NCUIH in the News: Practical hurdles, cultural distrust in Native communities could hamper vaccine distribution

Meredith Raimondi, the director of communications at the National Council of Urban Indian Health, said the consequences could be dire: “A big concern is that you make the wrong decision, and you choose the state, or you choose IHS and then one of those doesn’t go according to plan and you have no vaccines. I mean, it’s a gamble at this point.”

Cold-chain and two-dose requirements for promising vaccine candidates pose serious challenges for Native American communities without reliable electricity or transportation.

On the Hopi Nation in northeastern Arizona, the remote nature of its communities and transportation obstacles present logistical challenges to the tribe’s pandemic response. Here, homes line the top of the village of Shungopavi, one of three villages on Hopi’s Second Mesa. Hopi Tribe

When Timothy Nuvangyaoma, chairman of the Hopi Tribe, heard there were two coronavirus vaccines that both showed promising data of more than 90 percent efficacy, he felt initial relief that soon transitioned to cautious skepticism.

That’s because the logistic and cultural challenges of delivering a Covid-19 vaccine with precise temperature requirements and two-dose administration to members of the Hopi Tribe are vast: Hopi often live in remote locations and only one-third of the population has reliable means of transportation, according to officials with knowledge of vaccine distribution planning. Hopi lands span more than 1.5 million acres and encompass parts of both Coconino and Navajo counties in northeastern Arizona.

Power supply is always a concern, brownouts are common, and generators are a luxury. The Hopi Health Care Center has to outsource much of its care.

Full coverage of the coronavirus outbreak

Meanwhile, the Pfizer vaccine requires transportation at minus 94 degrees Fahrenheit and must be ordered in units with a minimum of 1,000 doses. And while this week’s preliminary results from biotech company Moderna Inc. showed encouraging data that its candidate was 94.5 percent effective, that vaccine still requires long-term storage at sub-zero freezer temperatures, short-term storage in a refrigerator and a two-dose administration separated by multiple weeks.

Other options progressing through the pipeline aren’t as finicky; one of the Johnson & Johnson candidates, for example, has a one-dose regimen and is expected to remain stable at basic refrigerator temperatures for longer periods of time.

Added to the logistical challenges is the broader, long-simmering cultural mistrust of vaccines and clinical trials felt by tribal communities as a result of historical trauma, making their skepticism about the safety of vaccines more pronounced.

“There’s always that reluctance as a Native American,” Nuvangyaoma said. “I have to make sure that it’s going to be able to help. And I don’t want to get people’s hopes up.”

Chairman Timothy Nuvangyaoma.
Chairman Timothy Nuvangyaoma. Hopi Tribe

For Nuvangyaoma and leaders across other tribal nations, Covid-19 has been an extraordinary crisis.

The pandemic has highlighted long-standing structural inequities and health disparities for American Indians and Alaska Natives, many of which are rooted in the federal government’s chronic underfunding of tribal and urban health care systems, despite legal and treaty obligations to do so. According to the Centers for Disease Control and Prevention, the Covid-19 infection rate is 3.5 times higher for American Indians and Alaska Natives, who are also more likely to suffer hospitalization or mortality than non-Hispanic whites.

The collapse of tribal economies due to the virus, as well as problems and regulations around the distribution of emergency federal funds, stalled any potential recovery even more.

Amid America’s mismanaged response to the pandemic, few communities have borne the brunt quite like smaller tribal nations. For the Hopi, a people who have maintained a connectivity to their traditional ways of life and identity, the loss of even one member is amplified.

The virus “has taken elders who should have been able to pass this down to the younger generation,” Nuvangyaoma said of the tribe’s cultures and traditions. “It’s taken the younger generation who should be the ones that are picking up where we’re leaving off, to continue with our story.”

‘It’s a gamble at this point’

Throughout the pandemic, tribal leaders have faced rushed processes and deadlines to make consequential decisions involving vaccine readiness, such as whether to receive vaccine allocations through the state or the Indian Health Service. Some Urban Indian health clinics were told one day before the presidential election that they needed to make the choice by the end of that week.

Tribal leaders are making “life and death decisions within their tribal communities on the reservations and villages right now . . . so they may not always have the time to respond in a week,” said Abigail Echo-Hawk, a citizen of the Pawnee Nation of Oklahoma, director of the Urban Indian Health Institute and chief research officer for the Seattle Indian Health Board.

IMAGE: Oraibi village water well site
Chairman Timothy Nuvangyaoma and others on the site of the new water well system that will supply water to the Oraibi village, funded with CARES Act funds. That will help with pandemic response by increasing hand-washing and sanitation, especially in individual homes. Hopi Tribe

Meredith Raimondi, the director of communications at the National Council of Urban Indian Health, said the consequences could be dire: “A big concern is that you make the wrong decision, and you choose the state, or you choose IHS and then one of those doesn’t go according to plan and you have no vaccines. I mean, it’s a gamble at this point.”

The Hopi Tribe opted to receive allocations through the Indian Health Service, the federally funded health care system responsible for providing services to approximately 2.6 million American Indians and Alaska Natives. According to officials involved in the logistics planning, the Hopi Tribe is preparing for a direct-shipment scenario from the manufacturer or a “hub and spoke” strategy using ultracold storage in a central location like Phoenix as a distribution hub.

Supply chain experts like Julie Swann, a professor at North Carolina State University who previously advised the CDC during the 2009 H1N1 pandemic, are greatly worried about the logistics involved in cold-chain management of the vaccine for these communities.

“Pfizer kind of acts like that’s going to solve the problem and to some extent, the federal government acts like that, as well,” Swann said of the company’s direct delivery approach that ships vaccines in specialized containers packed with dry ice.

While Pfizer’s strategy would work for a mass vaccination clinic, she explained, it would not be as effective for a health care provider trying to allocate small amounts of vaccine to multiple people over time.

“I think the changes in the Moderna vaccine make it much easier to give that one in rural or sparsely populated areas,” Swann said.

Moderna’s vaccine can remain stable at standard refrigerator temperatures of 36 to 46 degrees Fahrenheit for up to 30 days once thawed.

PRESS RELEASE: NCAI Supports HHS Urban Confer Policy and Extending Medical Care Protections for UIOs

FOR IMMEDIATE RELEASE

Contact: Sara Williams, swilliams@NCUIH.org

NCAI passed several resolutions in support of expanding access to health care for urban Indians.

Washington, D.C. (November 16, 2020) – On Friday, November 13, 2020, the National Congress of American Indians (NCAI) passed several resolutions aimed at improving the health and welfare of American Indians and Alaska Natives living in urban areas.  Two resolutions support the extension of coverage under the Federal Tort Claims Act (FTCA) to urban Indian organizations (UIOs) and the development of an urban confer policy with the U.S. Department of Health and Human Services (HHS). NCAI also reiterated their support for IHS-VA parity for UIOs in a resolution through the Veterans Committee (a resolution on IHS-VA parity for UIOs was passed in 2019). The National Council of Urban Indian Health (NCUIH) has long-advocated for parity for health services for urban Indians including FTCA for UIOs, IHS-VA parity for UIOs, and an urban confer policy. The support from NCAI is critical to continuing to advance these priorities that will improve health outcomes for all of Indian Country as we face COVID-19.

“We appreciate our partnership with NCAI and their commitment to bolstering urban Indian health to ensure that urban Natives have access to health care amid a pandemic that knows no borders,” said Francys Crevier (Algonquin), NCUIH CEO. “Families in our urban areas depend on the life-saving resources offered by our programs more than ever and this will allow their dollars to go further at a critical time. Congress and the Administration must take immediate steps to uphold the trust and treaty obligations to urban Indians by acting swiftly on these policies.”

Currently, UIOs must divert scarce dollars that could go towards health care delivery to pay for expensive malpractice insurance; this insurance can cost up to $250,000 per year for a UIO. The other components of the IHS system and even Community Health Centers receive medical malpractice coverage under the FTCA and thus do not have to divert these resources. Legislation providing FTCA coverage for UIOs enjoyed widespread and bipartisan support in the last Congressional session, including within the President’s FY 2021 proposed budget and with the endorsement of Rear Admiral Michael Weahkee.

In addition, the Indian Health Service (IHS) is currently the only federal agency that has an urban confer policy and thus must engage with UIOs regarding policy actions likely to significantly impact them. As urban Indians often have no representation outside of the Indian Health Service, they are excluded such as inclusion in the H1N1 vaccine distribution process. That means that the over 70% American Indians and Alaska Natives living in urban areas are left out of decision-making conversations that affect health outcomes.

In the most recent instance of exclusion, HHS gave IHS a deadline to choose a distribution plan for an eventual COVID-19 vaccine, either through their state or from IHS directly. This correspondence was only addressed to tribal leaders, leaving UIO leaders out of the discussion. Urban Indian organization leaders did not receive notice of the deadline, sufficient information to make a decision or a platform to ask questions and discuss concerns. The overall confusion and delay further demonstrates the real need for HHS to develop an urban confer policy. The Resolution PDX-20-021 calls for the Secretary of HHS to implement its urban confer policy across the Department and its divisions.

The IHS-VA parity for UIOs is a priority that has received broad support across Indian Country including from last year’s resolution at NCAI. Allowing urban Native veterans to have improved access to critical health services upholds the US government’s obligations to these heroes as Natives and as veterans.

Next Steps

NCUIH will continue to advocate to Congress to enact legislation to provide FTCA for UIOs (H.R. 6535 / S. 3650). Earlier this year, H.R. 6535 passed out of the House Committee on Natural Resources and S. 3650 passed the Senate Committee on Indian Affairs. Parity for urban Native veterans through the Coverage for Urban Indian Health Providers Act (H.R. 4153/ S. 2365) has also passed the House Natural Resources Committee. NCUIH is working with Congress to see if these provisions can be passed before the start of 2021 so that UIOs can start the new year with expanded resources. NCUIH will also work with Congress to develop legislation on an urban confer policy and coordinate with the Administration.

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The National Council of Urban Indian Health (NCUIH) is the national non-profit organization devoted to the support and development of quality, accessible, and culturally-competent health and public health services for American Indians and Alaska Natives (AI/ANs) living in urban areas. NCUIH is the only national representative of the 41 Title V Urban Indian Organizations (UIOs) under the Indian Health Service (IHS) in the Indian Health Care Improvement Act (IHCIA). NCUIH strives to improve the health of the over 70% of the AI/AN population that lives in urban areas, supported by quality, accessible health care centers.

Press Release: NCUIH Honors Senator Tom Udall with Lifetime Champion Award

FOR IMMEDIATE RELEASE

Policy Contact: Meredith Raimondi, mraimondi@NCUIH.org

Press Contact: Sara Williams, swilliams@NCUIH.org,

This award is presented to a Member of Congress who advocates for quality health care legislation for American Indians and Alaska Natives in urban areas.

Washington, D.C. (November 12, 2020) – The National Council of Urban Indian Health is pleased to award Senator Tom Udall with the first Urban Indian Health Congressional Lifetime Champion Award.

“We are proud to award Senator Tom Udall of New Mexico with the first Urban Indian Health Congressional Lifetime Champion Award,” said Francys Crevier (Algonquin), NCUIH CEO. “Senator Udall’s commitment and tireless efforts championing for quality health care legislation has and will create a lasting difference in the health outcomes of American Indians and Alaska Natives who live in urban areas.”

The Urban Indian Health Congressional Lifetime Champion is awarded to a Member of Congress who has made a lasting impact through championing health legislation to benefit urban American Indians and Alaska Natives (AI/AN).

“The federal government’s trust and treaty responsibilities to Native Americans do not stop at reservation boundaries,” said Sen. Tom Udall (D-NM). “Nearly 70 percent of American Indians and Alaska Natives live in urban areas and Congress must ensure they have access to quality health care — especially during this public health crisis. It has been an honor to work with the National Council of Urban Indian Health to ensure better access to health care for Native Americans no matter where they live. We must continue the work to build a stronger, better Indian Health Service system for generations to come.”

Throughout his career, Sen. Tom Udall, Vice-Chairman of Senate Committee on Indian Affairs, has prioritized the trust and treaty responsibility to Indian Country, including urban Indians. Because of his leadership, the health outcomes for urban Indians have considerably improved through the expansion of services at Urban Indian Organizations (UIOs). Earlier this year, Sen. Udall introduced a bipartisan bill to expand health care resources for UIOs amid the COVID-19 pandemic. This is just one example of how Sen. Udall springs into action to ensure tribal members living in urban areas are not left behind.

“We truly are grateful for Senator Udall,” Crevier said. “Not only has he made tremendous efforts for our UIOs, but he has left a lasting impact on Indian Country as a whole.”

Senate Releases FY21 Funding Bills with Increase for Urban Indian Health from FY20

The Senate bill includes $9.6 million above the Administration’s request for urban Indian health.

Today, the Senate Appropriations Committee released its FY21 funding bills, which included their proposals for the Indian Health Service and urban Indian health. The Senate Appropriations Committee will not move forward with mark ups, but instead use these bills for spending talks with the House as they work toward a full funding package before the year ends.

The Senate proposal includes $6.2 billion for the Indian Health Service, which is $49 million less than FY20. The Senate included $59.3 million for urban Indian health, which is $1.6 million above the FY20 amount and $9.6 million above the Administration’s budget request. The language in the report states: “The Committee strongly supports this program and does not concur with the proposal to reduce the program.”

“During a tough fiscal climate, NCUIH is encouraged by the Committee’s bipartisan commitment to urban Indian health and their decision to propose an increase to the President’s request. As Native families in urban areas face the COVID-19 pandemic that is impacting our populations at devastating rates, these resources offer a literal lifeline,” said Francys Crevier, CEO of National Council of Urban Indian Health.

 Line Item  FY20 Enacted  FY21 Tribal
Budget
Formulation
Request
 FY21
President’s
Budget
 FY21 House
Proposed
 FY21 Senate
Proposed
 Urban Indian
Health
 $57,684,000  $106,000,000  $49,636,000  $66,127,000  $59,314,000

Next Steps


Senate and House appropriators must negotiate funding levels and policy provisions across the dozen bills. Congressional leaders are aiming to pass a full-year spending package before the end of the year. Lawmakers have until Dec. 11 to enact more funding before the government shuts down.

Resources

Senate Releases FY21 Funding Bills with Increase for Urban Indian Health from FY20

The Senate bill includes $9.6 million above the Administration’s request for urban Indian health.

Today, the Senate Appropriations Committee released its FY21 funding bills, which included their proposals for the Indian Health Service and urban Indian health. The Senate Appropriations Committee will not move forward with mark ups, but instead use these bills for spending talks with the House as they work toward a full funding package before the year ends.

The Senate proposal includes $6.2 billion for the Indian Health Service, which is $49 million less than FY20. The Senate included $59.3 million for urban Indian health, which is $1.6 million above the FY20 amount and $9.6 million above the Administration’s budget request. The language in the report states: “The Committee strongly supports this program and does not concur with the proposal to reduce the program.”

“During a tough fiscal climate, NCUIH is encouraged by the Committee’s bipartisan commitment to urban Indian health and their decision to propose an increase to the President’s request. As Native families in urban areas face the COVID-19 pandemic that is impacting our populations at devastating rates, these resources offer a literal lifeline,” said Francys Crevier, CEO of National Council of Urban Indian Health.

 Line Item  FY20 Enacted  FY21 Tribal
Budget
Formulation
Request
 FY21
President’s
Budget
 FY21 House
Proposed
 FY21 Senate
Proposed
 Urban Indian
Health
 $57,684,000  $106,000,000  $49,636,000  $66,127,000  $59,314,000

Next Steps

Senate and House appropriators must negotiate funding levels and policy provisions across the dozen bills. Congressional leaders are aiming to pass a full-year spending package before the end of the year. Lawmakers have until Dec. 11 to enact more funding before the government shuts down.

Resources

2020 Election Results in UIO Areas

On November 7, Democratic Presidential nominee Joe Biden and running-mate Kamala Harris surpassed the required 270 electoral votes to win the oval office after securing Pennsylvania, electing them as President and Vice President-elect of the United States. Highly anticipated election results came days after Election Day on November 3 as the nation saw historic voter turnout and mail-in ballots. Counting is still being done to determine some winners of the Senate and House of Representatives seats up for election.

Three states containing Urban Indian Organizations (UIOs)MichiganWisconsin, and Arizona—flipped from red states to blue states during this Presidential election compared to the 2016 election, allocating 37 electoral votes to Joe Biden. Previous blue states containing UIOs—Washington, Oregon, California, Colorado, Nevada, New Mexico, Minnesota, Illinois, New York Massachusetts, and Maryland—all remained blue states while previous red states—Montana, Utah, Texas, Oklahoma, Kansas, Nebraska, South Dakota, and Missouri—all remained red states.

Pre-election, Republicans held a 57-43 majority of the upper chamber. The Senate is currently at a deadlock with Republicans and Democrats each holding 48 seats. Of the 35 Senate seats up for election for the 117th Congress, 31 have been called. Republicans have so far won 18 seats—losing 1, and Democrats have won 13 seats—gaining 1. Senate control cannot be determined until January, as Georgia has entered a run-off for both of its Senate seats. Georgia’s GOP incumbent Senator, David Perdue, and Democrat opponent, Jon Ossoff, will face each other again in January along with Republican Kelly Loeffler and Democrat Raphael Warnock. Arizona and Colorado, both containing UIOs, flipped their Senate seats from red to blue with the election of Mark Kelly (D-AZ) and John Hickenlooper (D-CO).

The Democratic party is expected to maintain majority control in the House of Representatives. So far, 411 of the 453 seats have been processed with House Democrats holding 215 seats—losing 5 seats from the 116th Congress, and Republicans holding 194 seats—gaining 6 seats. UIO area states where neither party has flipped a House seat so far are WashingtonOregonCaliforniaNevadaArizonaUtahMontanaColoradoSouth DakotaNebraskaKansasTexasMissouriWisconsinIllinoisNew YorkMassachusetts, and MarylandNew MexicoOklahomaMinnesota, and Michigan are states that contain UIOs where Republicans flipped one House seat and Democrats flipped 0 seats.

Some states are still processing ballots that can impact these current results.

STATEMENT: NCUIH Congratulates President-Elect Joe Biden, Vice President-Elect Kamala Harris

First Presidential platform to explicitly include Urban Indians in Tribal Nations agenda

FOR IMMEDIATE RELEASE

Contact: Meredith Raimondi, 202-932-6615, mraimondi@ncuih.org

Washington, D.C. (November 9, 2020) –  Today, the National Council of Urban Indian Health Chief Executive Officer Francys Crevier (Algonquin) released the following statement:

“The National Council of Urban Indian Health (NCUIH) congratulates President-Elect Joe Biden and Vice President-Elect Kamala Harris on their groundbreaking 2020 U.S. Presidential Election win. A record number of Native voters showed up in key states such as Arizona, Michigan, and Wisconsin to make a lasting impact on this historical election. This continued confirmation of the power behind the Native Vote reaffirms American Indians and Alaska Native (AI/AN) issues should be a priority for lawmakers in the 117th Congress. We are also thankful to our partners at the Coulter Foundation and the National Urban Indian Family Coalition for providing funding to NCUIH which allowed us to bring funds into those urban Indian communities to embolden the Native vote.

The Biden-Harris team is the first U.S. Presidential platform to include Urban Indian Organizations in their Tribal Nations agenda, and we look forward to partnering with the incoming administration in the development of quality, accessible, and culturally-competent health services for AI/ANs living in urban settings.”

Biden-Harris Plan for Tribal Nations