Nespelem, Okanogan County — Michele Thomas’ husband has had the same frustrating experience that many have had trying to get a COVID-19 vaccine: calling and calling his local health district in search of an appointment, and coming up empty.
Thomas, on the other hand, hasn’t had to lift a finger.
The 65-year-old’s phone rang one day last month, with an invitation to get inoculated. And at noon Wednesday, she arrived at the Nespelem Health Center to get her second and final dose of the Moderna vaccine.
The reason for the stark difference between Thomas’ and her husband’s experience is simple: She is a member of the Confederated Tribes of the Colville Reservation, and he is not.
While health districts across the state have struggled to get and distribute vaccine doses, tribal governments in Eastern Washington have had relative success, despite historical, geographical and technological obstacles.
About 12% of Washington residents had been vaccinated as of Monday, but the number is almost double that on Colville Reservation, where the tribes had inoculated 22% of their nearly 10,000 members as of Wednesday, according to Colleen Cawston, CEO for the Colville Service Unit of Indian Health Services.
And if all continues to go according to plan, Cawston said, the tribes expect to have 80% of their population vaccinated by the end of March, likely granting the Colville tribes herd immunity.
Some other Inland Northwest tribes have also exceeded state vaccination rates.
Health care workers at the Spokane Tribe of Indians’ David C. Wynecoop Memorial Clinic had administered 685 prime doses and 356 booster doses to reservation residents, essential tribal employees and active clinic patients as of last week, said tribal Chairwoman Carol Evans. Those 685 doses account for about 24% of the tribe’s approximately 2,900 enrolled members. The Coeur d’Alene Tribe estimated it would have inoculated about 1,500 people, or 17%, of its 9,000-person reservation population by the end of this week, according to Tyrel Stevenson, the tribe’s legislative director.
The relatively rapid distribution of the vaccine — and the promise of a relatively quick arrival at herd immunity — came as a major relief to Thomas and others making their way through the lobby of the Nespelem clinic Wednesday.
Daniel Stillings, 59, is a tribal member who came from his home off the reservation in Republic to get his first dose of the vaccine. A veteran with diabetes, Stillings said a drive to the Nespelem clinic was his fastest route to immunity.
“I didn’t hear anything about shots in Republic,” he said. “But I was notified I could get it here, so I did.”
Laura Morago, youth services manager for the Colville Tribes Youth Development Program, was also getting her first dose as part of Phase 2B of the tribe’s vaccine distribution plan.
Her organization works with some 2,500 students, 1,700 of them tribal members, who were out of school from the beginning of the pandemic until October, when they began attending in person half of each school day.
“I was incredibly worried about the virus,” said Morago, 34. “It has hit a pretty significant amount of our tribal elders and has been pretty devastating for a lot of our families.”
Across Washington, American Indians and Alaska Natives account for 2% of COVID-19 cases and hospitalizations and 3% of the deaths but only 1% of the total population, according to the state Department of Health.
At the Colville reservation’s clinics, 370 cases have been confirmed since the pandemic began and six residents have died of COVID-19, Cawston said.
The tribes’ effort to control the virus’s spread has been underway since March 13, according to tribal Chairman Rodney Cawston, who is Colleen’s husband.
That date is etched in his memory. It’s when he called an all-staff meeting where tribal employees began laying the groundwork for its response to what he called a “pretty frightening” threat to the tribe. After that, Rodney Cawston said, he and other tribal officials endured a blur of Zoom meetings as they worked to both understand the virus and to keep safe the residents of the 1.4-million-acre reservation.
With information and advice from the Centers for Disease Control and Prevention, Indian Health Service and others, the tribe “mirrored a lot of what the state did” while also deviating in important ways to respond to the particular needs of its population, according to Rodney Cawston.
The Colville tribes conducted random testing in an effort to identify and quarantine asymptomatic residents.
To encourage distancing and support isolated residents, the tribe distributed drop boxes to those who contracted the virus, bringing essential supplies like cleaning products and oximeters to their sometimes remote doorsteps.
To reduce transmission, the tribes shut down off-reservation travel for staff and closed the reservation to nonessential travel for a period of time. But the success in slowing the virus’s spread on the reservation came at a cost, Rodney Cawston said.
While much of the country kept work, school and social life alive in some fashion by moving it online, that was far harder to do on a reservation where broadband internet doesn’t exist and “a lot of our community doesn’t have internet” at all, he said.
That posed “huge challenges” for students, he said. Some parents resorted to “driving around with a cellphone” in search of a connection strong enough for their children to access materials for school, Rodney Cawston said.
The result, he said, is some kids “who are very depressed” due to their disconnection.
Internet access issues also complicated other initiatives designed to limit transmission, like telemedicine and remote work.
And some things — like food and a human connection — simply can’t be provided online, even if internet is available.
On a reservation with “very high unemployment,” Rodney Cawston said, the tribes also play an important role in meeting the nutritional needs of many people. And with the pandemic-induced slowdown that affected economies everywhere, those needs only grew.
To get people essential supplies, the tribes scheduled staff to drop their usual line of work and spend their time meeting the needs of residents, however they could.
Not that that was always possible.
“One of the biggest challenges we had is our people are very social,” Rodney Cawston said.
Some of that social interaction, he said, occurs as part of spiritual and religious activities that people “could just no longer” take part in.
Amid all of those ongoing challenges, others have flared up, too, like the fires that roared across the reservation this summer, displacing a significant number of reservation residents and compromising their ability to socially distance.
When the tribes found out in mid-October that vaccine delivery was imminent and they should begin preparing to distribute it, they faced other challenges, like how to get it and how to deliver it.
While most health districts receive their doses through the state, the tribes had the option of receiving it directly from the federally operated Indian Health Service.
The Colville tribes decided to do so, receiving their first doses on Dec. 28, 10 days after the first vaccine was administered in Spokane.
A day later, the tribes gave their first doses to elderly residents of the Colville Tribal Convalescent Center. After administering shots to the center’s residents and staff, the tribal government moved to vaccinate the residents of the tribes’ detention center.
Since then, the tribes have been working through a three-phase plan, with the first two phases broken into A and B categories. Those receiving their first doses Wednesday morning belonged to Phase 2B. Those receiving their second doses just after noon were from Phase 1B. Only Phase 3 — for healthy adolescents and adults under age 65 — has yet to begin.
Colleen Cawston said the tribes have stuck to a “pretty aggressive process,” including mass vaccination events at its four clinics.
“We’re really pushing high numbers every day, so we can get to herd immunity as quickly as possible,” she said.
She said it’s important that those giving the shots belong to the community they’re serving. The goal, she said, is “to ensure our people are cared for and they’re provided for by tribal members.”
That can help overcome hesitancy in a population that has historically been subject to a host of well-documented medical abuses, including from the federal government and Indian Health Service now supplying the COVID-19 vaccine.
Colleen Cawston said history contributes to some wariness among tribal members. Even a fraction of the Colville Service Unit’s staff have decided to wait to get inoculated, she said. While she said administrators “respect” the decision to defer inoculation, they also try to inform people about the vaccine’s safety.
Ultimately, she and Rodney Cawston agreed the tribes can overcome this challenge — and the many others — that the tribes have faced since the pandemic began.
“We know our own people. … We know our own communities,” Rodney Cawston said. “And I think we’re in the best position to make those decisions for ourselves.”