Joaqlin Estus
Indian Country Today

How is the Indian health system doing on vaccine distribution? “We're doing better than most states and counties in the country,” said Abigail Echo-Hawk, director of the Urban Indian Health Institute in Seattle.

At the start of the pandemic, tribes closed casinos before those in Las Vegas, Nevada, and implemented public health precautions, like road checkpoints and wearing masks, before many states. Several communities and pueblos completely shut down access to people from outside the communities.

“We have a system in place and as public health communities, I keep telling all of my friends in the state and federal levels like you should have asked an Indian. I had to do this a long time ago,” she said.

The Indian health system is just that, a system. There are mechanics in place to distribute vaccines efficiently to a population. That’s something that is missing from most of the U.S health system where doctors and hospitals are scattered about without any real logic.

A recent report by NBC News stated: “All 50 states in the U.S. are reporting shortages as America's fragmented administrative and health care systems struggle to distribute even the limited vaccine stocks that have been produced.”

The report said “what makes the U.S. especially troubled, according to experts, is that its health care system is not centralized, and the administration of President Donald Trump failed to build a proper national vaccine rollout plan to fill the void.”

President Joe Biden is trying to bring more equity to the vaccine rollout he inherited from the Trump administration. The Biden administration is encouraging states to map and target vulnerable neighborhoods using such tools as the CDC's social vulnerability index, which incorporates data on race, poverty, crowded housing and other factors.

“We are going to take extra steps to get to the people hardest to reach, and that work is happening right now,” said Dr. Marcella Nunez-Smith, the chair of Biden’s COVID-19 equity task force.

But Indian Country is different. The Indian health system — a combination of federal clinics and hospitals, plus those run by tribes and nonprofits — is a system serving a distinct population and so a distribution plan could be properly executed.

With a system in place, that means tribes already know how to reach out to their people.

“We know what it means to communicate to our communities,” Echo-Hawk said. “We know who our priority people are. We're always going to take care of our elders and youth.”

States and counties do not know how to reach those who are at most risk of contracting and dying from COVID-19, she said.

Echo-Hawk said the Seattle Indian Health Board has vaccinated more people than other places because they already vaccinated the majority of the high-risk Native people in King County.

The health center has now expanded to lower age groups and Echo-Hawk is seeing this nationwide for tribes and in urban Native communities. The rest of the country is still in the early stages of giving vaccinations for the elderly.

Anecdotally and across social media, some say they are traveling home, hundreds of miles, to reach a tribal health facility or an IHS direct-health facility to get vaccinated sooner.

“I really believe that folks need to quit coming to us because they think we have all the problems and all the issues,” Echo-Hawk said. “They need to come to Native communities because we have the answers and it's being shown in how we are rolling out the COVID vaccine right now in our communities.”

(Related: Timeline: How the pandemic unfolded in Indian Country)

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

As of Jan. 29, IHS has distributed a total of 424,200 vaccine doses (Pfizer and Moderna) to the 12 IHS areas.

If all of those vaccinations were administered, IHS has already vaccinated 21 percent of its approximately 2 million individuals.

So far, about 10 percent of the U.S. population has received at least one dose of the vaccine. About 3 percent has received both doses, an AP analysis showed.

Those are all rough numbers, well, because the data is still inadequate. But even rough numbers show pockets of effectiveness in Alaska, at Navajo Nation, and among the Muckleshoot.

All three are working to fight the disproportionately high toll COVID is taking on American Indians and Alaska Natives. Natives experience 3.5 times as many infections and nearly twice the number of deaths due to the coronavirus as non-Natives, according to the Centers for Disease Control and Prevention.

Navajo Nation

On Monday, Navajo Nation President Jonathan Nez said the tribe is seeing a 94 percent efficiency rate in vaccinations.

“As of Sunday, the Navajo Area Indian Health Service received 78,520 vaccine doses and 74,048 of those doses have gone into the arms of our people on the Navajo Nation,” he said.

He said the tribe is getting nearly 29,000 doses of COVID-19 vaccine this week plus 82 more federal personnel to help with vaccinations. Navajo health officials say more clinical and support staff and vaccinators will be arriving this week to help out on the reservation, which covers parts of Arizona, New Mexico and Utah.

The tribe has 330,000 enrolled citizens. About 175,000 live on the reservation. Nez said the goal is to administer 100,000 total vaccine doses by the end of this month.

Muckleshoot Indian Reservation

South of Seattle, the Muckleshoot tribe is also vaccinating people at a steady clip. It administered 3,000 shots over the weekend.

That’s only part of the equation, though. Health care providers need to be there to give the shots and people need to show up to get them.

An Urban Indian Health Institute report showed American Indians and Alaska Natives are more likely to get vaccinated than the general non-Native population, at rates of 75 and 64 percent respectively.

Despite historical mistrust and safety concerns, American Indians and Alaska Natives give weight to protecting elders, family and community.

(RELATED: Study: 75 percent of Natives would get vaccinated)

Donny Stevenson, vice chairman of the Muckleshoot Indian Tribe, told the Seattle Times that the tribe needed to be creative in education and outreach to ensure that all members were aware of coronavirus precautions and the benefit of being vaccinated.

The tribe used digital and paper newsletters, a video by high-school students, and Zoom meetings with health professionals and tribal members to encourage health precautions and to inform people about the vaccine.

“We look to take care of people,” Stevenson told the Seattle Times. “Generosity is a very important attribute in terms of who we are as a traditional people. That’s how we measured wealth.”

On Feb. 2, IHS announced plans for $1 billion for pandemic response. The funding was allocated in the Coronavirus Response and Relief Supplemental Appropriations Act, which became law on Dec. 27, 2020.

Of that, $790 million will go to testing, contact tracing, containment, and mitigation of COVID-19 in Native communities. Another $210 million will go to ensure broad-based vaccine distribution, access and coverage.

Alaska tribal health system

Alaska usually leads the nation in all the wrong areas — violent crime, lack of modern sanitation, chlamydia. Now for a change, it has bragging rights.

The financial planning company WalletHub looked at five indicators — rates of vaccinations, testing, hospitalization, death, and transmission. It ranked Alaska the safest state during the pandemic, followed by North Dakota, Hawaii, Colorado, and Vermont. Alaska has the nation’s highest per capita vaccination rate, with 15 percent having received one dose. The national average is 9.7 percent.

Alaska Chief Medical Officer Dr. Ann Zink said, “Alaska’s success in vaccination is because of the tribal success in vaccination.” In Alaska, a system run by several tribal health organizations provides comprehensive health services for American Indians and Alaska Natives. It's funded by IHS, Medicare, Medicaid and private insurance.

Tessa Walker Linderman, PhD, RN, is co-leader of a statewide COVID-19 task force. She said the 100-member team is a good example of close collaboration.

“We’ve got a massive team of people working on the Alaska vaccine task force. And at every level of leadership, it's a state co-lead and a tribal partner that's part of that co-leadership.”

Alaska’s high vaccination rate is all the more noteworthy given the challenges of delivering health services to far-flung villages lacking road access. Health care providers have been traveling by boat, plane, four-wheelers, snow machine, and sleds to administer vaccinations.

That comes after decades of cooperation among tribal health organizations in fighting infectious diseases such as tuberculosis and hepatitis.

“I think they [tribal health organizations] have a long history of vaccination, in moving vaccine across the state, working collectively together,” Zink said.

Another reason for Alaska’s success is that the CDC distributed vaccine doses directly to tribes as well as federal and state care providers.

Alaska Native Medical Center Administrator Dr. Bob Onders said, “recognizing the unique jurisdiction of tribes and giving them a separate allocation similar to the Department of Defense and Veterans Administration, that's an incredible step.”

“It’s something to celebrate,” chief executive of the Alaska Native Health Board Verné Boerner, Iñupiaq, told Alaska Public Media’s Nathaniel Herz in a Jan.14 story. “When you embrace tribes and tribal sovereignty, you can bring so much more to the state.”

Zink said in regions of the state where tribal health organizations are the only health care providers, they’re vaccinating both Natives and non-Natives, which allows the state to turn its attention to other locations.

*Corrected: Story was changed to give the correct job title of Dr. Bob Onders, Alaska Native Medical Center Administrator.

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Joaqlin Estus, Tlingit, is a national correspondent for Indian Country Today, and a long-time Alaska journalist. The Associated Press contributed to this story.

The Associated Press, Mark Trahant and Jourdan Bennett-Begaye contributed to this report.

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