Image 1: The Rosebud Indian Health Services hospital holds a weekly COVID-19 mass vaccination clinic in South Dakota (OPB)

With the rollout of approved COVID-19 vaccines, there is hope that herd immunity can put the country on track to establishing pre-pandemic normalcy. As of April 15, 24% of the US population and 64% of those 65 and older had been fully vaccinated.^[1]

While rates vary from state to state, great successes in the vaccine rollout have been seen in tribal communities compared to the overall federal response. Because Native Americans have higher rates of lower respiratory diseases, diabetes, and other health complications that increase their susceptibility to serious COVID-19 complications, vaccine initiatives among tribal populations are of great importance.^[2]

Due to the nature of tribal sovereignty in public health matters, Tribal Health Programs can choose to collaborate with the IHS or with the state to receive and administer vaccines.^[3] Both of the vaccines (Moderna and Pfizer) have been allocated to the IHS for distribution to its facilities, Tribal Health Programs, and Urban Indian Organizations. ^[4]

Image 2: Member of Lummi nation receives a COVID vaccination (The Associated Press)

Providers from Arc Health’s partner clinics have reported positive rollout data. Dr. Nassim Assefi, an Arc Health internist at a tribal clinic in Bellingham, Washinton State, shared that the facility has vaccinated 50% of tribal members as of 3/24/21 with at least one dose and has opened up eligibility to all members 16 years and older (before the state). It also started offering vaccines to nearby, non-tribal community members (such as post-office workers) who interface with the public. This includes vaccinating teachers within a nearby school district in February before the state had made educators eligible.^[5]

Image 3: Sage Memorial Hospital receives its first doses of the COVID-19 vaccine in December 2020 (NPR Knau)

Full-time Arc Health pediatrician, Dr. Anik Patel, and Family Medicine physician, Dr. Dominic Caruso, have both worked at tribal vaccination centers in Arizona and Oregon, respectively, over the past few months. They reported that at these community vaccination events, recipient flow was well-organized, and wait times were low. Additionally, both facilities that Patel and Caruso practice at also offer injections in-clinic for patients who aren’t inclined to go to the mass vaccination centers.

Arc Health family physician Dr. Evelyn Gandara reported that by mid-February, the Indian Health Service facility where she works in rural New Mexico had vaccinated all tribal members 65 and older and has currently vaccinated 50% of patients and local tribal residents.

Image 4: Showing eligibility updates for vaccinations via Zuni Service Unit (Zuni Public Schools)

In northern California and the Pacific Northwest, small bands of tribes have opened up mass vaccination events to the wider community, earning them broad recognition of their successes. Dr. Kyle Knuppel explained that the small Tribal clinic where he works in remote northern CA has “provided vaccines for people as far away as San Diego and Portland”. In Oregon, Arc Health’s partner clinic vaccinated patients from as far as Nebraska according to Dr. Caruso.  

The Navajo Nation, though, has one of the most notable success stories. 37% of those receiving health services from the Navajo Area Indian Health Service (IHS) have been fully vaccinated and 87% having at least one dose.^[6] Leadership attributes this success to strong public campaigning and advocacy amongst nurses and other health professionals in the community.^[7]

On Navajo Nation, Arc Health’s partner hospital utilized radio broadcasts and social media to announce eligibility updates. The recognition of the severity of the COVID impact early in the Navajo Nation also contributed to an initial high demand for vaccines.^[8]

Dr. Phuoc Le, Arc Health Co-founder and Interim Medical Director at a tribal clinic in Shasta County California, reported that the clinic received and distributed an estimated total of 700 vaccinations very early on. Despite great strides in vaccine numbers, many tribal health clinics are now working on advocating for and demystifying the vaccines to those more hesitant to receive it due to a historically oppressive relationship between tribal communities and the federal government.^[9] In Osage Nation, medical staff have taken mobile vans to bring the vaccine to the people in an attempt to remove any potential barriers.^[10]

As a physician, advocating for trust in the vaccine and keeping up to date on eligibility for community members can help speed the rollout process. For more ways to advocate for an equitable vaccine, visit the World Health Organization’s Year of Health and Care Workers 2021 Get Involved page.

[1] CDC Covid Data Tracker: “COVID-19 Vaccinations in the United States”
[2] IHS Fact Sheets: “Disparities”
[3] IHS: Covid-19 Vaccine FAQs
[4] IHS: “Covid-19 Vaccine Distribution”
[5] The Seattle Times: “Teachers crying tears of gratitude as Washington tribes help speed COVID-19 vaccines to them”
[6] Navajo Times: “In numbers: Tracking COVID-19 Across the Navajo Nation”
[7] Navajo Times: “Navajo outpacing states in rate of vaccinations”
[8] Forbes: “Here’s Why The Navajo Nation Is Beating Out Every State’s Coronavirus Vaccine Rollout”
[9] “Fast rollout of virus vaccine trials reveals tribal distrust”
[10] CNN: “How Osage nation healthcare workers are fighting vaccine distrust”