Fawn Sharp, President of the National Congress of American Indians

John Bridgeland, CEO of the COVID Collaborative

Since European settlers first reached American shores, Native populations have been devastated by foreign-born disease and other effects of colonization. The latest disease—COVID-19—caused American Indians and Alaska Natives early in the pandemic to suffer higher rates of illness and death more than any other racial and ethnic group in the United States. But the story is not all gloomy.

What is not well-known is that vaccination rates among some American Indian and Alaska Native communities have been higher than the national average during the COVID-19 pandemic and significantly higher than rates for Hispanics, Blacks and Asians.

Important lessons from these Native communities can help the rest of the country recover from COVID-19.

COVID-19’s devastating effects on American Indians and Alaska Natives have been catalogued, and during the initial months of the pandemic, they were twice as likely to be infected, four times as likely to be hospitalized, and two-and-a-half times as likely to die than whites. Lack of access to health care and insurance, higher rates of pre-existing conditions associated with risk for severe COVID-19 disease, distrust of government, lack of accessible water in some communities, and living in large, multigenerational homes are some of the causes of these dire outcomes.

This disproportionate suffering has been met with quick actions by tribal leaders and public health efforts in Native communities that are guiding the way toward greater vaccine uptake and recovery from COVID-19.

By early April, 32 percent of American Indians and Alaska Natives had received at least one dose of a COVID-19 vaccine, compared to 19 percent of whites, 16 percent of Asians, 12 percent of Blacks, and 9 percent of Hispanics. State analysis showed similar trends. In the Navajo Nation, nearly 88 percent of the eligible population has received at least one dose and more than 38 percent has been fully vaccinated, outpacing the U.S. population.

A combination of factors has led to this remarkable turnaround.

Supply matters 

The Indian Health Service is responsible for providing health care for over 2 million American Indians and Alaska Natives, mainly on tribal lands and in some urban areas and they received direct allocations of vaccines for the communities they serve. Vaccine coordinators have also gone to where the people are. In Alaska for example, public health officials have offered vaccines in high schools, hotels, churches, and airports.

Trust matters

Tribal leaders took the virus seriously early on, took swift action on mitigation efforts, set goals for vaccination and worked hard to build trust. Given the history of interaction between tribal nations and the U.S. government, that leadership has mattered even more. Tribal leaders across many tribal nations got vaccinated in public, held virtual town halls with the medical community to answer questions, and relied on science, public health practice, and trusted community providers.

Local control and flexibility to make decisions have empowered Native communities to determine their own priorities and set up their own call centers. Native speakers, reliance on local health care workers, and innovative partnerships to reach populations have borne fruit. Some tribal nations, such as the Lummi Nation in Washington state, have had such a successful vaccination campaign that they expanded their distribution and uptake efforts to the surrounding public, including to teachers and staff in school districts.

Not all is rosy and great challenges do remain. Vaccination rates are slowing all around the United States, many people are not showing up for appointments, and some are skipping their second dose. Barriers to access continue, such as lack of transportation or logistics related to appointments, and vaccine hesitancy remains a significant barrier.

Understanding the reasons for vaccine hesitancy is critical to ensure continued progress to end this pandemic. A recent national survey of American Indians and Alaska Natives mostly living off tribal lands showed that, among those who are “wait and see” vaccinations, 79 percent believed the vaccine can make people sick, only 7 percent trusted the federal government, and more than half believed their community would get a less safe vaccine.

Surveys like this can help inform efforts to encourage more American Indians and Alaska Native people to get vaccinated, especially in urban areas where they may be far from their home communities. Other surveys with more responses from those living on tribal lands show higher levels of vaccine acceptance.

Success to date has been driven by solutions developed by and for Native peoples, drawing on their own cultural values and traditions. Leadership, trust, goals, ease of access, and partnerships have so far led to better results for communities that were disproportionately harmed by COVID-19.

It is encouraging that some of the most severely affected communities are setting the pace for national recovery and paving the way toward a better tomorrow.

Fawn Sharp is the 23rd President of the National Congress of American Indians, Vice President of the Quinault Indian Nation in Taholah, Washington & Member of the COVID Collaborative. John Bridgeland is former Director of the White House Domestic Policy Council & CEO of the COVID Collaborative, which issued this national survey of American Indians and Alaska Natives.