Hundreds of cars wrapped around the Muckleshoot Indian Reservation’s health clinic, where tribal employees and their families lined up Sunday to receive their first doses of the Pfizer-BioNTech COVID-19 vaccination. Music by Lauryn Hill played over a speaker as volunteers in white tents registered patients in their cars.
Lawrence Foulkes, a 32-year-old computer technician and enrolled Muckleshoot Tribal member, received his first dose from the comfort of his car that morning. Though he was nervous, Foulkes got vaccinated to protect his multigenerational household, which has members ranging from 3 to 65 years old.
Native Americans are more willing than the general population to be vaccinated against the coronavirus, primarily out of responsibility to their communities, according to a new report by the Seattle-based Urban Indian Health Institute.
A survey of 1,435 Native Americans across 46 states found that 75% of participants would be willing to receive a vaccine. The findings could help inform public-health campaigns geared toward Native Americans in rural and urban settings, said Abigail Echo-Hawk, director of the institute, which is the research division of the Seattle Indian Health Board.
Still, typical campaigns on coronavirus precautions and vaccination have focused on individual decisions — messaging that does not resonate with Native American communities, even though they often have worse outcomes from the disease, Echo-Hawk said.
“The rest of the nation should be looking at the Native community, the messaging, and community cohesiveness that we have about making these decisions on behalf of an entire community,” Echo-Hawk said.
Indigenous people continue to be disproportionately impacted by the COVID-19 pandemic. According to the Centers for Disease Control and Prevention, Native Americans are 3.5 times more likely to contract COVID-19 and 1.8 times more likely to die from it than white people.
Contributing factors, including asthma and diabetes, are direct results of systemic racism within the health care system, which has led to a high rate of COVID-19 cases within the nation’s Indigenous population, Echo-Hawk said.
“We’re more at risk because we are Native people living in the United States, where we have been experiencing this kind of oppression for the past 500 years,” she said.
She helped spearhead the survey at the end of November after noticing public-health campaigns on the coronavirus vaccine did not include information relevant to Native Americans. The survey was promoted through social media, email lists and tribal organizations throughout the nation.
To help overcome hesitancy, the study recommended public-health officials acknowledge medical harm that has led to skepticism toward vaccines among Native Americans. The forced sterilization of thousands of Indigenous women in the 1960s and 1970s by the Indian Health Service, for example, has stayed with many, said Derrick Belgarde, deputy director of the Chief Seattle Club, an organization that serves Indigenous people experiencing homelessness.
Distrust of the medical system was reflected in the study’s findings, which found 72% of participants wanted evidence about the vaccine’s safety.
Belgarde shares his own journey of overcoming skepticism of the vaccine in an effort to address people’s concerns. On Thursday, he received a second dose at Eagle Village, a Chief Seattle Club-run program that provides transitional housing in Sodo for formerly homeless Native Americans.
Foulkes, from the Muckleshoot Tribe, was hesitant to receive the vaccine because of its potential risks. He waited a month after the Muckleshoot Tribe’s first vaccine drive in mid-December to see if anyone complained of adverse reactions, and he concluded that the potential benefit outweighed the risks.
His family cited biological warfare against Indigenous people throughout history as their reason for distrusting the vaccine. He quelled his family’s concerns by reminding them of the supply shortage.
“There’s a lot of people that want this vaccine. There’s a lot of people that can’t get it, and that says something about the vaccine itself,” Foulkes said.
After receiving a vaccination, Foulkes put on a reflective vest and volunteered to direct people through the drive-thru clinic for the remainder of the afternoon.
Nearly 3,000 doses of the Pfizer-BioNTech vaccine were administered over the weekend at the Muckleshoot Health and Wellness Center. It followed a similar drive on the reservation from Dec. 18-20 for elders and enrolled members. Second doses were administered throughout January. Since Jan. 13, the tribe has offered the Moderna vaccine to enrolled Muckleshoot Tribal members and federally recognized Native Americans in King County on Wednesday afternoons.
The tribe needed to be creative in education and outreach to ensure that all members were aware of coronavirus precautions and the benefit of being vaccinated, said Donny Stevenson, vice chairman of the Muckleshoot Indian Tribe. Digital newsletters were emailed to members, and elders were given paper copies during free-lunch deliveries. A video made by high-school students posted on Facebook encouraged people to wear masks, and Zoom meetings by Tribal members and health professionals informed the community about the vaccine.
“We look to take care of people,” Stevenson said. “Generosity is a very important attribute in terms of who we are as a traditional people. That’s how we measured wealth.”
Because of the Tribe’s mask mandates and stay-at-home orders early on, Stevenson said the Muckleshoot Tribe did not experience high rates of infection and death.
Seattle Indian Health Board was the first organization in Washington to receive doses of the Moderna vaccine for distribution, CEO Esther Lucero said.
Starting in December, the board’s staff and health care providers were vaccinated, followed by those in partner organizations that serve the local Native American community, such as the Chief Seattle Club. Then vaccinations were rolled out to Native Americans over 55 who were in the health board’s database.
In Indigenous communities where fewer than 10 fluent language speakers remain, the loss of an elder would have a widespread impact for an entire tribe, Echo-Hawk said.
“Our elders are our culture keepers, they’re our language speakers,” Lucero said. “We really have to preserve our cultural epistemologies and our Indigenous ways of knowing and being.”
The Seattle Indian Health Board also vaccinated influential Native American leaders to help encourage widespread vaccination. Lucero, for instance, was the first person to be vaccinated within the local Indigenous community. Native American staff and health care providers were encouraged to share the effects of the first and second dose to address concerns about the vaccine.
Other barriers to accessing the vaccine within the Native American community includes organizational resources. The Seattle Indian Health Board has hired additional staff to field up to 3,000 phone calls a day, which increased from about 6,000 phone calls a week before the vaccine rollout. Another challenge is the ability to vaccinate entire families, particularly ones with non-Native members or those in multigenerational households.
As a result, the health board will announce Monday that the vaccine will be available to anyone 50 and older, regardless of ethnicity. The organization had vaccinated 1,400 people as of Wednesday.
The organization’s survey and vaccination rollout is a model for a community-centered approach to vaccine distribution, Lucero said. She hopes the information gathered for the report influences the way health care agencies distribute vaccines to marginalized communities.
In Belgarde’s eyes, the report shows the significance of the Native American tradition of protecting loved ones.
“We don’t take the vaccine for ourselves,” Belgarde said. “We take it for our community.”
Correction: The article was updated to reflect the accurate percentage of vaccine distrust among Native American survey participants.