“We have some real crushing challenges in the Indian Country,” said Stacy Bohlen, executive director of the National Indian Health Board. “We have a perfect storm for a pandemic like this to really bring us down. But we are also very, very resistant people.”
It is important to note that there are 574 federally recognized tribes, which makes it difficult to characterize widely how the vaccine is being implemented throughout the indigenous country. Natives obtain their health care from a patchwork system of Indigenous Health Service facilities, tribal-operated clinics and urban indigenous health centers, and vaccination efforts vary from tribe to tribe and from state to state.
Still, the success of some tribal health providers offers lessons for communities struggling to vaccinate their populations effectively. Here are some of them.
They adapted their messages to build trust
It is a strategy that the Cherokee nation says has worked for them.
The Cherokee nation administered more than 17,000 vaccines as of February 8, according to the tribe. About 141,000 citizens of the Cherokee nation live within the limits of the tribe’s reserve in northeastern Oklahoma, suggesting an impressive pace so far.
The tribe’s “biggest confidence maker” in the vaccine was its decision to put fluent Cherokee speakers on the front line, said chief chief Chuck Hoskin Jr.
By inoculating its most revered and esteemed citizens first, the Cherokee nation signaled to others that they may have been on the fence that they believed the vaccine was safe.
“It did something to create a sense of optimism among our people and also to increase the confidence of other Cherokees who see these Cherokee elders very revered, in many cases who are fluent speakers, getting vaccines and celebrating it,” he told CNN .
Navajo Nation President Jonathan Nez said people were hesitant to get the vaccine early on, so he filmed it to help build confidence in it. The tribe also answers questions from the Navajo people on the radio and in city halls twice a week, sometimes bringing in experts like Dr. Anthony Fauci.
Also key to the tribe’s confidence-building efforts are Navajo doctors and health professionals, who are able to speak to citizens in their own language and alleviate any concerns about their safety.
“Using our way of life and teaching helps our Navajo people to feel that it is okay to shoot,” said Nez.
About three in four Navajo citizens are now interested in receiving the vaccine, according to Nez. To meet this interest, the tribe has been hosting mass vaccination events seven days a week.
They have the autonomy to decide who has priority
Tribes are sovereign nations with autonomy to determine how to meet the health needs of their communities. For those who operate their own health care system, this meant being able to decide who should have priority for the vaccine.
This autonomy allows tribes to respond adequately to the unique challenges they face, said Bohlen.
“Our life expectancy is much less than that of the general population that we have to be able to make the decision that perhaps a 55-year-old man is in fact an elderly man, if you are in a tribe where life expectancy is 58, “Bohlen said.
In the state of Washington, this self-determination also extends to urban indigenous health centers.
The Seattle Indian Health Board, a community health center specializing in the care of American Indians and Alaskan Natives, opened vaccines for American Indians and Alaskan Natives aged 55 or older at the beginning of its distribution plan. This ensured that they could protect all the elderly served by their program of elders, many of whom are homeless, said CEO Esther Lucero.
“Sometimes, this is the only place where they get a hot meal or social interaction or don’t have to go out in a really bad climate,” she said, referring to the place where the program’s elders meet. “So that was very important for us.”
Since February 1, the organization has opened consultations for everyone aged 50 and over, native or not.
This health system is owned by its people
Having successfully inoculated some of their most vulnerable populations, some tribal health providers are now opening consultations for even the youngest and relatively healthy natives – groups that would otherwise be probably months away from receiving the vaccine.
The Southcentral Foundation, a regional health organization owned and operated by the local native community in south-central Alaska, offered its first vaccines to frontline and indigenous health professionals aged 85 and over. After the organization acquired the staff necessary to operate larger vaccination clinics, it quickly expanded its distribution to offer the vaccine to successively younger age groups, said interim president and CEO April Kyle.
It has vaccinated natives aged 16 and over since January 22.
The Southcentral Foundation administered more than 12,000 doses of vaccines as of February 8, according to the health care system. The organization serves some 65,000 Alaska Native and American Indians in Anchorage, Matanuska-Susitna Borough and surrounding rural villages.
The Southcentral Foundation’s success is a credit to its community-owned health model, Kyle said.
Kyle attributes the smooth launch of the organization’s vaccine so far to native peoples in south-central Alaska, who have developed a community-focused health system that, in turn, was able to plan how to get vaccines even for people in challenging terrain .
She is seeing similar results in tribal health systems across the country.
“I am watching the news and I am really impressed by the passion and sophistication of tribal health care and the ways in which communities are able to know how to distribute this vaccine,” she said.
They made big investments in health
The chief chief of the Cherokee nation, Hoskin, has some advice on how the United States can replicate the tribe’s success. But it is not a quick fix.
“We are a country that does not make access to health just part of being a citizen,” he said. “Because of this, there is unequal access to health care across the country. This is a problem during good times and it is certainly a problem during the pandemic.”
Meanwhile, Cherokee Nation has spent the past decade strengthening its healthcare system, which is now the largest tribes-operated healthcare system in the United States, Hoskin said.
“I hope the lesson that people can learn from the success of Cherokee Nation is that you should invest in health during the good times, make it a priority for your nation and make it universally accessible to its citizens,” said Hoskin.
Ultimately, success depends on the country’s vaccine supply
Tribal health care providers interviewed by CNN say they are taking vaccines out the door and in arms shortly after receiving the remittances, which come from the Indigenous Health Service or their state governments.
But whether they can keep their vaccination rates stable ultimately depends on whether the United States can continue to supply vaccines at the speed and volume they need – a challenge that has already dampened efforts for counties and states.
If so, tribal health providers say they will be ready.
“Can the United States follow the Cherokee nation?” Hoskin asked. “That is really the key issue for us.”