How a legacy of colonialism hinders vaccination efforts in Indigenous communities

By Soham Govande

Today, hopes are held high that the COVID-19 vaccine will gradually bring an end to the pandemic. Due to systemic health disparities, disadvantaged groups such as Indigenous peoples have especially suffered this past year—both biologically and culturally. Hence, vaccination efforts in these communities must be successful to prevent further damage. Yet, the lack of trust between Indigenous communities and governmental programs stands as a significant challenge to overcome.

Health Disparities in Indigenous Communities

Why is vaccination so important for Indigenous peoples?

First, health disparities stemming from systemic oppression have placed these communities at a significantly greater risk of infection; a recent CDC report found that tribal members were more than three times more likely to become infected, a figure later found to be an underestimate due to insufficient data. Furthermore, even after infection, Indigenous peoples remain at a greater risk of hospitalization and mortality. One reason for this could be that many reservations suffer from poorer social determinants of public health. For example, the non-nutritious food given by the federal government increases the risk of diabetes and obesity, comorbidities that increase one’s immunological susceptibility to COVID-19. In addition, the lack of potable water and adequate housing on some reservations can create unsanitary conditions and increase one’s exposure to pathogens—in turn, this places Indigenous peoples at a greater risk of sickness.

Yet, there’s a cultural impact just as important as the biological one: as elder tribe members are guardians of language and traditions, their loss would impact the transmission of these cultural elements to younger generations. In an era so deeply influenced by the day-to-day cultural diffusion of media and information, preserving traditional tribal culture is of even greater importance. Thus, it’s clear we need to take whatever steps we can for vaccination efforts to be successful.

A Lack of Trust: The Living Legacy of Colonialism

One challenge to tribal members providing consent to vaccination is that they mistrust Indian Health Service (IHS), the federal agency in charge. Indeed, their worries are supported by a historical legacy of settlers worsening tribal health. For example, in the 1800s, settlers “gifted” tribes blankets infected with smallpox in an effort to eliminate the tribe through the deadly disease. More recently, similar efforts have taken place: in the 1970s, the federal government forcibly sterilized Indigenous women, a modern form of genocide.

Joseph Gone at Harvard’s Native American Program says that tribes feel “sensitized to and wary of government” in turn translating into “acts of mistrust.” Indeed, this lack of trust has manifested tangibly. In a recent vaccination effort in the Navajo community, 50 out of 200 members declined to receive vaccinations. While a 75% consent rate is most likely enough to achieve herd immunity to the virus, a higher rate may help reach herd immunity more quickly.

Solutions and Successes Regarding Tribal Vaccination Efforts

How can we build trust between Indigenous peoples and vaccine providers?

First, local tribal leaders and traditional healers should serve as channels of communication between agencies and tribes—as they have stronger connections with the community, they can communicate in a more effective and culturally-competent way. For example, the Yurok Tribe in California found success by connecting the CCUIH’s vaccine advocacy to their tribal values of protection and duty. This approach is backed by research; a recent study by Northwestern University found that Indigenous peoples are most likely to place trust in voices within their own community, suggesting that doing so is a feasible mechanism to reduce vaccine hesitancy.

Secondly, tribes should increase outreach to tribal members in geographically remote locations, who are more likely to experience vaccine hesitancy. For instance, the Navajo Nation sent public health officials to provide 5,000 vaccines to community members in desert areas of New Mexico, Utah, and Arizona. They found that recipients felt more reassured about the vaccine because the tribe had reached out to them first, mitigating some of the uncertainty they experienced. The Cherokee Nation is experimenting with a similar strategy, deploying single-dose Johnson & Johnson vaccines to members in remote areas.

These examples are indicative of broader national optimism. Thanks to the tireless and proactive efforts of tribal leaders, there have been significant successes in Indigenous vaccination efforts. A national poll by the Urban Indian Health Institute found that 75% of Indigenous respondents were willing to receive a vaccine, much greater than the percentage of white Americans who wanted a vaccine.  Indeed, the Navajo Nation, the Oglala Sioux Tribe, and Alaskan sovereign tribes—as well as countless others across the country—have outpaced both the national rate of vaccination and their respective state departments; some reservations have been so successful that they’ve opened their supply to non-Natives as well. Each success demonstrates that independent tribal initiatives, tailored culturally and geographically, can be more effective than traditional state-run efforts for vaccination.

While modern medicine may advance the horizons of science, addressing societal concerns is just as critical to expanding public health to minorities; by building stronger relationships between our healthcare system and oppressed groups, we can envision a healthier society for all.

Soham Govande is a junior at Round Rock High School, and he hopes to study the intersection between anthropology and public health to expand healthcare access to underprivileged communities. Feel free to reach out to him at sgovande@anthroanalyst.com!