The story of COVID-19 is a kaleidoscopic one, shifting in color and shape to reflect each patient’s background. There is no single narrative that describes the pandemic experience. Economics, ideology, and population health all play a role, with much ink and airtime devoted to the nuances driving infection rates and outcomes. The same holds true with the Native American vaccine programs.

Consider the disproportionate impact of COVID-19 on Native American and Alaska Native communities:

Indigenous communities also have a unique relationship with American medical institutions. Dennis Yi Tenen, a Columbia University professor who studies COVID-19 vaccine hesitancy, found people decline vaccines for several reasons – including problematic experiences with the medical community. Native Americans and Alaskan Natives have a long and ugly history of unethical medical practices and violations at the hands of the U.S. government, such as when Dr. Connie Pinkerton-Uri found that one in four Native American women had been sterilized without consent. These communities have every reason to be wary of new government medical programs.

So odds are the COVID-19 vaccine rollout in Indian Country has gone poorly – right? Wrong. So far it’s been an impressive success story. And the reasons hold valuable lessons for everyone working in healthcare today.

The Need for a Culturally Informed Approach

Because they are treated as sovereign nations, American Indians and Alaska Native tribes receive their own vaccine shipments, with the choice of receiving the vaccines through Indian Health Services (IHS) or the state. Like every other nation, their rollout success isn’t just about arranging distribution; reluctance to get the vaccine can also present a stumbling block. But many tribes have fostered high enthusiasm and efficiency in their communities.

Take the Rosebud IHS in South Dakota, which launched their vaccine program on Martin Luther King Day for the Rosebud Sioux Tribe. They exceeded their goal the first day and vaccinated 10% of their entire target goal within just a few days. A similar success story happened at the Bay Area Indian Health Center in California’s Santa Clara Valley. Like Rosebud, local tribes chose to receive vaccines from the IHS rather than the states – and even initially skeptical members scheduled vaccinations.

The reason their rollouts are going so much better than other areas? Their leadership understood the importance of transparency, authenticity and clinician diversity. Here’s how that played out:

  1. Extensive outreach from the tribe. Rodney Bordeaux, President of the Rosebud Sioux Tribe, said the tribe educates people about COVID-19 and the vaccine through social media, the tribe’s cable TV channel and 2 local radio stations. It’s important these messages come from the tribe itself; a Northeastern University study found that indigenous people are more likely to rely on trusted voices within their own communities for information about the pandemic and the vaccine. 
  2. Leveraging the influence of respected elders. The Native American emphasis on respect for elders has motivated many communities to listen to their advice. When the Prairie Island tribal community in southeastern Minnesota hosted a Zoom meeting with tribal council members and Prairie Island Health Center’s primary doctor to answer vaccine questions, local elders played a prominent role in the discussion.
  3. Emphasis on communal benefit. Throughout the U.S., public health vaccine campaigns tend to feature messages based on individual benefit and protection. But tribal members respond to messages about protecting their children, elders and community well-being. By positioning the vaccine as a step toward benefitting Indian Country, leaders have inspired active participation.
  4. Micro-targeting. Instead of a one-size-fits-all approach, tribal health leaders tailor their Native American vaccine campaigns. The Cocopah Indian Tribe in Arizona sent out a 10-question survey to tribal members in December. They designed the survey to help leaders understand any existing stigma around the vaccine and dissolve misunderstandings. About half of the respondents were willing to take the vaccine; the other half indicated they would like to ask questions first. Now the tribe has designed social media messaging to answer those questions.
  5. Counseling and support. The Flandreau Santee tribe in Sioux Falls, South Dakota works with a team of mental health therapists to both deal with pandemic stress and talk about the vaccines. Each patient can ask questions, express their thoughts and misgivings, and receive transparent information about the vaccination process.

Valuable Lessons for Public and Native Health

In many ways, the story of COVID-19 vaccines in Indian Country is the story of Indigenous health. Systemic barriers still hold; but efforts to entwine cultural intelligence with the work of physicians, researchers and epidemiologists, and the push to increase clinician and administrative diversity, are creating real transformation. Tribal leaders are deftly navigating their community health dynamics for successful program outcomes. These strategies hold vast potential for the future of Indian Country – and offer lessons in communication to everyone working in public health.