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AASTEC, Kevin English, DrPH, Director Albuquerque Area Southwest Tribal Epidemiology Center

Abigail Echo-Hawk, Director Urban Indian Health Institute

Nick Hill, MPH, Director Data Coordinating Unit & Lead Epidemiologist, Great Plains Tribal Epidemiology Center

United South and Eastern Tribes Tribal Epidemiology Center

German Gonzalez, M.D., M.P.H., FACE. Director Great Lakes Inter-Tribal Epidemiology Center - Medical Epidemiologist, Great Lakes Inter-Tribal Council INC.

Victoria Warren-Mears, PhD, RDN, Director Northwest Tribal Epidemiology Center

Inter Tribal Council of Arizona Tribal Epidemiology Center

There is a dangerous misconception that the Johnson & Johnson COVID-19 vaccine is not as effective as other vaccines and that American Indian/Alaska people shouldn’t get it. That would be a deadly mistake - one that would almost certainly increase the rates of hospitalization and death among communities that have already suffered devastating loss from the virus.

One out of every 475 American Indians and Alaska AI/ANs has died from COVID-19 in the last year and AI/AN people have the highest COVID-19 case rate, hospitalization rate and death rate in the United States. Quick and extensive COVID-19 vaccination is necessary to slow the spread of the virus and end the pandemic.

Despite the need for wide distribution of vaccines to save Native lives, a recent op-ed in Indian Country Today suggests that Native communities should avoid the Johnson & Johnson vaccine.

The author, Dr. Bruce Davidson, a public health and pulmonary physician, says Native people did not receive the same benefits of the vaccines as other racial or ethnic groups.

He’s wrong.

Here’s what the data says. All racial groups benefited from receiving the vaccine, including Native people. No one who received the COVID-19 vaccine was hospitalized for COVID-19, including Native people. No one who received the COVID-19 vaccine died from COVID-19, including Native people. Again: no Native person died of COVID-19 after receiving the Johnson & Johnson vaccine.

The call for Native people to reject the Johnson & Johnson vaccine is alarming. Many Native people are hesitant about receiving the vaccine - as are many Americans. Suggestions that one vaccine does not provide protection against COVID-19 for a particular racial group have no plausible biological foundation and are not supported by the available evidence. Unfortunately, these assertions echo many concerns that Native people have about the COVID-19 vaccinations. Their publication in Indian Country Today - where many Native people turn for news - threatens the lives of Native people across the country.

(Related: Native communities should avoid the Johnson & Johnson COVID-19 vaccine for now)

In his op-ed, Dr. Davidson focuses his discussion on the efficacy results of the Johnson & Johnson COVID-19 trial, saying that the vaccine did not work in Native people. We - epidemiologists and public health professionals serving Indian Country- disagree with his analysis. First, the American Indian and Alaska Native group in this trial is made up of primarily Indigenous people outside of the United States. Generally, studies use race as a marker for other factors: such as the overall health of a particular group or socioeconomic conditions. Indigenous people living outside the US are not representative of American Indians and Alaska Natives. These results cannot be specifically applied to Native people within the US.

Additionally, although Dr. Davidson states that the trial is “conclusive for lack of protection by 28 days after a dose for these two groups (American Indian/Alaska Native)”, the data do not support such a conclusion. There were not enough Native people in the trial to show a difference between American Indian and Alaska Native people and other groups. Seeing this type of difference in vaccine efficacy would be unexpected. There are currently no vaccines approved for use in some racial or ethnic groups and not in others. To make this type of recommendation would require much more data - more than is available from this trial.

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Finally, as unfortunately is true in many clinical trials, there were very few Native trial participants. Because there were so few participants, any results specific to that group are highly uncertain. If you only have a small number of people in the trial, the results are much more likely to be influenced by a few unexpected events.

The op-ed not only provides a misleading and inaccurate interpretation of the Johnson & Johnson COVID-19 trial data, it also misses the forest for the trees. At its most dangerous, COVID-19 kills people.

In particular, it kills AI/AN people at higher rates than any other racial or ethnic group in the United States. We need to stop people from dying of COVID-19. No one who received the Johnson & Johnson vaccine in the trial died of COVID-19. Not a single person — including any American Indian or Alaska Native person.

We need to use every tool we can to save our elders, our loved ones and our communities. Native people should embrace the mRNA vaccines and the Johnson & Johnson vaccine to get as many people vaccinated as quickly as possible. The more people that get vaccinated — with any of the currently available vaccines — the more lives that will be saved.

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