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Indian Health Services Is an Unsung Hero of the COVID-19 Vaccine Rollout

Navajo vaccine

Micah Garen / Getty Images

Key Takeaways

  • Indian Health Services (IHS) receives COVID-19 vaccine allocation separately from state allocation in most cases.
  • Some IHS areas are outpacing states when it comes to vaccine rollout in the regions they serve.
  • IHS attributes its success to autonomy from state eligibility requirements, good communication and messaging, and eliminating barriers to vaccine access. 
  • Public health experts say IHS’s fast, efficient vaccine rollout teaches key public health lessons for communities.

Some states—like those in the Southwest and across the Great Plains—are leading the nation when it comes to COVID-19 vaccine dose administration, according to Centers for Disease Control and Prevention (CDC) data.

These states also tend to have higher percentages of American Indian and Alaska Natives. One factor that may be contributing to the success in these states is the fast, efficient vaccine rollout by Indian Health Services (IHS). 

“We wanted to be sure we had a very equitable distribution,” Cmdr. Kailee Fretland, PharmD, deputy lead of IHS Vaccine Task Force, tells Verywell. “And I think there are a lot of things that are really helping us.”

IHS and Vaccine Allocation

IHS, an agency within the U.S. Department of Health and Human Services, is responsible for providing federal health services to 2.6 million American Indians and Alaska Natives who belong to 574 federally recognized tribes in 37 states. However, American Indians and Alaska Natives are citizens of the United States and can participate in any public health programs available to the general population.

When determining vaccine allocation to states and jurisdictions, the U.S. Department of Health and Human Services gave tribal health programs and Urban Indian Organizations (UIOs) an option. They could either receive vaccine allocation through their state or through their IHS area. 

“IHS is broken up into 12 geographical areas,” Fretland explains. Currently, she says 348 facilities are receiving their vaccine doses from 11 of the 12 IHS geographical areas. All of the Alaska-area tribes opted for state-based allocation.

The 11 regions then determined a population-based vaccine allocation for the 340-plus vaccine facility distribution lists among them, Fretland says. Those facilities either get a direct shipment of vaccine each week or the vaccine is distributed to those facilities once the at-large IHS region receives its shipment. 

A Look at IHS Success by Area

Even though most of IHS isn’t receiving doses from state allocations, IHS vaccine data is still included in the COVID-19 vaccine CDC data for each state, Fretland says. For example, the IHS Bemidji area, which spans several states, reports vaccine data to the state where a specific vaccine site is located. 

So are IHS numbers behind some of the faster rollout seen with states outpacing the rest of the country? “It may be a driver,” Fretland says, “but I don’t know if we can make that conclusion.”

According to CDC data, IHS has fully vaccinated 11% of its population, just slightly more than the 9.9% of people fully vaccinated across the U.S. as a whole. Those percentages don’t show a huge difference. But a look at specific IHS areas shows a different picture when compared to individual states. 

Three IHS areas that have trended toward administering about 80% of their doses every single week are Bemidji, Billings, and Albuquerque, Fretland says.  

Bemidji

The Bemidji IHS area serves American Indians and Alaska Natives in Minnesota, among other states. Minnesota vaccine data shows two counties outpacing the rest of the state. Mahnomen County is home to people in the White Earth Band of Chippewa Indians of Minnesota. And Cook County is home to populations of Chippewa (Ojibwe), as well. In Mahnomen, 37% of the population has received at least one vaccine dose; and in Cook, 44%.

Billings

The Billings IHS area serves more than 70,000 American Indians and Alaska Natives in Wyoming and Montana. State of Montana vaccine data shows counties where vaccination rates are outperforming others. Those frontrunner counties tend to coincide with places of higher concentrations of Crow Nation, Northern Cheyenne Tribe, Blackfeet Nation, Confederated Salish and Kootenai Tribes, Assiniboine (or Nakoda) and Gros Ventre peoples.

Albuquerque 

The Albuquerque IHS area serves 27 different tribal groups across four Southwest states. New Mexico data shows that 18% of American Indians and Alaska Natives in the state have been vaccinated, leading all other race and ethnicity categories.

Factors in IHS Fast, Efficient Vaccine Rollout

In addition to having their own vaccine allocation (if elected), tribal health programs and UIOs have sovereignty from state eligibility lists. This has been another factor Fretland attributes to IHS’s overall success. 

“All of our facilities at the local level can determine who their priority populations are,” she explains. “When you get your tribal elders getting the vaccine first, that really gets out that positive messaging. That piece helped quite a bit.”

IHS has also been offering many ways for people to get their vaccine doses, including employing mobile clinics, using local gymnasiums as vaccine sites, hosting drive-through events, and even offering home visits. “There’s no magical event,” she says, “but a whole variety.” 

The variety may actually be the magic. The less time it takes, and the more barriers removed, Fretland explains, the easier it is for someone to get a vaccine. And that helps make for a smoother rollout. She credits open events as a big help. After a year of getting creative with removing barriers to COVID-19 testing, IHS was poised to offer accessible options for vaccination, she adds.

Others agree that IHS has shined throughout the public health crisis. “A cultural, all-hands approach and vaccine messaging have propelled Indian Health Services (IHS) to be a beacon of hope during the COVID-19 pandemic,” Harley Jones, MA, senior manager of domestic emergency response for Project HOPE, tells Verywell. “IHS began vaccine preparation early on, creating an emergency response system to oversee their rollout, and they involved everyone.”

Project HOPE partnered with IHS to provide pandemic support to the Navajo Nation. Volunteers with the organization have been helping the Navajo IHS area, which serves over 244,000 American Indians across Arizona, New Mexico, and Utah, with vaccine rollout. 

Jones says the Navajo Nation community is now fairly close to having its entire eligible population vaccinated, a testament to IHS. “IHS has focused on listening to experts, fighting misinformation, building trust with all residents, and showing leadership from the top,” he adds.

Harley Jones, MA

IHS began vaccine preparation early on, creating an emergency response system to oversee their rollout, and they involved everyone.

— Harley Jones, MA

Learning From IHS

IHS’s fast and efficient COVID-19 vaccine rollout offers several key public health lessons, according to Jagdish Khubchandani, PhD, a professor of public health at New Mexico State University.

First, good communication and trust matters. “Global health crises are, in part, communication crises,” Khubchandani tells Verywell. “Throughout the pandemic, a key area where societies worldwide failed to do well was effective communication and efficient coordination of efforts.” 

Second, when community members serve as leaders, that helps create a collective sense of community responsibility. “People in the communities of American Indians and Alaska Natives have a lot of say, stake, and ownership of health clinics and systems,” Khubchandani explains. “This has given them the ability to quickly communicate messages and vaccinate people.”

Looking to the future, Fretland says she hopes the lessons learned during the pandemic and the evolution that’s occurred with telemedicine help to provide advances and improvements in health care for tribal communities and beyond. “I hope we have a renewed sense of community and togetherness,” she says. “When we partner as a tribe and as a community, that’s really when we’re seeing success.”

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.

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