The elders lined up outside a one-story Federal Way office building, umbrellas and hoods shielding them from a soft rain. A broad-shouldered man in a red hoodie with black Pasifika patterns and a black mask walked the line greeting his elders while they waited for something everyone is trying to get: the COVID-19 vaccine.

Even in the gathering of 100-plus people, Joseph Seia is hard to ignore. The outspoken 37-year-old can’t afford to be ignored if he wants to help fellow Pacific Islanders, whose suffering during the coronavirus pandemic far outstrips their numbers in Washington, the state with the third-largest population of Native Hawaiians and Pacific Islanders in the nation.

Before the 150 elders were inoculated at the first-in-the-nation pop-up COVID-19 vaccination clinic specifically for Native Hawaiian and Pacific Islanders (NHPI) on Feb. 4, Seia didn’t know one elder in his community who had been vaccinated without his help.

Seia, and others in the NHPI community, knew they had to take action because more than a year after the first case of COVID-19 was confirmed in a Snohomish County man and a year after the nation’s first death, Pacific Islanders are being infected and dying at higher rates than any other group.

Joseph Seia, executive director and founder of the Pacific Islander Community Association of Washington, says the state’s vaccine rollout hasn’t been fair to people with fewer resources. “It’s an equity thing. People don’t have technology,” he says. “The most impacted folks aren’t able to do it.”  
(Erika Schultz / The Seattle Times)
Joseph Seia, executive director and founder of the Pacific Islander Community Association of Washington, says the state’s vaccine rollout hasn’t been fair to people with fewer resources. “It’s an equity thing. People don’t have technology,” he says. “The most impacted folks aren’t able to do it.” (Erika Schultz / The Seattle Times)

Unlike the mass-vaccination clinics across the state that are mostly booked through online appointments, the NHPI clinic put on by the Pacific Islander Community Association of Washington (PICA-WA) at its office and Swedish Hospital was intentionally a low-tech affair.

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There was no race to secure an appointment online. Instead, PICA-WA reached out to Native Hawaiians and Pacific Islanders by phone and social media, registering them when they arrived at the clinic.

“It’s an equity thing. People don’t have technology. People don’t have the time. It’s essentially privileged people that are signing up for these appointments, and the most impacted folks aren’t able to do it,” said Seia, PICA-WA’s founder and executive director. “They have to rely on their family to do that for them.”

The coronavirus pandemic has touched every corner of the globe, yet not all people are experiencing the same pandemic. 

The numbers tell the devastating story. Native Hawaiians and Pacific Islanders make up about 1% of Washington state’s population but account for 2% of cases in the state, according to the state Department of Health (DOH).

Native Hawaiians and Pacific Islanders have the highest average case rate of any race and ethnicity in the state at 7,132 per 100,000 people and also lead in deaths per 100,000 with an average of 151 as of Feb. 21, according to the UCLA Center for Health Policy Research.

Va’eomatoka Valu, left, and Joseph Seia, second from left, welcome people in line at the COVID-19 Pacific Islander community vaccination clinic with Swedish in Federal Way on Feb. 4. “Clinics are life and death for our community, given the lack of access of the vaccine for our BIPOC [Black, Indigenous and people of color] communities,” says Seia. “It’s unacceptable to be essentially erased from the implementation phase of vaccinations.” (Erika Schultz / The Seattle Times)
Va’eomatoka Valu, left, and Joseph Seia, second from left, welcome people in line at the COVID-19 Pacific Islander community vaccination clinic with Swedish in Federal Way on Feb. 4. “Clinics are life and death for our community, given the lack of access of the vaccine for our BIPOC [Black, Indigenous and people of color] communities,” says Seia. “It’s unacceptable to be essentially erased from the implementation phase of vaccinations.” (Erika Schultz / The Seattle Times)
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Herema Pouono has spent the past year preaching the importance of taking preventive measures like wearing masks and social distancing, even though those actions were counter to the tightknit and warm services run by her and her husband at the Malua Samoan Congregational Christian Church in Kent.

The Pouonos moved services online last spring and after stay-home orders were eased began holding outdoor services under a tent. She said, no cases of COVID-19 were traced back to the church gatherings.

Despite Pouono practicing the precautions she has taken and urged others to take, COVID-19 still found her family. Her mother and father in Southern California were both hospitalized Dec. 28. Her mother lived. Her father, Liki Tiatia, died Jan. 8, six days shy of his 73 birthday.

“It gutted me deeply because I was able to keep thousands of people safe here in Seattle. Yet I couldn’t do anything to save my dad,” she said.

His death is all the more painful, Pouono says, because Tiatia — who was the Reverend Elder at the Dominguez Samoan Congregational Christian Church in Compton, California — was eligible to be vaccinated but wasn’t able to do so before getting sick. Her mother, who is home and recovering, is set to be vaccinated in April.

The uneven vaccination of Pacific Islanders is evident within Pouono’s family. Her sister and brother-in-law, with whom Pouono’s parents had been living, also contracted COVID-19. So Pouono was vaccinated as a caregiver at Swedish’s Seattle University clinic before going to take care of her mother.

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In many parts of the country you don’t even have the data. For the most part, they go invisible to public health departments just because they’re a difficult population to gather data from using conventional surveillance techniques.”

The pandemic has surfaced the poor health outcomes Native Hawaiians and Pacific Islanders have long dealt with. The disparate penetration of COVID-19 in the Pacific Islander community doesn’t surprise Dr. Raynald Samoa. The endocrinologist and former resident of Parkland, Pierce County, now lives in San Diego and works at City of Hope, a cancer hospital.

The NHPI community suffers from high rates of chronic issues like diabetes and heart disease. These health disparities are difficult to address because NHPI health, employment and other social determinant data was for years lumped in with Asian Americans or wasn’t collected, Samoa said.

“One of the things that has really plagued the community is the fact that we know these things happen, but we don’t know that well,” Samoa said. “In many parts of the country you don’t even have the data. For the most part, they go invisible to public health departments just because they’re a difficult population to gather data from using conventional surveillance techniques.”

In 1997, the federal government mandated that data on Native Hawaiians and Pacific Islanders be disaggregated from Asian Americans, two groups with wildly different histories and health care needs. It has been a slow process that is starting to be sorted out now that NHPI organizations have had time to form, grow and seek out resources that had been going to Asian American organizations, Seia said.

Pacific Islanders, also known as Pasifika people, come from or are living in Polynesia, Micronesia and Melanesia in the South Pacific Ocean.

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Collecting discrete data about NHPI might be a federal mandate, but the group was omitted from President Biden’s COVID-19 plan — an omission that rankles Seia, who, along with the National Native Hawaiian & Pacific Islander Policy Council, has sent a letter to the White House, the president’s COVID-19 task force, Sen. Patty Murray and Rep. Adam Smith.

The letter requests the COVID-19 Health Equity Task Force to include a Native Hawaiian and a Pacific Islander, and:

  • Disaggregate NHPI data from Asian Americans by subgroup and require all federal agency reports with information about race and ethnicity to at a minimum report independently categorize NHPI.
  • Send federal resources to community-based organizations and coalitions led by the communities hardest hit by COVID-19.

DOH started reaching out to communities of color last fall about vaccinations by funding messaging on media channels and working with organizations headed by and for people of color.

The best way to reach communities suffering from systemic racism in the health care system is to work through organizations like the Marshallese Women’s Association, said Paj Nandi, DOH’s director of community relations and equity.

“We know that community-based organizations are closest to the solutions,” Nandi said. “And we’ve heard from them even before the pandemic that we need to be resourcing them appropriately, because they are the trusted messengers and leaders in their community.”

Proclamations from local and state governments and health care systems about the importance of health equity haven’t translated to the rollout of the vaccine, a number of Black, Indigenous and people of color (BIPOC) community leaders say.

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“We’re in this time — the state and federal governments are focusing on the number of arms they’re getting a shot into when they should be focusing on whose arms,” said Abigail Echo-Hawk, chief research officer for the Seattle Indian Health Board. “If we’re going to end this pandemic, we must first go to those disproportionately impacted, which is people of color predominantly.”

Public Health – Seattle & King County located its mass vaccination sites in Auburn and Kent to reach NHPI and other communities of color that live in large numbers in South King County. But according to data from Public Health as of Feb. 18, Native Hawaiian and Pacific Islander, Black people and Latinos were being vaccinated at much lower rates than white people and Asian Americans at the Kent and Auburn sites.

Seia’s frustration with DOH’s vaccination plan forced him to find a way to get shots into the arms of NHPI elders by working directly with hospitals and local health districts. To do this, he had to find a way around the online registration system that favors people more comfortable with the system.

Besides the Federal Way clinic, PICA-WA organized another in Spokane, where more than 100 elders were vaccinated, and has rented a bus to drive elders from Southwest Washington to Oregon to be vaccinated.

“Clinics are life and death for our community, given the lack of access of the vaccine for our BIPOC communities,” Seia said. “Other BIPOC communities have not been able to have their own vaccine clinics. It’s unacceptable to be essentially erased from the implementation phase of vaccinations. We are seeing how racist this vaccination rollout plan has been.”

Pacific Islander elders are being missed also because many of them live with family as opposed to long-term care facilities or adult family homes where residents were vaccinated.

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“Our elders don’t stay in residential [facilities]. They stay with us,” Seia said. “If that’s your approach, you’re missing my whole community.”

This disconnect is acutely felt in the Marshallese community. The United States used the Marshall Islands as a testing ground for nuclear weapons during the middle of the last century, leaving an environmental and health disaster for the Marshallese. This legacy has left a deep scar of distrust.

To overcome this dubiety toward American systems, some Marshallese have taken it upon themselves to educate their community about the vaccine and how and where to get it.

Social media — Facebook in particular — has become a vital tool for reaching Native Hawaiians and Pacific Islanders. Jiji Jally, president of the Marshallese Women’s Association, is using the platform to educate her fellow Marshallese who use Facebook Messenger to speak with friends and family in the Marshall Islands.

Marshallese Women’s Association president Jiji Jally, left, interprets medical information for Bokai Mokin at the COVID-19 Pacific Islander vaccination clinic with Swedish in Federal Way on Feb. 4. The night before, Mokin shared about her fears of needles and coming alone. Jally says it’s important to have culturally tailored care and to help elders with vaccinations because there is mistrust of U.S. government due to nuclear testing in the Marshall Islands. (Erika Schultz / The Seattle Times)
Marshallese Women’s Association president Jiji Jally, left, interprets medical information for Bokai Mokin at the COVID-19 Pacific Islander vaccination clinic with Swedish in Federal Way on Feb. 4. The night before, Mokin shared about her fears of needles and coming alone. Jally says it’s important to have culturally tailored care and to help elders with vaccinations because there is mistrust of U.S. government due to nuclear testing in the Marshall Islands. (Erika Schultz / The Seattle Times)

Jally reached out to as many people as she could leading up to the Federal Way clinic, gathering phone numbers so she can reach people about future vaccine clinics geared toward Pacific Islanders.

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“Everyone is a lot more comfortable with familiarity,” Jally said. “They’re more comfortable with people they know and faces they are familiar with.”

It was clear to many in the NHPI community, which stretches from the South Pacific Ocean to the mainland, that they needed to simultaneously make enough noise to be seen and take care of their own.

On a national level, PICA-WA formed the National Pacific Islander COVID-19 Response Team with other Pacific Islander organizations that advocate for health care, testing and vaccinations. 

Closer to home, PICA-WA, through its five Washington chapters, is distributing food and other support, such as $500 to help families that have lost loved ones.

“That is one of the things that we continue to think about … how do we honor those that have passed during the pandemic? Our elders have so many stories, so much knowledge and they’re essentially the wisdom keepers of our culture,” Seia said.

Seattle Times staff photographer Erika Schultz and staff reporter Evan Bush contributed to this story.