When the COVID-19 vaccines arrived at her Bay Area Indian Health Center in California’s Santa Clara Valley, Miriam Mosqueda of the Chichimeca Guamare tribe almost didn’t take one. She was afraid.
But the 26-year-old staffer thought of her immunocompromised grandparents, whom she hadn’t seen since March.
She thought of never again sipping her grandmother’s traditional vanilla atole while she told her stories, or never hearing her grandfather’s laughter as he insists she pick lemons from his tree.
Her culture reveres elders, and her grandparents helped raise her. “They’re like our third and fourth parents,” she said.
“I was like, ‘I have to get this vaccine.’ If that means that I can protect them, too … and safely see them, then I will do that,” she said. “I can’t not take the opportunity to protect our community.”
Just before the New Year, Mosqueda, the center’s youth professional development counselor, went in 30 minutes before the last round of the first dose was administered to the center’s staff.
The center is one of 340 tribal health programs or urban Indian organizations nationwide to receive vaccine allocations from the federal Indian Health Service. Tribal nations had the choice to receive vaccines from the IHS or their states.
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So far, 290,900 Pfizer and Moderna vaccines have been distributed by the IHS among its 12 geographic areas, and more than 74,000 first doses have been administered, according to the U.S. Centers for Disease Control and Prevention. Tribal health care workers and Native residents of long-term care facilities began receiving vaccinations last month as part of Phase 1 of the nation’s coronavirus vaccine roll out.
COVID-19 has disproportionately impacted Native communities, in part due to long standing social inequities that have put American Indian and Alaskan Natives at higher risk for contracting the virus.
A CDC study found that among 23 states with data on race, American Indian and Alaskan Native people were 3.5 times more likely to be diagnosed with the coronavirus than white people and four times as likely to be hospitalized.
“It’s been devastating for many of our community members,” said Sonya Tetnowski, CEO of the Indian Health Center of Santa Clara Valley. The state has one of the largest populations of American Indians, at more than 720,000, and 109 federally recognized tribes.
“Because we’re serving a population that already has significant challenges just day to day, adding the coronavirus … have just added to that stress and pressure of that community,” she said. Many patients at the center, which also serves Hispanic and migrant workers, suffer from diabetes, hypertension and heart disease, making them vulnerable to the virus.
But as the virus hits their communities hard, tribal leaders are also grappling with the challenge to help members feel comfortable taking the vaccine and understand its safety for most people. Hesitancy due to past injustices on tribal communities have planted seeds of doubt in many.
‘Bringing all the facts to the table’
As health centers remain the nexus of making sure Indian communities get vaccinated, respected elders and tribal leaders within the groups are leveraging their influence to help get the message out.
People of color, including indigenous people, are more likely to rely on trusted voices within their own communities for information about the pandemic and the vaccine, a study by Northeastern University that tracked online behaviors suggests.
“It’s helped tremendously in Indian Country for people to have a transparent perspective,” said Virginia Hedrick, executive director of the California Consortium for Urban Indian Health. The group has been streaming Facebook Live question-and-answer sessions every other week.
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“It’s about transparency. It’s about bringing all the facts to the table,” said Hedrick, a member of the Yurok Tribe who grew up on the tribe’s rural reservation. She said connecting CCUIH’s messaging about the vaccine to American Indian values, such as community, has been essential.
“We don’t know about this vaccine’s ability to prevent transmission. What we do know is that it will save lives. And we do know as indigenous people that that value resonates with us — that we really have to meet our prayers halfway,” she said. “So, when we’re praying for health and wellness and long life, we have to do the things that gets us there.”
CCUIH is working with another agency to create educational digital and print fliers about the vaccine featuring relatable images and taglines.
“When they see images that don’t resonate with them, when they see taglines that are not important to them, they put the material to the side,” she said. “‘That’s not important to me. That’s not inclusive of what we do as a family.’ Then it’s a total missed opportunity.”
In southeastern Minnesota, the Prairie Island Indian Community on the Mississippi River had early buy-in on the vaccines from community elders.
In mid-December, the tribe hosted a Zoom meeting for community members with elders, tribal council members and Prairie Island Health Center’s primary doctor to answer questions and talk about the vaccines.
“The majority of tribal elders have accepted the vaccine. They really feel a responsibility to protect their community,” said Katie Halsne, director of clinical operations for Neopath Health, which runs the Prairie Island clinic.
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The first round of vaccines went to health care workers at the clinic and long-term care facility, as well as residents of the facility and first responders, Halsne said, followed by about 80 elders and 200 members considered high-risk.
Emphasizing protecting elders also has been key to helping communities understand the importance of the vaccine because of the important roles they hold in tribes. “We do have a profound respect for our elders. They are our encyclopedias. They are our libraries. They cannot be replaced,” Hedrick said.
Tetnowski says she and other IHC leaders have also been posting on their personal social media accounts about the vaccine.
“That has really allowed for a lot of community members who were kind of on the fence … because they know people now who’ve received it,” she said. “Who were comfortable with the way the process went.”
‘I can say I’m alive and I’m doing OK’
In Sioux Falls, South Dakota, a team of mental health therapists is helping guide the area’s Flandreau Santee tribe. The therapists, who’ve been helping the community navigate stress brought on by the pandemic, discuss the vaccine with each patient. Other professionals, such as doctors at other clinics, also make a point of publicly taking the vaccine to model its safety.
Family physician Dr. Courtney Keith said she wanted to be one of the first to receive the vaccine not just because she’s a health care worker treating patients — but to show the tribal community the vaccine is safe.
“I work with a clinic that has had an abusive history with medicine,” she said after receiving her first dose in December. “The reason I want to be one of the first (to get the vaccine) is to show I have confidence, and so six weeks down the road when people are thinking and saying, ‘Should I get it?’ I can say I’m alive and I’m doing OK.”
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At Minnesota’s Prairie Island clinic, Halsne said staff doled out vaccines to 140 people Wednesday. Of the 224 people they reached to offer the vaccine to, 27% refused it. Word of mouth is bringing people in, she said.
Blackfeet Nation health care workers in Montana received their first doses of the Moderna COVID-19 vaccine ahead of the Christmas holiday. The Nation peaked in cases mid-October at around 400 diagnoses.
In preparation for vaccine distribution, the tribe’s COVID-19 Incident Commandlast week shared an announcement featuring a shaggy “rez dog” puppet who interviews a nurse practitioner about the new vaccine.
In the video, the self-identified “Rez Dog Rep” asks the nurse questions ranging from the cost of the vaccine and whether he will need to continue to wear a mask after being immunized to who gets it first and potential side effects.
“Indian people like humor,” said the tribe’s public information officer James McNeely. “The idea of the PSA is to help ease people’s minds, give them a sense of comfort and an education on the vaccine.”
Tracking COVID-19 through ‘population lens’
IHS COVID-19 Vaccine Task Force Distribution and Allocation Team lead Cmdr. Andrea Klimo said the allocations were calculated based on population and storage abilities.
“Each geographical area has their own considerations,” Klimo said. “They have different population lens, they have different geographical constraints sometimes and some of them have different capabilities of storing the vaccines at various temperatures.”
Klimo said IHS is relying on larger tribal health centers to distribute vaccines to their surrounding rural tribal communities.
“Some areas have a really robust hub-and-spoke model,” she said. “We send to our hubs and then they distribute out to the more rural isolated locations.”
One such tribe of varying needs using this model is the Navajo Nation, one of the largest in the country with about 172,000 residents living on land spanning more than 27,000 square miles across three states.
Earlier this year, the tribe had the highest infection rate per capita, despite aggressive preparation a month before its first confirmed case.
The tribe’s COVID-19 task force enforced policies and protocols, decreasing the case count significantly, according to data from the Navajo Department of Health.
But as the tribe battles a recent spike amid a surge nationwide, authorities have scrambled to keep a lid on cases while prioritizing vaccine distribution to health centers with proper storage.
The Kayenta Health Center in Arizona, a rural hospital serving Navajo Nation residents, has a smaller freezer than other health centers that serve the tribe. Officials worked to get the vaccine to hospitals with more space and proper equipment to store doses, since the Pfizer vaccine requires such cold temperatures.
“We are placing it strategically in those freezers so that we can then take that vaccine to the other health centers and hospitals,” said Dr. Loretta Christensen, the chief medical officer for the Navajo area Indian Health Service.
Other places, like Mosqueda’s Santa Clara Valley for example, host a diverse and robust population because of the Indian Relocation Act of 1956 that forced native people to move from reservations and assimilate into urban areas. The inter-tribal makeup makes tribal health centers like her IHC and other hubs integral to making sure members of different tribal communities get vaccinated when the vaccine becomes available to the general public.
The day after Mosqueda got vaccinated in Santa Clara, she was finally able to visit her grandparents.
“I could worry about myself getting side effects after the vaccine, or I can think bigger picture,” she said. “If I have chills the next two three days but in the long run my community as a whole will be safer, then I’m OK with that.”
Contributing: Danielle Ferguson, Sioux Falls (S.D.) Argus Leader, and Chelsea Curtis, The Arizona Republic.