Joaqlin Estus
Indian Country Today

As a vaccine against COVID-19 nears final approval, Native American health care providers are putting the final touches on their vaccination plans.

A panel of independent experts recommended approval of the Pfizer-BioNTech vaccine on Thursday. The Food and Drug Administration and the Centers for Disease Control and Prevention are expected to approve it and issue final distribution guidelines in the next few days. The vaccine will be in short supply at first so people will get vaccinated in groups.

The Indian Health Service is expected to receive 46,000 doses of the Moderna vaccine and 22,425 doses of the Pfizer vaccine, said IHS Rear Adm. Francis Frazier, lead of the IHS Vaccine Task Force, on Friday in a press conference.

“This would allow the IHS to vaccine 100 percent of its healthcare workforce and residents of long-term care facilities,” Frazier said. “The IHS anticipates that vaccines will be shipped to IHS within 24 hours of a vaccine receiving emergency use authorization from the Food and Drug Administration. Health facilities will use the remainder of the Pfizer and Moderna doses to vaccinate the next priority populations based on CDC guidelines.”

The COVID-19 vaccines will be allocated to 11 of the 12 IHS regions based on the number of individuals in the first priority group, Frazier said. The IHS Alaska region opted for the state distribution of the vaccines. The Oklahoma City, Navajo, and Phoenix IHS regions have the larger user population areas.

“The total current IHS request is for enough doses to provide COVID-19 vaccines to 2,044,513 individuals,” said IHS spokesperson Joshua Barnett. That number is updated weekly according to distribution preferences and updates from health facilities. 

If the FDA approves the vaccine, the Navajo Nation will receive 3,900 doses of the Pfizer vaccine early next week, according to a Navajo Nation statement. The vaccine “will be distributed to each of the service units based on user population percentage.”

Essential workers at the highest risk of infection — health care personnel — may be lining up to get vaccinated as soon as mid-to-late next week, according to the CDC guidelines.

That first group would include some 21 million people who work in hospitals, nursing homes, long-term care facilities, clinics, pharmacies and public health clinics.

Cmdr. Andrea Klimo of the Distribution and Allocation Team lead of the IHS COVID-19 Vaccine Task Force said IHS anticipates vaccinating 44,300 of the health care personnel within the phase 1 priority group.

Right behind them would be teachers, law enforcement, high-risk people aged 65 and up and people in prison or homeless shelters. Then would come other essential workers and after them, everyone else aged 16 and up.

Depending on how quickly the vaccine gets produced, the last group may not get vaccinated until April or May.

The program could move more quickly if other pharmaceutical companies complete tests and get the necessary approvals. Next week, the FDA will review a vaccine from Moderna and the National Institutes of Health. A candidate from Johnson & Johnson and another from AstraZeneca and Oxford University are in trials.

Once they get the vaccine, Native care providers can tailor immunizations to the needs and priorities of their people. For example, the Cherokee Nation determined the first to get vaccinated will be Cherokee language speakers, National Treasures, and elders over age 65, followed by teachers and infrastructure support workers.

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Cherokee Nation Principal Chief Chuck Hoskin Jr. said he knows elders have reservations about taking a vaccine but it’s a step forward to saving lives and helping stop the spread of the virus in Cherokee communities.

“As we continue our phased plan and get more doses into 2021 to begin vaccinating our employees and citizens, we can begin the process of healing from what we know is the worst public health crisis our tribe has faced in generations,” Hoskin said.

The CDC is distributing the vaccine to states, territories, tribes and federal agencies, including the Indian Health Service, to distribute via their own networks. Tribes can receive the vaccine through the Indian Health Service or via their respective states.

Lyle Ignace, MD, MPH, of the Menominee Indian Tribe of Wisconsin and the Coeur d’Alene Tribe of Idaho, heads the Gerald L. Ignace Indian Health Center in Milwaukee, Wisconsin. He’s been hosting a weekly Native town hall on COVID-19 response since April.

Thursday he said Wisconsin Indian health and tribal providers opted to get their allotment of the vaccine through the Indian Health Service.

“IHS only has to worry about, like, 12 sites in the state of Wisconsin versus the state itself has to worry about over several hundred either hospitals or health centers throughout the state. So it's going to take some time for this to trickle through the state. It will take less time for the Indian Health Service to distribute to their designated sites here in Wisconsin,” Ignace said.

Alaska IHS Region

Dr. Bob Onders is medical director for the Alaska Native Tribal Health Consortium and interim administrator of the Alaska Native Medical Center. He said the consortium and other Alaska tribal health organizations opted to get the vaccine through the state of Alaska.

Onders said Alaska tribal health organizations are familiar with the state’s vaccine inventory and ordering system. And “the state has been involved in the transport of vaccines to regional clinics and even villages for a long period of time.”

That expertise is important given Alaska’s dicey weather and the difficulty of serving small communities across great distances. It will also help that the Indian Health Service successfully advocated to get Alaska treated more like US territories than other states. To reduce logistical challenges, Alaska will receive larger shipments monthly while other states get smaller allotments every week.

“Given the correct resources like the vaccine or other tools to combat COVID, I always think creative solutions occur in all the regions [of Alaska] and really give us a lot of opportunity to help prevent COVID from spreading,” Onders said.

At the Native Strong town hall, Dr. Ignace closed with, “My parting thought here is that it's been a long year in all kinds of ways,” as COVID-19 wreaked havoc in everyone’s lives. He stressed the importance of getting vaccinated, saying people are facing “a decision that every single one of us will need to make. So, between now, today, and when that decision for you comes, stay safe. Stay healthy and be strong….take care.”

How will the vaccine work?

The Pfizer-BioNTech vaccine is recommended for people aged 16 and older.

It will be administered in two doses, with the second one coming 21 days after the first. People must take both doses for it to be effective.

The Pfizer vaccine protects about 95 percent of the people who get the two doses.

Some people will experience side effects such as fatigue, headaches, chills and muscle ache.

To avoid anaphylactic reactions, people with a significant history of allergic reactions should not be given the Pfizer-BioNTech vaccine.

Additional information is needed about the vaccine's effects on pregnant and lactating women, who were not studied in the vaccine trials. Data is also needed to determine the effects of the vaccine on young children and those who are severely immunocompromised.

About 60 to 70 percent of the US population has to be immune to the virus to reach “herd immunity.” That’s when disease rates are low enough that community spread of the disease is unlikely. Until then it’s best to continue to use masks, physical distancing and hand washing to stay well.

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Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a long-time Alaska journalist.

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