The pandemic has consistently exposed the underlying inequities and effects of systemic racism on American Indian (AI) and other marginalized communities.
The health equity challenge of 2021 is around COVID-19 vaccine equity. Over the first months since the vaccine has become available, communities of color are not getting shots in the arm at the same rates as are white Americans.
Kaiser Family Foundation summarized recently, “There is a largely consistent pattern of Black and Hispanic people receiving smaller shares of vaccinations compared to their shares of cases and deaths and compared to their shares of the total population.”
Data availability is an issue as well – CDC reports that race/ethnicity is known for only 55% of vaccines given to this point.
COVID-19 and American Indian Communities
Here in New Mexico, a state where 11% of the population are American Indian (AI), 58% of COVID-19 cases statewide were amongst AI in the early months of the pandemic. The CDC reported national rates of infection being 3.4 times higher among AIs, with mortality rates 1.8 times higher than non-Hispanic whites. CDC noted:
Long-standing inequities in public funding; infrastructure; and access to health care, education, stable housing, healthy foods, and insurance coverage have contributed to health disparities (including higher prevalences of smoking, obesity, diabetes, and cardiovascular disease) that put indigenous peoples at higher risk for severe COVID-19–associated illness.
Historical trauma and systemic inequities affecting American Indian vaccine rates
Trying to break through those statistics, I share the story of an American Indian health professional, a colleague of mine. She shares “I am a 4th generation boarding school graduate.” What does this have to do with the COVID-19 vaccine?
Written out of our history books for the most part, the US government has treated American Indian Tribes with policies that the United Nations would label as genocide. The boarding schools, set up by missionaries in conjunction with the US government infamously pronounced “Kill the Indian, Save the Man” as their motto. The goal was to rid AI children of their Indigenous language and culture, assimilating them and in the process “saving” them.
Now, we ask these same communities who carry direct and historical trauma to accept that the US government, who wants them to accept a shot in the arm, has pure intentions in doing so.
Here, we must be careful about adopting a blame-the-victim stance. First, when we look at the inequities in vaccine uptake, vaccine hesitancy is an issue, especially in some communities.
But the data suggests that a larger component are the systemic inequities making it harder for AI and communities of color to access the vaccine. On the Navajo Nation, for example, running water is still not in 1 of 3 homes. Access to technology, including computers and internet access needed to sign up for vaccines, lag far behind the US population. Persistent high rates of poverty and unemployment may pose a more immediate risk to a given family than COVID-19, influencing their decisions around pursuing the vaccine.
Using strengths of American Indian communities to guide vaccine efforts
The Urban Indian Health Institute (UIHI) conducted a survey with 1,435 American Indians and Alaska Natives across the United States, with participants representing 318 different tribes across 46 states. They found that 75% were willing to receive the COVID-19 vaccine, higher than Pew Research Center reports of the general US population of 60% for the same question.
UIHI notes, “The primary motivation for participants who indicated willingness to get vaccinated was a strong sense of responsibility to protect the Native community and preserve cultural ways.”
Their report includes six recommendations that similarly focus on the strength of AI social networks and a strong sense of responsibility to one another. Included in UIHI’s guidance is a recommendation to have trusted local health entities guide vaccine efforts. This will require states using a centralized vaccine approach to become flexibly decentralized in the case of AI communities.
We cannot reverse the disproportionate effect of COVID-19 on communities of color in this last year. However, if we take a strength-based approach to vaccinating these same communities, we can get it right in terms of vaccine equity. Let’s make it so.
