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Mary Annette Pember
Indian Country Today

Vaccine hesitancy; a new term for a very old phenomenon.

Historically many people have distrusted public vaccine programs from the very beginning. Much of the early opposition stemmed from lack of knowledge about germ theory or scientific understanding of contagion. However, some arguments against vaccination in the late 19th and early 20th centuries are remarkably similar to those we hear today.

Citizens rebelled in the 1890s when some U.S. cities tried to forcibly vaccinate people against smallpox. Despite the horrible nature of the disease, 40 percent of those infected died; those who survived were often disfigured or blinded, many people refused vaccines. They expressed the belief that the government had no right to inject disease into their bodies; in 1902, the U.S. Supreme Court agreed, ruling that the government could not force people to be vaccinated.

Although vaccine hesitancy today is also fueled by political beliefs as well as conspiracy theories often driven by social media, the real culprit is a simple human frailty. Inexperience.

Vince Rock, interim health director for the Leech Lake Band of Ojibwe, notes that reluctance to take the vaccine is greatest among people ages 18-40.

“People in that age group really haven’t been faced with anything like COVID-19; vaccines have never been a major point in their lives,” Rock, a citizen of the Leech Lake Band, said.

“I’m 66 years old and I remember the conversations and fear about polio, seeing pictures of people in iron lungs,” he said.

People line up to receive COVID-19 vaccines on the Leech Lake reservation during the tribe's weekly clinic on Friday March 5. The clinic serves Native and non-Natives. (Photo by Mary Annette Pember)

Indeed, before Dr. Jonas Salk created the polio vaccine in 1955, the disease caused more than 15,000 cases of paralysis a year, almost entirely among children. The fear and dread surrounding polio is difficult to comprehend today. Parents were afraid to allow their children outside especially in the summer when the virus was most virulent. What seemed to start with the symptoms of a simple flu or cold, polio had the power to paralyze, relegating children to a lifetime of crutches, wheelchairs or forced into iron lungs in order to breathe.

(Related: Most tribal clinics offer COVID-19 vaccines to non-Natives)

Polio was eradicated in the United States by 1979, although a few cases continue to emerge globally. Today, most who survived the disease are over 70; there is little memory of the terror wrought by polio.

Since death rates from COVID-19 have been greatest among people over age 65, younger people often have a sense of invulnerability regarding the disease, according to Rock.

“Early on the messaging indicated that the aging population was at greatest risk, plus there seems to be a general sense of mistrust among some of the younger population,” Rock said.

“There’s so much strife in the world, so much disagreement on almost everything; I think politics also plays a big part in vaccine hesitancy.”

Generally, according to Rock, people know little about the history of disease and the role science and vaccines have played in saving lives.

Indeed, smallpox, a centuries old scourge that decimated populations, especially among Indigenous peoples, was eradicated globally in 1980, according to the Centers for Disease Control and Prevention.

Endemic in Europe, Asia and Arabia for generations, the death rate for Indigenous peoples in the Americas from the disease was astronomical.

“There hasn’t been a kill off in human history to match what happened in the Americas (after European contact); 90 to 95 percent of the Indigenous population was wiped out over a century,” said Thomas Mockaitis, professor of history, refugee and migration studies at DePaul University.

For instance, smallpox epidemics in the late 18th and early 19th centuries led to the almost total collapse of the Mandan, Arikara and Hidatsa Nation in North Dakota.

Anthropologist Alfred Kroeber (center) is shown with an Indigenous man he named Ishi, right, and Yahi translator Sam Batwai. The photo was taken in 1911 in San Francisco, near what was then known as the University of California Museum of Anthropology. Ishi lived and worked in the museum until he died of tuberculosis in 1916. (Photo courtesy of UC San Francisco History Collection)

The first epidemic in the Great Plains arrived in 1781, years before Europeans arrived in North Dakota. The disease moved tribe by tribe up river along the Missouri River. Historians estimate that about 68 percent of the Mandan, Arikara and Hidatsa tribes perished.

The disease arrived in the area again in 1837 when a steamboat, St. Peters, traveled from St. Louis to Fort Union in North Dakota carrying trade goods. Crew members on the St. Peters were found to be sick with smallpox while in Kansas City; had the captain waited to continue the trip northward until the likelihood of contagion passed, the Native peoples may have been saved.

A chilling account of smallpox epidemics among the Mandan, Hidatsa and Arikara tribes is given by Clay Jenkinson, author of “Smallpox and Indians: When pandemic warnings go unheeded.”

Jenkinson and other scholars dispute claims made by Ward Churchill, in his book, “Indians are Us? Culture and Genocide in Native North America,” that settlers intentionally distributed small pox blankets among Native peoples as a means to reduce their numbers and open up land for Europeans.

Even if the smallpox epidemic was not deliberately introduced to tribes as germ warfare, the responsibility still lies with white traders and crew members who chose profit over precaution, according to Jenkinson.

Death from smallpox among Indigenous people was so great that it posed a threat to White settlers moving westward.

As a result, Congress enacted the first piece of legislation in 1832 specifically aimed at Native health, the Indian Vaccination Act.

The smallpox vaccine was mankind’s first successful vaccine. In the early 19th century, Edward Jenner, a British doctor, discovered that milk maids who were infected with a milder form of the virus, cowpox, seemed immune to smallpox. In a procedure known as variolization, Jenner placed a small amount of pustular matter from a patient infected with smallpox into an incision cut into the flesh of the person to be inoculated.

The gruesome technique was not always successful. Sometimes the procedure introduced other diseases; people who were inoculated still grew sick, sometimes taking weeks to recover from a weaker version of smallpox.

Tribes who had witnessed the devastation of smallpox, however, lobbied for the vaccine among their people. According to J. Diane Pearson in her 2003 article “Lewis Cass and the Politics of Disease: The Indian Vaccination Act of 1832,” published in Wicazo Sa Review, groups of Senecas and Shawnees from Lewistown, Ohio, refused to agree to removal without vaccine protection.

Secretary of War Lewis Cass supervised the Indian Vaccination Act and purposefully omitted tribes in the upper Missouri River, the Mandan, Hidatsa, Arikara as well as the Assiniboine, Cree and Blackfeet from receiving vaccines. Considering these tribes hostile and of no greater economic use to the federal government, Cass helped seal their fates during the 1837 outbreak.

An Indigenous man called Ishi, who survived two massacres of the Yahi people, worked as a janitor and “living exhibit” at what was then the University of California Museum of Anthropology. He died of tuberculosis in 1916. (Photo courtesy of The Bancroft Library, UC Berkeley)

Medical miracles

“I think gratitude is the key to understanding the COVID-19 vaccine,” Rock said.

Without today’s advances in science and research, there might not be a vaccine, according to Rock.

“We forget that the polio and smallpox vaccines and drugs like penicillin were considered to be miracles,” he said.

“Albert Einstein said there are two types of people, those who believe in miracles and those who don’t. Science has contributed to the miracle of this vaccine.”

Although, there has been some concern over some versions of the COVID-19 vaccine such as the efficacy of the Johnson & Johnson single-dose vaccine among Native American populations, all three of the vaccines including Moderna, Pfizer are safe, according to the Indian Health Service. Moderna and Pfizer require two doses.

“The bottom line is that the number of American Indians and Alaska Natives in the (Johnson & Johnson) study were not large enough to make the conclusion that the op-ed made (by Bruce Davidson in Indian Country Today),” said Captain Matthew A. Clark, MD, chief medical officer, Alaska area Indian Health Service, the team lead of the Indian Health Service Vaccine task force safety and monitoring team.

According to the CDC, American Indians and Alaska Natives have the lowest series completion rate at 83.7 percent among race and ethnicity, and the highest prevalence of missing the second dose at 5.1 percent. This has pertinence with American Indians and Alaska Natives who are eligible for the one-shot Johnson & Johnson vaccine, as it’s truly one and done.

Besides, said Dr. Dakotah Lane, health director of the Lummi Nation, “The general population doesn’t really care about that.”

“Here, in Lummi, we take a harm reduction approach; we consider the best vaccine to be the one people choose to receive,” he said.

“We’ve (tribes) demonstrated that we’re probably doing one of the best jobs in getting vaccines to our people; overall it’s a testament to the Indian Health Service,” Lane said.

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Mary Annette Pember, citizen of the Red Cliff Ojibwe tribe, is national correspondent for Indian Country Today. On Twitter: @mapember. Based in Cincinnati, Ohio. Pember loves film, books and jingle dress dancing.

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