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Joaqlin Estus
Indian Country Today

Updated: Correction noted at the end of this story
American Indians and Alaska Natives are willing to get vaccinated at rates above the national average to prevent COVID-19 — despite safety concerns about the vaccines.

Many are motivated by a desire to protect their community.

That’s according to the first national study of Native American and Alaska Native attitudes toward, knowledge of and beliefs about COVID-19 vaccines.

The Urban Indian Health Institute posed 49 questions in an online survey between Dec. 11 and Dec. 30, 2020. It received responses from 1,435 American Indians and Alaska Natives in 46 states and representing 318 tribal affiliations.

The Seattle-based tribal epidemiological center issued the results Thursday. The institute said the goal was to gather information such as individuals’ willingness to receive a COVID-19 vaccine, and hurdles they face in accessing healthcare and resources.

The survey found that 75 percent of the American Indian and Alaska Native participants would be willing to get vaccinated. A different study shows 64 percent of the U.S. general population is willing to get the shots.

However, 75 percent of the respondents were also concerned about potential side effects.

“Willingness to receive a vaccine and hesitancy are not mutually exclusive,” said Urban Indian Health Institute Director Abigail Echo-Hawk, Pawnee and Athabascan. “Fear and distrust of government and medical systems still exists in our community, which are hurdles that we have to overcome.”

Image from the Strengthening Vaccine Efforts in Indian Country report published by the Urban Indian Health Institute on Jan. 28, 2021 (Screenshot)

The study notes “…historic distrust, rooted in the legacy of colonialism, genocide, and medical experimentation may contribute to vaccine hesitancy.”

“The data indicates that most Native people willing to be vaccinated feel it is their responsibility for the health of their community,” Echo-Hawk said. “This shows what motivates our community when it comes to decision-making.”

Other key findings

  • 74 percent of participants said getting vaccinated is their responsibility to their community
  • 72 percent of participants wanted evidence of the vaccine’s current and long-term safety
  • 39 percent of all participants reported difficulty traveling to their clinic for an appointment
  • Two-thirds of participants willing to get vaccinated were confident COVID-19 vaccines were adequately tested for safety and effectiveness among Native people
  • 75 percent of participants willing to get vaccinated had concerns about potential side effects
  • 25 percent of participants were unwilling to receive a COVID-19 vaccine
  • 90 percent of participants unwilling to get vaccinated recognized COVID-19 as a serious disease
  • 89 percent of participants unwilling to get vaccinated had concerns about potential side effects

“This data will be important to all organizations conducting COVID-19 vaccine education efforts,” Echo-Hawk said. “Native communities have unique challenges and needs that usually are not considered in public health campaigns.”

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(Related: First COVID-19 vaccine hits Indian Country)

Echo-Hawk hopes the report will increase understanding of the unique perspectives of Native people.

Cover of a study by the Urban Indian Health Institute, "Strengthening Vaccine Efforts in Indian Country," which was released Jan. 28, 2021 (Screenshot).


Based on the survey results, the institute recommends:

  1. Tailoring and centering vaccination campaigns on the cultural values of Native peoples
  2. Supporting tribal and urban Indian health clinics in leading COVID-19 vaccination efforts, given their position in the community as a trusted, safe, and familiar spaces, with cultural knowledge and expertise.
  3. Utilizing effective ambassadors, such as healthcare providers, elders, and tribal leaders, to provide accessible and clear information about the COVID-19 vaccines, including the process of vaccine development, vaccine safety and effectiveness, potential side effects, cost, and personal and community benefits of vaccination.
  4. Acknowledging how historic and current harms perpetrated by healthcare institutions and the U.S. government have contributed to skepticism of vaccines. This could be done by a public form.
  5. Grounding vaccination campaigns in community participation and community voice to ensure vaccine messaging is culturally relevant.
  6. Recognize that vaccine acceptance is a spectrum and those unwilling to get vaccinated may change their opinions once concerns of safety, effectiveness, and accessibility have been addressed. Conversely, acknowledge vaccine acceptance does not mean hesitancy is not present, as those willing to get vaccinated voiced similar concerns around safety for Native people.

Disproportionate impacts

Studies show American Indian and Alaska Native people continue to be disproportionately impacted by the COVID-19 pandemic. Their numbers of cases and deaths are 3.5 and 1.8 times that of non-Hispanic Whites.

“These inequities are also the result of structural racism produced by policies and practices sanctioned by various levels of government and built into economic systems and societal norms,” the report states. It also points to disparities in opportunities in health literacy stemming from Western education. “However, as Native people we recognize that traditional Indigenous knowledge systems will continue to sustain us as we build thriving communities grounded in our traditional ways.”

The institute is one of 12 tribal epidemiological centers across the country working to strengthen the health of American Indian and Alaska Native communities. It conducts research such as a recent study of the impacts and needs of urban Native direct-service organizations due to COVID-19. It promotes health, collects and analyzes data, and provides disease surveillance and resources.

Correction: 72 percent of participants wanted evidence that the vaccine is safe right now and in the long term. An earlier version of this story included a different number.

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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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