Tribal Nations and the Pandemic: What's Worked and What Hasn't

Despite enduring tremendous loss of life during the COVID-19 pandemic, tribal nations have led the way on vaccination, according to witnesses at a hearing Tuesday of the House Subcommittee for Indigenous Peoples of the United States.

"We consider our work with IHS [Indian Health Service] to be a success story," said Rodney Cawston, chair of the Colville Business Council for the Confederated Tribes of the Colville Reservation in Nespelem, Washington.

The IHS-Colville Tribes collaboration led to 40% of those tribes' vulnerable population -- roughly 3,000 patients with underlying health conditions -- receiving a vaccine.

And approximately 850,000 doses have been administered by IHS in Alaska as of March 22, said William Smith, chair and Alaska Area representative for the National Indian Health Board. In some communities, vaccination rates for seniors have even reached 90%, he said. Alaska was the first state to open vaccine eligibility to anyone over age 16.

Charles Grim, DDS, MHSA, secretary for the Department of Health for the Chickasaw Nation, in Ada, Oklahoma, said over 35,000 vaccines have been administered to Indian and non-Indian people there.

He also noted that because of non-essential business closures early in the pandemic, along with effective screening, testing, and contact tracing, the Chickasaw Nation was able to maintain a 7-day positivity rate that was 50% below the community and the state. The nation also developed the "Chickasaw Caring Cottages" where individuals who contracted COVID-19 could self-isolate.

Urban-Area Delays

Despite these successes, some American Indian and Alaska Natives, particularly those in urban areas, are still waiting for their shot.

Francys Crevier, who identifies as Algonquin and heads the National Council of Urban Indian Health in Washington, said that some Urban Indian Organizations (UIOs) have been "very impressed" by their "Area Office" -- one of a dozen regional offices under the IHS umbrella that serve a specific geographic area of the country -- and its ability to distribute vaccines.

Still, "some of our people are actually flying back to the reservation to get the vaccine," stated Crevier, who said she personally is weighing the risk of air travel in order to get vaccinated.

One reason for the delayed distribution to urban Indian groups was communication problems between UIOs and federal agencies, such as the Department of Health and Human Services.

For instance, the deadline for deciding whether to a receive a vaccine from IHS or the state was not clearly communicated to UIOs on a national level, Crevier explained in her written testimony. Some UIOs learned of the deadline from the regional offices, but because there was no "national communication" from HHS, many UIOs weren't aware of the deadline and "felt rushed" in their selection.

She urged the subcommittee to help ensure that in the future, agencies with jurisdiction over urban Indian health (HHS, CDC) communicate with UIOs directly. Currently, IHS has a policy that only requires it to "confer" with UIOs, she said.

While more vaccine is definitely needed in general for tribal populations, Crevier emphasized that she doesn't want to see doses taken from other tribes and given to UIOs.

Indian Healthcare Challenges

Beyond vaccine rollout, tribal leaders told the subcommittee, which is part of the House Natural Resources Committee, about some of the reasons for the disproportionate number of deaths from COVID-19 among tribal populations. According to a 2020 CDC report, age-adjusted COVID-19-associated mortality among American Indian/Alaska Natives was 1.8 times that among non-Hispanic whites.

Subcommittee Chair Teresa Leger Fernandez (D-N.M.) noted that even a year after the pandemic, "American Indian and Alaska Native populations continue to have the highest COVID-19 infection, hospitalization and death rates in the country."

Adrian Stevens, acting board chair for the National American Indian Housing Council in Irving, New York, explained that in many tribal communities, three or more generations live under the same roof, which makes it "impossible for families to practice safe social distancing."

He also noted that less than 10% of homes on Native American lands have indoor plumbing, according to a 2017 housing assessment report from the Department of Housing and Urban Development, which makes it difficult to engage in basic pandemic safety precautions, such as frequent hand washing.

Lack of funding to meet the healthcare needs of tribal population is a perpetual problem, Crevier stressed. She pointed out that the National Tribal Budget Formulation Workgroup's recommendation for IHS for fiscal year 2022 is a little under $13 billion with approximately $201 million earmarked for urban Indian health versus the current $63 million.

'A Celebrity Bill'

Rep. Don Young (R-Alaska), ranking member of the subcommittee and the House's longest-serving member, recommended that Fernandez collaborate with other members on drafting "a new American Native bill" to respond to tribes' issues with housing, water, sewer, education, transportation, "you name it," he said.

"Make it [an attention-getting] celebrity bill ... so that we can get something really out in front," said Young, who telephoned into the hearing. "Because right now, as I've said before in the past, in my 48 years we do a lot of talking and not much action."

Fernandez told Young, "You could not see all the smiles and nodding heads when you suggested such a historic, comprehensive Native American ... Alaskan and Native Hawaiian bill."

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