AMERICAN INDIANS/ALASKA NATIVES LEAD THE WAY IN VACCINATIONS
How a long marginalized group is leading the way out of the pandemic
**QUICK UPDATE**
AMERICAN INDIANS/ALASKA NATIVES LEAD THE WAY IN VACCINATIONS
29 April 2021/Thursday/100pm PDT
BACKGROUND
This burden of this pandemic has fallen hard on American Indian communities across the United States. This graphic is from a report issued by the Kaiser Family Foundation (KFF) showing that despite the heavy burden endured in this pandemic, our Native American patient population are getting their COVID vaccinations at a higher rate than any ethnic/racial group in the United States.
"Underlying inequities that existed prior to the pandemic contribute to AI/AN people facing increased barriers to accessing health care and being disproportionately affected by the COVID-19 pandemic. Chronic under-funding of the Indian Health Service (IHS) relative to health needs and high uninsured rates contribute to barriers to health care among AI/AN people. Existing social, economic, and health inequities have also led to higher rates of illness and death among AI/AN people due to COVID-19."
The KFF report: https://www.kff.org/.../covid-19-vaccination-american.../
THE PANDEMIC BURDEN
Native Americans are nearly twice as likely to get infected with COVID than white Americans. They have an over three times the rate of hospitalization as white Americans and 2.5 times the death rate from COVID than white Americans.
Overall hospitalizations for COVID in white Americans is 395 per 100,000. For the American Indian/Alaska Native community, that number is is 1047 per 100,000. If we were just to look at individuals ages 18 to 49, the incidence of COVID hospitalization amongst white Americans is 131 per 100,000. For the same age bracket amongst Native Americans, it is a staggering 778 per 100,000, nearly six times higher.
Having worked in Reservation communities in this pandemic, nearly everyone knows someone who has had COVID, has been hospitalized for COVID, and died of COVID. Imagine small reservation communities holding five funerals for COVID deaths in a single week. That's the reality of this pandemic in Indian Country, not just in the Pacific Northwest where I am assigned, but across the United States.
THE IHS VACCINATION CAMPAIGN
So why is it the American Indian/Alaska Native population has been vaccinated as such a high rate? After all, there have been generations of mistrust between Native Americans and the federal government and push back on the vaccinations would almost be expected.
Many of the same socio-economic barriers also exist in African-American and Latino communities, yet their vaccination rates have been much less.
There are several factors that have led to our success in the Indian Health Service:
1/ Our vaccine allocation was independent of the state allocations for the rest of the United States. Early on when the vaccines were under development, we were made a Department of Health and Human Services priority for vaccination not just of our patient population but also our employees. Early on, we were getting more vaccine than nearly all but two US states. Some tribes manage their own health care clinics instead of the Indian Health Service (we call those Part 638 clinics based on the law that allowed tribes to self-manage) and they were given the choice to piggyback on the IHS allocation or go with the state allocations. Most Part 638 clinics joined the IHS allocation.
2/ The tribes were given the autonomy to develop their own vaccine roll out plans in cooperation with the Indian Health Service and their own tribal councils. While they followed the prioritization plans about who to vaccinate first, tribes were allowed some flexibility based on their own situations- the Cherokee and Sioux, for example, placed native language speakers. Some tribes were so successful with their vaccination campaigns they elected to start vaccinating non-Native people who live in the area. The Chickasaw and Cherokee in Oklahoma did this, as well as the Lummi in Washington state, for example.
3/ The tribes utilized existing networks and resources to reach priority populations early on. Because of the remote locations of many reservation communities and socio-economic factors, a web-based sign up would not work at all. Many IHS clinics and tribal Part 638 clinics set up call centers and in many cases called at-risk patients directly to offer vaccination and get them scheduled. One of the places I've worked on the Yakama Nation in Washington state for example, the staff there kept a running list of diabetics who needed vaccination from scouring the charts and updated the tally each day of who was left to contact and vaccinate.
4/ Our messaging was culturally relevant-
"Tribes have launched tailored outreach and communication plans that share culturally relevant messages through trusted individuals in the community. A national survey of AI/AN people conducted in late 2020 found that the majority were willing receive a COVID-19 vaccine and that the most commonly held motivation for getting a vaccine was a sense of responsibility to protect the Native community and preserve cultural ways. Regardless of willingness to get a vaccine, the most frequently reported concern about the vaccine was how fast the vaccine moved through clinical trials. Some Tribes have utilized fluent language speakers to address concerns about the vaccine among the community. For example, the Cherokee Nation prioritized Cherokee language speakers to create optimism and show that the vaccine was safe. Similarly, the Navajo Nation employed fluent doctors and health care professionals to serve as trusted sources of information on the vaccine."
We were fortunate that the pandemic came at a time of renewed Native American activism and for many of our patients, getting vaccinated resonated strongly with that activism as an expression of preserving and protecting the community.
The individual as the fundamental basic unit of society is a Western/European notion. A lot of Asian and Latino societies have the family as the fundamental basic unit of society. Amongst Native Americans, there is no such things a unit. Yes, everyone understands individuality but on a cultural scale, the American Indian/Alaska Native sense of self is more of a "sphere of consciousness" centered on the individual that moves outward in a continuum that has to exist in harmony with nature. So your immediate family is more of "you" than your next door neighbor or friends, but there is also a part of "you" in them as well as the world around you.
Getting vaccinated to protect yourself just so happened to protect those around you because in the Native American mindset, those around you were also a part of you. It was something unexpected for me as a non-Native physician, to experience just how tight-knit the communities are compared to my own hometown.
The data in this graphic is from the beginning of the month. By tomorrow, we will have at least 40% of all adult Native American patients fully vaccinated with 55% having received at least one dose. And this is despite the 11-day pause on the Johnson & Johnson single dose vaccine.
PARTING THOUGHTS
"The red nation shall rise again and it shall be a blessing for a sick world; a world filled with broken promises, selfishness and separations; a world longing for light again. I see a time of seven generations when all the colors of mankind will gather under the sacred tree of life and the whole earth will become one circle again."
-Crazy Horse
Public posts on my Facebook page here: https://www.facebook.com/jp.j.santiago