It seems increasingly likely that a safe and effective novel coronavirus vaccine is coming, even if snags in ongoing trials continue to raise questions about when that might be. But that vaccine may be available last to some of the people who need it most: the roughly one million Native Americans who live in the country’s approximately 500 tribal communities.
Native Americans are more than three times more likely to become infected with SARS-CoV-2, the novel coronavirus, than white Americans, according to the U.S. Centers for Disease Control and Prevention. And in part because they’re more likely to suffer underlying health conditions, they’re also more likely to die of COVID-19 than non-natives.
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What’s more, some Native Americans live on sprawling reservations that depend on underfunded clinics for basic health services. Such clinics may lack the special equipment that could prove crucial to storing and administering top vaccine candidates.
But morbidity and logistical factors aren’t even the biggest challenges indigenous communities face as they plan ahead for a coronavirus vaccine. The biggest problem is trust, experts told The Daily Beast.
Between genocidal wars, broken treaties, and forced relocations, America’s indigenous people have been the victims of centuries of abuse and neglect by the same federal government that is overseeing the development and distribution of a coronavirus vaccine.
The upshot is, many Native Americans don’t trust the government to administer a vaccine and might not volunteer for vaccination even if it were readily available. Some Black communities are also skeptical of government-led immunization efforts, for similar reasons.
“For trust-building to happen, the government needs to be transparent—and needs time to do that,” Jessica Elm, a scientist at the Center for American Indian Health at Johns Hopkins University and a member of the Oneida Nation, told The Daily Beast. “I think it’s going to be a big mess.”
The result could be low vaccination numbers in Native communities—and a continuing high death rate.
There were more than five million Native Americans in the United States as of the 2010 Census. Slightly fewer than one million of them lived on a reservation with its own autonomous government. Reservations and other indigenous communities are often sparsely populated, under-developed, and impoverished compared to non-Native communities.
The poverty rate in the Navajo Nation, which lies at the corner of Arizona, Utah, and New Mexico, is a whopping 43 percent, compared to just 10 percent nationwide. Poverty was a factor when the Navajo suffered a devastating spike in coronavirus infections over the summer. Between March and July, nearly 6,800 Navajo fell sick and 322 died. The infection rate was over 3,500 per 100,000 residents, compared to 3,000 in hard-hit New York City.
Thomas Sequist, a physician at Brigham and Women’s Hospital in Boston and a member of the Taos Pueblo tribe in New Mexico, attributed the high infection rate to poor nutrition and other lifestyle factors, along with the inability of low-wage workers to practice social-distancing.
But he also cited deep mistrust between everyday people and health authorities.
“The rapid spread of COVID among communities of color is not because race or ethnicity is a risk factor for disease spread,” Sequist wrote in The New England Journal of Medicine in July. “Racism—not race—is the risk factor for spread.”
The same factors that allowed coronavirus to spread quickly through the reservations could also weigh on the deployment of a possible vaccine. Reservation clinics count on the federal Indian Health Service for funding.
But IHS budgets are 40 percent below need, according to Nicole Redvers, an assistant professor in the Department of Family & Community Medicine at the University of North Dakota’s School of Medicine & Health Sciences, and a member of the Deninu K’ue First Nation Band. On a per-person basis, federal inmates benefit from higher levels of government health spending than Native Americans, Redvers said.
“This funding shortfall left [clinics] with limited resources to address the coronavirus pandemic,” Francys Crevier, CEO of the National Council of Urban Indian Health, told a U.S. House of Representatives committee in September.
Budget shortfalls mean staffing and equipment shortages at clinics. Meanwhile, the leading vaccine candidates from Pfizer and Moderna are both messenger-RNA vaccines that are chemically unstable and require refrigeration. Cold storage is in short supply at vaccine-distribution sites even in wealthier communities. Reservations are even less well-equipped.
Jay Butler, the Deputy Director for Infectious Diseases at the CDC, told reporters last week that the CDC was working with tribal authorities to “ensure all communities across the U.S. have equal access to a vaccine.” But it’s not clear that coordination is getting results.
In a September presentation, the CDC advised tribal clinics to hold off on trying to acquire refrigerators to facilitate vaccine distribution. “Ultra-cold vaccine may be shipped from the manufacturer in coolers that are packed with dry ice, can store vaccine for an extended period of time, and can be repacked for longer use,” the agency stated.
But of the major vaccine developers, only Pfizer is investing heavily in refrigerated shipping containers. If Moderna or another developer is first to get approval from the U.S. Food and Drug Administration to distribute a vaccine, reservations might not be able to store doses at first. That could delay—by weeks or by months—clinics’ efforts to vaccinate large numbers of reservation residents.
The 2020 Coronavirus Preparedness and Response Supplemental Appropriations Act, one of the federal government’s main vehicles for pandemic relief, set aside $209 million specifically for tribal COVID response. But that funding expires in December, potentially before the FDA approves a vaccine, and before health authorities know exactly what they need to do to prepare.
Refrigerators could be the least of the clinics’ problems. It won’t matter how much vaccine a tribal clinic can keep on ice if no one wants to get dosed. “Uptake”—that is, the rate at which a community gets any given vaccine—was low in Native American communities even before the Trump administration began pressuring the FDA to release a possibly untested vaccine.
One 2008 study found that 58 percent of older Native Americans received a pneumonia vaccine, compared wi 67 percent of non-Hispanic whites. Indigenous communities also have a lower uptake of the flu vaccine, according to Redvers.
Elm, for one, predicted that many in her own community would reject a vaccine. “I would say that we would reach herd immunity before people would have trust in a vaccine,” she told The Daily Beast.
But at least 40 percent of a population has to catch a disease before that population can achieve herd immunity. If Native American communities can’t or won’t get vaccinated against the coronavirus, a lot of people could get sick.
Elm was more stark about what could happen next. “A lot of people will die.”
