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    American Indians have the highest Covid vaccination rate in the US

    According to CDC data, Indigenous people are getting vaccinated quicker than any other group. Here are the successes—and challenges—of getting vaccines to urban Native American communities.

    BySukee BennettNOVA NextNOVA Next

    A Navajo family practices social distancing and mask-wearing during the coronavirus pandemic. Image credit: Getty Images

    Before getting vaccinated against COVID-19 was an option, Francys Crevier was afraid to leave her Maryland home.

    She ordered all of her groceries and limited her time outside, knowing that each venture would put both herself and her immunocompromised mother, with whom Crevier shares her home, at risk. Knowing she could provide for Mom was “a blessing, for sure,” Crevier says. After all, American Indians and Alaska Natives were hospitalized and died from COVID-19 at a higher rate than any other racial group in America throughout the pandemic, says Crevier, who’s Algonquin.

    “As a Native woman, I didn’t know if I was going to make it through this,” she says.

    Indeed, the U.S. Indigenous population had more than 3.5 times the infection rate, more than four times the hospitalization rate, and a higher mortality rate than white Americans, reports the Indian Health Service (IHS), a federal health program for American Indians and Alaska Natives. Official data reveal that the Navajo Nation, the largest tribe in the U.S., has been one of the hardest-hit populations, reporting one of the country’s highest per-capita COVID-19 infection rates in May 2020, the Navajo Times reports.

    Being so disproportionately affected led to a sense of urgency toward vaccination among American Indians and Alaska Natives, says Crevier, who is the chief executive officer of the National Council of Urban Indian Health, a partner of IHS. And many IHS affiliates stepped up, showing early success with vaccination education and campaigns specifically for Indigenous communities, some of whom would otherwise have trouble accessing coronavirus vaccines.

    In May, the Centers for Disease Control and Prevention (CDC) announced on Twitter that its COVID-19 data tracker now displays U.S. vaccination progress by race and ethnicity. The tracker, “Percent of People Receiving COVID-19 Vaccine by Race/Ethnicity and Date Reported to CDC, United States,” showed that as of July 6, American Indians and Alaska Natives have the highest vaccination rate in the country, with 45.5% having received at least one dose and 39.1% fully vaccinated. They’re followed by Asians (36.6%, 35%), whites (33.7%, 32.2%), Native Hawaiian/Pacific Islanders (35.9% 31.3%), Hispanic/Latinos (31.8%, 28.3%), and Black people (25.8%, 23.2%). As of late May, American Indian and Alaska Native vaccination rates were higher than white vaccination rates in 28 states, including New Mexico, Arizona, and Alaska, where many Indigenous people receive care from tribal health centers and the IHS, Connecticut News Project’s CT Mirror reports.

    Francys Crevier, the chief executive officer of the National Council of Urban Indian Health. Image courtesy of Matthew P. D’Agostino, University of Maryland, Baltimore

    For many, it’s a reason to celebrate. Choctaw Nation of Oklahoma member Walter Murillo, the chief executive officer of Phoenix-based Native Health Central, says he felt “almost daily” the loss of family members, community members, and extended community members. “Every day, having lived through that trauma, when there’s a way for safety, that’s the way to go,” he says of vaccination, wiping his eyes over Zoom.

    Success and challenges of Indigenous vaccine rollout

    In November 2020, the federal government offered tribes and urban Indigenous communities two potential options: Receive vaccines through the state or separately through the IHS. Many chose the latter, as receiving vaccination via the state, Crevier and Murillo explain, would have required Indigenous communities to fully adopt the CDC’s vaccination rollout phases. These phases, though recommended to tribes, Crevier says, didn’t completely align with Native American viewpoints, which often emphasize putting culture and language—and their keepers —first. (Some Native speakers are younger than 65 years old and therefore weren’t included in the earliest U.S. vaccination phases, for example.)

    In some tribes, fully complying to the CDC’s recommended phases would have entailed adopting slower vaccine rollouts than tribes actually undertook. “People knew they didn’t have to be hemmed in by those phases,” says Kerry Hawk Lessard, the executive director of Baltimore and Boston-based Urban Indian Health program Native American LifeLines. “You can’t blame them. That’s their right as a tribal citizen.”

    The Mashpee Wampanoag of Massachusetts, Lessard says, opted to make vaccines available for tribal citizens and anyone who shares a household or works for a Native organization. In Oklahoma, once tribal members were vaccinated, surplus supplies of vaccines went to teachers and other non-tribal citizens serving tribal communities, often before these people were eligible per state guidelines, she says. “Some of my family members live on the Fort Peck Reservation” in Montana, where “a huge amount of people are vaccinated” compared to people in the rest of the state, explains Lessard, who is Shawnee. “We’re fortunate in the Phoenix area,” Murillo adds, referring to having ample IHS resources and support, which greatly helped make vaccines accessible to Indigenous people living in the Southwest.

    And in Washington, the Native Project, a primary health care facility that services the greater Spokane community, decided to get its vaccine allocation through the state. “The state was very cooperative,” Crevier says. After a quick rollout, excess doses went to the NAACP and the Asian American community. “It was really kind of beautiful,” she says. “We are one big country, right? It’s nice that this community prioritized not just our [Native] community but other historically marginalized ones.”

    The “language you hear throughout Indian country is ‘be a good relative.' Do this for the grandmas, do this for the ceremony, do this for the language, because our people are precious...We already lost a lot. We can’t afford to lose more.”

    In states like South Carolina and Tennessee, however, vaccination rates have been far lower for American Indians and Alaska Natives than for white Americans, CT Mirror reports.

    After all, more than 70% of Indigenous people live off of reservations, many in urban communities that lack full IHS services: dental care, primary medical care, mental health care, and other facilities under one roof, free of charge for the Native American community. While IHS facilities in the American West commonly include full outpatient care, the entirety of the East Coast lacks such IHS services due to limited funding. (Though the IHS is promised an annual $48 billion by the federal government, it received $6.4 billion for the 2021 fiscal year.) A lack of urban services affected many vaccination campaigns, Crevier says, though Murillo points out that it ethically shouldn’t have: “Managing an outbreak of a communicable disease on a reservation is important. Why would it be less important for Indians living in the city?” he asks.

    A woman receives a coronavirus vaccine through Native Health Phoenix's program. Image courtesy of Susan Levy, Native Health

    Lessard is very familiar with the challenge of offering vaccines to Indigenous people living in urban areas who are far from home reservations and full outpatient care. The Boston and Baltimore Indigenous communities her organization serves had “a lot of fear”: “We have a pretty good size of Navajo Nation citizens here. Seeing what’s happening at home is devastating” and plays into wanting to get vaccinated quickly, she says. Furthermore, Lessard and her team knew that many people in their community grappled with the decision to travel to their home reservation, where they could be vaccinated immediately but potentially put family members and tribal elders at risk of infection. “If they were at home, they wouldn’t necessarily have to wait for the U.S. phases,” Lessard says. This “amped up the pressure on us to make sure the vaccine was available in their area.”

    Native American LifeLines faced a lack of healthcare providers and no comprehensive healthcare services through the IHS on the Eastern seaboard, meaning there was no way for it to receive, store, and administer vaccines. The temperature requirements and shorter lifespan of Pfizer, a vaccine now used exclusively at some of Native American LifeLines’ vaccination sites, added to the challenge, Lessard says. Her organization ultimately had to get its vaccine allotment through the state, potentially slowing rollout to Boston and Baltimore’s Native American communities.

    Faced with urgency and enthusiasm from the people her organization serves, “We realized early on we had to make a change,” Lessard says.

    “Managing an outbreak of a communicable disease on a reservation is important. Why would it be less important for Indians living in the city?”

    In January, Native American LifeLines began seeking out partnerships “to try to fill in the gaps,” deciding that identifying institutional partnerships would be best. Ultimately, it partnered with Massachusetts Department of Public Health and the University of Maryland Baltimore to establish IHS vaccine clinics, and as part of Governor Larry Hogan's Vaccine Equity Task Force in Maryland, with the National Guard to reach remote state-recognized tribes.

    The UMD Baltimore clinic, which carries only Pfizer, has seen a spike in appointments since youths became eligible to receive that vaccine, Lessard says. Now, she says, it’s just a matter of addressing situational gaps. For example, Native American LifeLines’ clinic with the Maryland National Guard uses only Moderna, so Lessard and her team are keeping an eye on the eligibility of younger people. And they’re deciding whether to set up other tribal health clinics to serve the growing list of eligible people.

    In Phoenix, Murillo and his team at Native Health Central, which recently administered more than 500 shots across two school districts, hope to soon incorporate modified vaccine storing standards into their rollout plans.

    “We can’t afford to lose more”

    The successes of Native American LifeLines, Native Health Central, and other organizations’ vaccine campaigns, and the CDC’s vaccination rate data, counter longstanding assumptions about vaccine hesitancy in Indigenous communities—assumptions that were already disproven in January by the results of a survey conducted in urban Indigenous communities, Lessard and Crevier say.

    The survey, issued by the Urban Indian Health Institute (UIHI), involved nearly 1,500 American Indians and Alaska Natives representing 318 tribes across 46 states. Seventy-four percent of those surveyed said they’d be willing to be vaccinated against SARS-CoV-2, the virus that causes COVID-19. Many cited having a “strong sense of responsibility to protect the Native community and cultural ways,” as their primary motivation to get vaccinated, the UIHI reports on its website.

    The “language you hear throughout Indian country is ‘be a good relative,’” Lessard says. “Do this for the grandmas, do this for the ceremony, do this for the language, because our people are precious....We already lost a lot. We can’t afford to lose more.”

    As a Native American, “You have obligations to your community and your family,” adds Crevier, who on April 16 received her first dose of Pfizer through Native American LifeLines’ Baltimore program.

    Still, Crevier says, the CDC’s vaccination data likely has some gaps due to poor data collection practices.

    Many Indigenous people, particularly those living outside of reservations, may be listed by the CDC as “other” rather than American Indian/Alaska Native, Lessard explains. All Indigenous health data, she says, reports up from healthcare providers, and then sometimes to the Indian Health Service, before getting to the CDC. And not all healthcare providers collect data thoroughly with regard to race and ethnicity. Some of the forms that Lessard has personally filled out have included Black, white, Hispanic, Asian, and other, but not Alaska Native or American Indian. “It’s kind of a junk in, junk out system,” she says. Crevier adds, “I always fill out American Indian/Alaska Native at the doctor’s office, but sometimes I get the form back and it says white.”

    And Crevier points out more white people have been vaccinated against COVID-19 than white people who got sick from the virus. “They were the first race to have that. That kind of shows the priority,” she says. She’d love to see more efforts during the current pandemic and in the future to prioritize “people who have never been at the front of the lines: Black, brown, Indians, and Alaska Natives who have had the worst outcomes.”

    A global pandemic wasn’t something that the National Council of Urban Indian Health or other Indigenous organizations could have possibly planned for, says Crevier, who personally grappled with the decision of where to go to get vaccinated before deciding to stay in the D.C. area “and fight for vaccine availability for my community.” But the pandemic reinforced a principle close to Crevier’s heart: While caring for patients and making treatments and vaccines available, historic barriers and trauma must be taken into account. “How do we do that moving forward?” she asks. “True, true investment guarantees we won’t be as vulnerable as we have been.”

    Funding for NOVA Next is provided by the Eleanor and Howard Morgan Family Foundation.

    Major funding for NOVA is provided by the David H. Koch Fund for Science, the Corporation for Public Broadcasting, and PBS viewers. Additional funding is provided by the NOVA Science Trust.