders and urban Indian health care providers.

Benefits for non-Native population

Melissa Heglund, a non-Native woman who lives near the Leech Lake reservation, received her first vaccine dose recently at the tribe’s weekly clinic.

“I'm a little overcome by the kindness and generosity of the Leech Lake Band of Ojibwe, White Earth Nation and Red Lake Nation. They received resources to vaccinate their members, and then when they had more than they needed, they opened the doors to surrounding communities. They didn't have to do that. I am amazed and humbled that they did,” she said.

In a Public Radio Tulsa article, Toedt noted that discretion over who gets vaccinated is usually left up to local clinics and tribal health departments. Many tribal facilities, however, are expanding the eligibility to include non-Natives.

There is currently no centralized listing of facilities offering vaccines. Toedt suggests contacting local facilities directly.

Although IHS clinics serving urban Natives are allowed to offer vaccines to non-Natives, the clinics may not be funded to do so. Urban clinics can use their IHS funding only to vaccinate eligible urban Indians, those people who are enrolled citizens of federally recognized tribes.

Offering the vaccine to non-Native citizens, however, has been a huge benefit to the White Earth area, according to Snetsinger.

“We know that Covid-19 doesn’t stop at borders,” he said.

Heglund agrees.

“I grew up in a small town and live in one now. Money for government resources often gets eaten up in metropolitan areas with larger populations. But some of us in THIS out-state area don't have to wait for the scraps this time, and it's because of the tribes.”

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Mary Annette Pember, a citizen of the Red Cliff Ojibwe tribe, is a national correspondent for Indian Country Today.

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