How Indigenous communities are leading the way in COVID-19 vaccination rates

Overcoming significant challenges, American Indian and Alaska Native (AI/AN) communities enacted a swift, innovative, inclusive, and community-driven approach to rolling out the COVID-19 vaccination, and there’s a lot to be learned from their methods. A perspective penned by two University of New Mexico (UNM) faculty members and recently published in the New England Journal of Medicine explains the effectiveness of Indigenous communities’ response.

“In the vaccination process we’ve seen what happens when communities are empowered to lead and exert their own perspectives in terms of how they respond to crisis,” explained Raymond Foxworth, visiting scholar in the UNM Department of Political Science. “We’ve seen some great things in terms of vaccination programs in Indigenous communities.”

Foxworth teamed up with Gabriel Sanchez (political science faculty and director of the UNM Center for Social Policy) and co-authors from the University of North Dakota, Yale University, Harvard Medical School, and the University of Miami to write the perspective. Foxworth and Sanchez hope their collective scholarship can help Native communities sustain their high vaccination rates during the continued and collective battle against COVID-19.

“The reality is Native communities continued to be resilient, practice their customs and traditions, and see the value of community. Those are great assets that they’ve been able to leverage in their response to the COVID-19 pandemic.” – Raymond Foxworth, UNM visiting scholar

According to the CDC, COVID-19 has had a disproportionate impact on some racial and ethnic minorities, including AI/AN communities. Health disparities are leading to higher rates of COVID-19 related hospitalization and death among Black/African American, Hispanic/Latino, and AI/AN, making it even more important that these communities be prioritized for vaccination. Foxworth lamented that, unfortunately, ignoring health inequities is par for the course when it comes to how Native communities have been historically treated.

“The history of colonization has conditioned a response from Native communities and that response has always been about community survival, survival of Indigenous languages, world views sovereignty and land rights,” Foxworth reflected.

The COVID-19 pandemic, Foxworth explained, is another iteration of that process of colonialism, another attempt at making make Native communities vulnerable in a systemic and institutional way, through policy and neglect. Much like many states and communities, Indigenous communities received little to no coordinated support from the Federal government at the onset of the pandemic, further deepening this historic divide.

“But the reality is Native communities continued to be resilient, practice their customs and traditions, and see the value of community,” he said. “Those are great assets that they’ve been able to leverage in their response to the COVID-19 pandemic.”

With limited response from the Federal government, especially during the first months of the pandemic, Native communities acted quickly on their own – shutting down borders and limiting access to their sovereign lands. They were early adopters of mask wearing and kept mandates in place longer than neighboring non-Native communities. They enacted strict practices and were innovative in thinking about policy response and ways to keep their communities safe.

Then vaccines became available, and by September 2021, vaccination rates among non-Hispanic AI/ANs were about 14 percent higher than rates among non-Hispanic White persons for first-dose vaccination and 8 percent higher for full vaccination.

Higher-than-average vaccination rates in AI/AN populations have been corroborated by state and county data.

“What we saw in Native communities in terms of the push for vaccinations was a networked response by various kinds of institutions in communities including health centers, non-profits, and other community-based organizations,” Foxworth said. “It was a vibrant ecosystem of response, which has always existed in Native communities, from my perspective.”

COVID-19 messaging focused on protecting elders, knowledge-holders, and Native linguists was particularly effective. It struck a deep chord in the communities who are built on the importance of caring for and protecting their history passed from generation to generation.

“Losing elders, Native language speakers and those holding valuable cultural knowledge was a huge blow. Historically there’s been a targeted policy effort to suppress Indigenous knowledge systems,” Foxworth explained. “And Native communities understood that if we don’t take steps to protect elders and perpetuate our knowledge systems, then we’re going to experience even greater losses from this pandemic.”

Indigenous societies consistently value one another and their most vulnerable. It’s a perspective and historical pattern that has certainly benefitted them and brought a sturdy foundation during the chaotic COVID-19 pandemic.

“Most Native communities always have had structures and practices to keep each other safe and to help one another. So, to me it’s not surprising that we’d see this kind of response from Indian Country because it has been the innate fabric of Indigenous communities and societies. In this context we see it in full display in terms of the level care and compassion taking place in communities while mobilizing those traditional values,” Foxworth concluded.

There is not yet enough data to understand if similar trends will be present in booster vaccine messaging. But Foxworth says when he and other researchers are eagerly awaiting those numbers.