The New York Times
Many vaccines, but not enough weapons: a warning sign in the Cherokee nation
TAHLEQUAH, Oklahoma – As people in the United States jockey and wait to be vaccinated, a surprising problem is unfolding in the Cherokee nation: many shots, but not enough arms. “We are running out of people to vaccinate,” said Brian Hail, who helps oversee the tribe’s vaccination efforts. He shuddered when he pulled up the day’s schedule on a recent morning: Vaccines were open to basically everyone on the reservation, but 823 appointments were not claimed. It is a side effect of the initial success, tribal health officials said. With many enthusiastic inoculated patients and declining new coronavirus infections, the urgency for vaccines has gone terribly still. Subscribe to the New York Times newsletter The Morning Now, the tribe is facing what appears to be a major obstacle for the entire country as vaccine supplies increase to meet demand: how to vaccinate everyone who is not looking forward to a injection. It is a dizzying challenge for public health that permeates the entire country. It includes persuading skeptics, calling people who don’t realize they are now eligible, and making vaccines accessible to patients living at home, overworked working families and people in rural areas and minority communities. Cherokee Nation administered more than 33,000 doses at nine vaccination sites across its reserve, which spread from cities through rural forests, cattle pastures and poultry farms in northeastern Oklahoma. After vaccinating health professionals, Cherokee-speaking elders and essential workers, the tribe opened consultations for any qualified person, a member of the tribe or not, living on its borders. Still, hundreds of vacancies have not been filled, health officials said. Cherokee-speaking vaccine schedulers hired to make appointments are waiting for their phones to ring. “These early waves of people who really wanted and needed the vaccine – we worked on it,” said Hail, executive vice president of external operations at Cherokee Nation Health Services. The tribe has 141,000 citizens in the reserve and 380,000 worldwide. “We are struggling to get people in.” Dennis Chewey, 60, gave his brother and sister the tribe’s vaccination hotline and asked them to call. Chewey’s wife was at great risk because of her job as a casino’s housekeeper, and he knew several people who had died, including a health professional who had helped him treat diabetes. But none of them called. “They are afraid to take it,” said Chewey, just minutes after he and his wife, Clara, received a second dose at the tribe’s new outpatient clinic. “They are my family. I can’t make anyone do anything ”. Public health teams across the country are redirecting their energy and resources to bring vaccines to people. They are diving into New York neighborhoods to reach people living at home and visiting rural communities where the unreliable internet makes it difficult to sign up for appointments or access vaccination sites. They are driving along long dirt roads to reach families without cars or money for gas to visit vaccination clinics. The Navajo Nation, which claims to have vaccinated about 70% of its citizens, has sent public health workers to rural corners of the high desert to vaccinate up to 5,000 people near their homes. Cherokee Nation is planning “attack teams” of nurses with Johnson & Johnson single dose vaccines. The Osage Nation, in northeastern Oklahoma, is vaccinating about 200 people a day at a clinic that has the capacity to deliver 500 vaccines. She tried two mass vaccination events in her casinos, but the results were disappointing. Therefore, the tribe bought two 30-foot “medical RVs” that will reach smaller cities like Hominy and Fairfax to reach 30% to 40% of tribal elders and essential workers who have not volunteered to be vaccinated. It is a house-to-house campaign against disinformation and caution, waged with long conversations and patience. “You kind of crush it,” said Dr. Ronald Shaw, medical director for the 23,000-member Osage nation. “We try to remove all obstacles for people who were sitting on the fence.” The coronavirus has been particularly devastating for indigenous communities. It killed American Indians and Alaskan natives at almost twice the rate of whites and inflicted a cultural crisis by killing elders who passed on traditional language and teachings. The economic toll of the pandemic has hit native economies already devastated by high poverty and unemployment. Launching the vaccine in native communities has been a surprising source of strength, especially since vaccinations from other communities, such as blacks and Hispanic Americans, remain behind white populations. Working through the Indigenous Health Service and long-established networks of tribal-run clinics, tribes are overtaking much of the country, already applying vaccines to healthy adults and eligible teenagers. Some have even opened the doors to non-tribal members within their borders. In all, about 1.1 million vaccines have been distributed by the Indian Health Service and 670,000 have been administered. Still, health advocates said there were still frustrating gaps. Many indigenous people in large cities and areas without tribal health centers struggled to find vaccines. Now, native health professionals are desperately hoping to reach people like Nora Birdtail, 64, one of an ever-decreasing number of elders who speak Cherokee. Their names are noted in a leather notebook that was created to record their importance for Cherokee heritage and culture. Today, the notebook is a record of loss – at least 35 lives and countless stories interrupted by the virus. Despite hundreds of elderly people being vaccinated, Birdtail resisted. She is vulnerable to coronavirus due to a stroke. Her job as a teaching assistant puts her in close contact with the children at the Cherokee Immersion School, where face-to-face classes are due to resume shortly. But Birdtail is afraid of being vaccinated, mainly because she passed out once after getting an injection of penicillin years ago. The government’s legacy of medical malpractice in the Indian country – a history of coercive treatments, inadequate care, forced sterilizations and more – has also instilled deep skepticism about getting a government-backed vaccine. “It made me think of the Trail of Tears, how they all got sick,” said Birdtail. “I don’t trust that.” The number of Americans willing to get vaccinated has grown as people watch family and friends, politicians and Dolly Parton roll up their sleeves. But about 18% of American adults said they probably would not or would definitely not be vaccinated, according to a recent survey by the Census Bureau. Across the country, people’s adherence to the vaccine has split sharply along party lines, with one-third of Republicans saying they would not get the vaccine and another 20% saying they were unsure, according to a CBS News / YouGov poll. Ten percent of Democrats said they would not get the vaccine. Across the Cherokee nation, people who acted to get vaccinated said they wanted to protect themselves and, most importantly, to safeguard their community, the elderly and children who are not yet eligible for vaccines. Those who hesitated said they still had many questions – about the effectiveness of vaccines, side effects and the speed with which they reached the market. The three vaccines that received emergency clearance in the United States have been shown to significantly reduce serious illnesses and deaths caused by the virus, and all have undergone various analyzes by the government and outside scientists. But those guarantees have not yet reached a trailer in the Dry Creek community, where Fred Walker, 65, has to transport his drinking water from a neighbor’s home. Walker is disabled and cares about the virus. But he avoided the vaccine because he fears it could harm his health. He said that no health professional had contacted him to schedule an appointment or answer his questions. “Nobody said anything about it,” he said. Others just seemed to want a little push. In a Walmart that provides injections, unvaccinated customers said they were not opposed, just waited. For more informations. On the recommendation of a doctor. For more people to take. Even in places where vaccine nominations are plentiful, some people worry about stealing a spot. Shelldon Miggletto, a Cherokee citizen and director of economic development for the city of 4,000 inhabitants of Stilwell (“Strawberry Capital of the World”), held back because he did not want to intrude in front of someone with asthma or diabetes. Similar problems arose in Alaska, where vaccine vacancies were not filled because people did not know they were eligible. The nurses who run the Cherokee nation’s vaccination program are obsessed with how to attract more people. They are planning to vaccinate eligible students at Sequoyah High School. There is talk of vaccination at barbecues and T-shirts for the newly vaccinated. The health service called and sent mass text messages asking unvaccinated members if they were willing to enter. One of these messages found Sherry Garrett, 68. She and her husband had deep suspicions about the vaccine and planned to refuse it. But then her sister died in July, after what her family believes to be an undiagnosed case of COVID-19 months earlier. Someone at Walmart coughed in Garrett’s face. And when a Cherokee health worker called to offer a place, Garrett said he relented and convinced her husband, Larry, to come along. While they were sitting in a half-empty monitoring area, waiting the necessary 15 minutes after Larry’s first dose, Garrett said he now saw getting the injection as part of who she was: “I’m Cherokee, so I have to do it this”. This article was originally published in The New York Times. © 2021 The New York Times Company