Indian Country Today
A lot of people are waiting for a vaccine. The idea is profound: A quick shot and that scary COVID-19 fades away.
Some hopes were boosted Tuesday when Russia became the first country to approve a novel coronavirus vaccine. But the move also shows the problem with rushing a vaccine into production: It’s effects have only been studied in dozens of people.
Russian President Vladimir Putin said one of his two adult daughters has already been inoculated. “I know it has proven efficient and forms a stable immunity,” Putin said. “We must be grateful to those who made that first step very important for our country and the entire world.”
Most scientists are not so sure. The Russian vaccine skipped what’s called a Phase 3 trial — which involves tens of thousands of people and can take months — in order to prove if an experimental vaccine is safe and if it really works.
In the United States there are more than 150 vaccines under development and two of those potential vaccines have begun Phase 3 testing. The U.S. government is pushing for a quick trial and marketing plan, the fastest ever in history, pledging $10 billion to develop 300 million doses for a “safe, effective coronavirus vaccine by January 2021.” The goal is to deliver two billion doses by the end of the year.
There is a lot of new science that is developing these vaccines, some transferring proteins of a different virus, others that stimulate our immune system. And, it’s possible there will be more than one answer. (And more than one shot.)
But there remain lots of questions.
First: The cost. Kaiser Health News reports that the recent vaccines, such as those for meningitis B had a retail cost of $300 to $400 for the full course. Other estimates say it could be $500 or more for COVID-19. If that holds true … the cost of vaccinating Indian Country alone would be $1.28 billion and the total for the country would exceed $150 billion.
Even at that price, would the Indian Health Service have access to the vaccine in enough numbers to make a difference?
In the plan for Operation Warp Speed, the U.S. Department of Health and Human Services says there will be a “tiered approach to vaccine distribution.” Given the high rates of COVID-19 in many Native communities there is a strong chance that priority will be met.
One group working on a distribution plan is the Advisory Committee on Immunization Practices, a committee at the Centers for Disease Control and Prevention. That group’s next meeting is Aug. 26 and recommendations about who should get the vaccine first are expected by the fall. States are expected to play a significant role in determining the distribution plans. The Indian Health Service has not released any of its planning for vaccine distribution or even the potential for early access.
The National Academies of Sciences, Engineering, and Medicine also has appointed an ad hoc committee to develop a framework for Equitable Allocation of Vaccine for the Novel Coronavirus.
Abi Echo-Hawk, Pawnee, is a member of that committee. Echo-Hawk is chief research officer for The Seattle Indian Health Board and director of the Urban Indian Health Institute , a national tribal epidemiology center serving urban-dwelling American Indians and Alaska Natives.
Among the questions being debated:
- How should the criteria be applied in determining the first tier of vaccine recipients? As more vaccine becomes available, what populations should be added successively to the priority list of recipients? How do we take into account factors such as:
- Health disparities and other health access issues
- Individuals at higher risk (e.g., elderly, underlying health conditions)
- Occupations at higher risk (e.g., health care workers, essential industries, meat packing plants, military)
- Populations at higher risk (e.g., racial and ethnic groups, incarcerated individuals, residents of nursing homes, individuals who are homeless)
- Geographic distribution of active virus spread
- Countries/populations involved in clinical trials
IHS Director Rear Admiral Michael Weahkee, Zuni, assured Indian Country Today June 29 that IHS is involved in the vaccine conversations.
“We're also party to the conversations about once a vaccine is develops, what the distribution plan could and should be, and whether it should mirror what we do for other vaccines, like the flu vaccine, that certain populations get the vaccine earlier than others like first responders and health care workers and, and those in special groups like elders and children and those who might be immune compromised,” Weahkee said.
A recent letter to President Donald Trump from William Smith, acting chairman of the National Indian Health Board, cites the history of pandemics in Indian Country. During the 1918 Spanish Flu and the 2009 H1N1 pandemic death rates among American Indians and Alaska Natives were “four times higher than the national average.” The health board said in those cases Congress failed to set aside access to vaccine distribution for the Indian health system and there were not “specific plans to safeguard Tribes or their citizens.”
The letter said there should be a set aside of at least 5 percent for vaccine distribution across the Indian health system.
The letter said Congress should act because American Indians and Alaska Natives “experience among the starkest disparities in the underlying conditions that increase the risk for a more serious COVID-19 illness.”
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Indeed, Smith wrote, a recent “data visualization comparing State and Tribal COVID-19 case rates found that if Tribal Nations were States, the top seven case infection rates nationwide would all be Tribal Nations.”
Experts calculate that at least 70 percent of the population must be vaccinated in order to achieve herd immunity; that’s when the virus slows its spread because it is not transmitting quite so easily.
Now consider the flu. The Indian Health Service has a goal of 70 percent vaccination rate for its service population and a vaccination rate of 90 percent for medical professionals.
The first goal is a long way off: The national rate within IHS for influenza vaccination in 2019 was a little higher than 30 percent. But IHS is exceeding the goal of 90 percent for its professional team (by more than 5 percentage points at that).
This is important because it shows that an elevated campaign can motivate behavior. That also requires public acceptance of a vaccine.
North Dakota Gov. Doug Burgum said that the state is working with the Centers for Disease Control and Prevention on a logistical plan for distributing a hypothetical vaccine. He said the agencies chose North Dakota for the program, in part, because they are interested in forming plans for vaccine distribution to the tribes. There is already push back. At Standing Rock, on social media, people were asking for the tribe to reject any vaccine program. Others called for a methodical process, such as a review board, to consider the science and the effectiveness of any vaccine before proceeding.
How effective must a vaccine be?
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said last week at Brown University’s School of Public Health, “the chances of it being 98 percent effective is not great, which means you must never abandon the public health approach."
Nonetheless the federal Food and Drug Administration is prepared to authorize a coronavirus vaccine as long as it's safe and reduces a person’s risk of a COVID-19 infection by 50 percent.
“Just let me just say it and hope we could have people play this over and over when you have a disease in which the body's natural response to infection is inadequate, then it is very difficult for you to get a vaccine,” Fauci said.
“I've been developing vaccines now as director of the Institute for 36 years, you should never feel confident when you're dealing with something that requires a randomized placebo controlled trial to prove it,” he said. “You feel confident when you start to see the data come in. So what I'm confident is in data, I'm not confident in guessing or surmising, but having said that, the reason I do feel cautiously optimistic is that when you look at the early response, both in the animal data, but importantly in the human phase, one, it induces a response with neutralizing antibodies.”
In other words the early tests show that a vaccine can help people’s own immune system fight off the disease. But even that answer won’t be clear until more Phase 3 tests are reported.
But then Dr. Fauci asked the Brown students, what happens after that?
“They're going to have hundreds of millions of doses in 2021. If you look at the first couple of months of 2021, we're not going to have a hundred million doses. We're going to have tens of millions of doses, which means that we got to prioritize,” he said.
“You'll prioritize healthcare workers, frontline people, those who need it, the most, the elderly, those with underlying conditions,” Fauci said. ”The way you determine that is you make sure your vaccine trials have people who are perfectly well and young people who are elderly and well and people who are elderly and or young with underlying conditions, they're going to be tried. So we're going to know at the end of the trial whether or not you induce a good response in those individuals, sorry for the long answer, but you asked for questions.”
Mark Trahant, Shoshone-Bannock, is editor of Indian Country Today. On Twitter: @TrahantReports. Trahant is based in Phoenix.
Jourdan Bennett-Begaye and The Associated Press contributed to this story.
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