Vaccine Rollout Highlights Tribal Health Programs' Strengths Despite Chronic Underfunding
This is the first in a two-part series about the vaccine rollout in Indian Country. Part two looks at the challenges of vaccinating our region's urban Native population.
On a Saturday morning, it's all hands on deck at Gallup Indian Medical Center. Custodians are directing traffic. Dental and medical assistants are checking in patients. Inside a gymnasium, nurses, pharmacists and physical therapists are administering coronavirus vaccine doses to hundreds of eager patients."Some of these people have been waiting in line for hours. I think the record today was 4 a.m.," says Dr. Jonathan Iralu, a top infectious disease specialist for the federal Indian Health Service and the incident commander for this event in Gallup, New Mexico.
Unlike other segments of the U.S. healthcare system, Iralu says the IHS is very centralized. During the pandemic, that's been the agency's superpower."We do primary care, we do hospital care, and we do public health. All three segments are wedded together," Iralu says. "So, it's fairly easy to shift from primary care mode to public health mode and arrange something like this with the same staff."
The IHS has been in "public health mode" since the start of the pandemic, dedicating much of its staff andother resources to coronavirus testing, contact tracing, and now, vaccination. As of this week, the agency has administered more than 800,000 doses to its patients.
They include 62-year-old Melvin Foster, who's here to get his second shot of the Pfizer vaccine. He says the pandemic has taken a massive toll on his family."Ten relatives of ours have passed," Foster says. "It was hard for us. We had their services graveside. This virus is something that nobody should play with or laugh about. This is a serious issue."
He says he's getting the shot to protect his family.
"Easy poke, now," Foster says, rolling up his sleeve.
"Don't worry, I'll be as gentle as a lamb," says the physical therapist administering his shot.
As he waits out the 15-minute observation period, Foster feels a sense of relief."I've got grandchildren, so I've got to stay here as long as I can with them," he says.
Foster's willingness to get the vaccine, and his motivation, track with the results of a recent survey by the Urban Indian Health Institute. Out of about 1,400 Indigenous respondents representing more than 300 tribes, the survey found that 75% were willing to get the shot."Most reported that they were making this decision for their families, tribes and communities, which is, at its core, a public health decision," says the institute's director, Abigail Echo-Hawk. "Seeing themselves as individuals with a responsibility to the larger community. That's an Indigenous value system."
That value system helps explain the success of Indian Country's vaccine rollout, she says. Plus, IHS and tribally-run facilities are often the only healthcare option on rural reservations, making these hospitals and clinics deeply ingrained in the communities they serve.
"We have these operating public health systems where we know who our community is, we know the barriers they have to accessing services, such as transportation. We know how to reach our people, and we're doing it better than anyone else," Echo-Hawk says. "We just need more resources to be able to protect our entire communities."
The U.S. has a legal responsibility to provide healthcare to Indigenous people, protected by treaty provisions, laws, executive orders and court precedents. Quality healthcare is part of what was offered in exchange for the millions of acres of Indigenous land that now make up the United States.
In spite of that, the IHS is severely and chronically underfunded. The federal government budgeted $6.2 billion for the agency in 2021. That's a fraction of the $48 billion tribal leaders say it would actually take to fully meet their communities' healthcare needs.
And that underfunding has consequences, including disproportionate rates of conditions like heart disease and diabetes among Native people. According to the CDC, Indigenous Americans are more vulnerable to serious COVID-19 illness and death than any other group in America.
"What I'm used to saying is that IHS, our tribal programs, our urban Indian programs do the best they can with the scarce resources they have. I don't want to say that anymore," Echo-Hawk says. "What if they had all the resources they needed? We could possibly be at herd immunity in our tribal communities. And we're already close to getting there without it."
Take the Blackfeet Nation in Montana, where 95% of Native and non-Native adult residents have received at least one vaccine dose, and more than 80% are fully vaccinated.
"So, we have a lot of happy people right now," says Blackfeet tribal spokesman James McNeely. "Grandparents who haven't seen their grandchildren in a long time and what have you.".
He says the rollout has been so successful that the tribe has joined dozens of others in the Mountain West in expanding eligibility to non-Natives in the broader community.
"We have people driving from as far away as Kalispell, Whitefish, Cutbank, Bozeman, all over coming to get the vaccine and we're not turning anyone away," McNeely says.
From the start of the pandemic, tribal governments have been leaders in responding to it. They imposed some of the earliest and strictest lockdowns and stay-at-home orders to slow the spread of the coronavirus, and launched some of the first mass testing programs. Now, as many tribal communities are approaching herd-immunity levels of vaccination, they may well take the lead again, serving as models for how to safely ease into the new normal.
McNeely says the Blackfeet Nation's reopening will be slow and cautious, with restrictions on business operations and large gatherings still in place, and a reservation-wide mask mandate likely to stay on the books for the next two years.
"We're going to take every and all precautions no matter what," McNeely says. "We will still follow the rules that the CDC has set forth for the safety of all of our people."
This story was produced by the Mountain West News Bureau, a collaboration between Wyoming Public Media, Boise State Public Radio in Idaho, KUNR in Nevada, the O'Connor Center for the Rocky Mountain West in Montana, KUNC in Colorado, KUNM in New Mexico, with support from affiliate stations across the region. Funding for the Mountain West News Bureau is provided in part by the Corporation for Public Broadcasting.
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