Be a Good Relative: What We Learned

Wonderful news; the National Council of Urban Indian Health has just completed its Be a Good Relative Campaign (BAGR). NCUIH is committed to the continuation and promotion of vaccine equity for Urban Indians. The BAGR campaign was launched to provide educational material on vaccines culturally tailored to Native and Urban Native communities. This series of four videos, promoted on February 16th, April 20th, April 29th, and June 16th.

These videos have been one of our most successful campaigns yet, reaching many people thanks to enhanced promotion for the third and fourth videos. The first video (#BeAGoodRelative Campaign: Flu Immunization) had 311 total views, with 5 reshares and 23 likes. It received 1,318 impressions. The second video posted on April 20th (#BeAGoodRelative Campaign: COVID-19 Myths vs Facts) was viewed 4,473 times, retweeted 104 times, and liked 656 times. The link was clicked 75 times.  The impressions on this video were 17,936 and the engagements were 1,275. The third video (#BeAGoodRelative Campaign: Annual Vaccines) had 249 total views, with 5 reshares and 4 likes. The last video (#BeAGoodRelative Campaign: Youth Immunization), was also quite successful. The video was viewed 3,182 times, retweeted 96 times, and received 472 likes. The link was clicked 53 times. The impressions on this video were 11,063 and the engagements were 819.

Feedback surveys showed that the second and final BAGR videos were effective at reaching and engaging the Urban Native community on vaccination.

One Third of respondents did not receive a COVID-19 vaccine. 66% were very likely to get vaccinated after watching the video, and only 5% were still not likely to get vaccinated.

Further, of the 271 AI/AN people who responded to the feedback survey, they overwhelmingly agreed that the video represented their community. People who worked at facilities that serviced American Indians and Alaska Natives also agreed that these videos were representative of the communities they serve.

Be a Good Relative: What We Learned


Be a Good Relative: What We Learned


Respondents were also asked what factors were the most important when considering getting a vaccine. There was a range of sentiments, the most prevalent of which was a desire to protect oneself against the virus and the disease. However, there were also a substantial group of respondents who indicated concerns for the safety of the vaccine as well as potential side effects. Additionally, respondents indicated that they would consider the effectiveness of the vaccine in protecting against the virus, a desire to protect their family or community, as well as trying to stop the pandemic. Some of the less common concerns were the perceived cost of acquiring the vaccine, access to the vaccine and equity, as well as more trials for effectiveness and safety. Knowing this we can see what sort of messaging would be most receptive to our community.

NCUIH thanks the Urban Indian community and everyone who viewed and provided feedback to our #BeAGoodRelative Campaign. We have learned much about effective vaccination messaging for our community. Moving forward, we will continue to share materials to promote vaccination and vaccine equity that our community would find helpful and useful.

NCUIH Endorses Bicameral Bill that Extends Grants to Urban Indian Organizations to Treat Long COVID

On April 7, 2022, Representative Ayanna Pressley (D-MA-07) and Senator Tammy Duckworth (D-IL) introduced the bicameral Targeting Resources for Equitable Access to Treatment for Long COVID (TREAT Long COVID) Act (H.R. 7482/S. 4015) to increase access to medical care and treatment for communities and individuals struggling with Long COVID. Specifically, this legislation would establish a grant program for eligible entities, including urban Indian organizations (UIOs), for the purpose of creating or enhancing capacity to treat patients with Long COVID through a multidisciplinary approach. The bill authorizes up to $2 million in grant funding to eligible entities and the period of a grant shall be up to three years, with an opportunity for renewal.

The TREAT Long COVID Act is co-sponsored by Rep. Donald Beyer (D-VA-8), Rep. Lisa Rochester (D-DE-1), Sen. Tim Kaine (D-VA), and Sen. Edward J. Markey (D-MA). The National Council of Urban Indian Health (NCUIH) endorses this bill that brings critical funding to UIOs to treat the lasting effects of COVID on the American Indian/Alaska Native (AI/AN) community.

“NCUIH is pleased to endorse Rep. Ayanna Pressley and Sen. Tammy Duckworth’s Targeting Resources for Equitable Access to Treatment for Long COVID Act. The COVID-19 pandemic has disproportionately impacted Native communities and we are left to deal with the devastating lasting impacts of this disease. We are grateful for the inclusion of urban Indian organizations to be eligible for these critical grants to address Long COVID conditions,” – Francys Crevier (Algonquin), CEO, NCUIH.

Next Steps

The bill was referred to the House Energy and Commerce and Senate Health, Education, Labor, and Pensions Committees. It currently awaits consideration. This bill has been added to the NCUIH legislative tracker and can be found here.


Native communities face some of the harshest disparities in health outcomes of any population in the U.S. and are disproportionately impacted by the COVID-19 pandemic. American Indians and Alaska Natives have infection rates over 3.5 times higher than non-Hispanic whites, are over 3.2 times more likely to be hospitalized as a result of COVID-19 and have higher rates of mortality at younger ages than non-Hispanic whites.

The impact of COVID-19 on American Indian and Alaska Native health will continue beyond the pandemic. Lasting illness such as Long COVID need to be addressed.

NCUIH Resource: American Indian/Alaska Native Data on COVID-19

The TREAT Long COVID Act would expand treatment for Long COVID nationwide by:

  • Authorizing the Department of Health and Human Services to award grants up to $2,000,000 to health care providers, including community health centers;
  • Granting funding for the creation and expansion of multidisciplinary Long COVID clinics to address the physical and mental health needs of patients;
  • Prioritizing funding for health providers that plan to engage medically underserved populations and populations disproportionately impacted by COVID-19;
  • Ensuring that treatment is not denied based on insurance coverage, date or method of diagnosis, or previous hospitalization;
  • Encouraging ongoing medical training for physicians in Long COVID Clinics and other health care workers serving patients; and
  • Requiring grantees to submit an annual report on its activities that includes evaluations from patients.

Full Text of the House Bill

Full Text of the Senate Bill

Suicide Statistics in AI/AN Communities on the Rise: Recent Updates from the CDC

During November 2021, the CDC released a report on “Provisional Numbers and Rates of Suicide by Month and Demographic Characteristics: United States, 2020”, which covers initial pandemic-era data on suicide rates nationwide.

One of the most important findings for the AI/AN community that the study found is that, “for males, age-adjusted suicide rates were higher in 2020 than in 2019 for non-Hispanic Black, Non-Hispanic AI/AN, and Hispanic males and lower for non-Hispanic White and non-Hispanic Asian males.” Suicide is a complex multifaceted public health issue, which affects the AI/AN community at disproportionate rates. Although suicide rates decreased for many non-Hispanic White groups within the country, they increased for many other ethnic minority groups including non-Hispanic American Indian or Alaskan Native people. Due to a lack of overall research on issues pertaining to the AI/AN community and the complex issues related to suicide, studies like this are necessary to highlight the impact of mental and behavioral healthcare on AI/AN communities (and the supports that are needed). Without data, organizations and the nation are unable to provide accurate support and solutions.

The COVID-19 pandemic has caused many public health issues to be amplified, such as ongoing issues with mental health, substance abuse, financial difficulties, as well as many other factors. Due to the COVID-19 pandemic, many of the possible risk factors associated with suicidal behavior may have increased, which increases the concern that deaths by suicide in 2020 might have increased as well. This report details the numbers of deaths by suicide by the demographics of sex and race and Hispanic origin, by month for the year 2020. These statistics are then compared with final 2019 rates. Rates are compared year-to-year to monitor changes within key demographics by year.

These provisional estimates are based on 99% of all 2020 death records received and processed by the National Center for Health Statistics, but this likely is still an undercount of AI/AN deaths. Since 1979, over 45% of people who self-identified as AI/AN on a national survey had their race misclassified after death (usually as White).




Centers for Disease Control and Prevention. (n.d.). Vital Statistics Rapid Release – Retrieved January 20, 2022, from

Study Shows Native Children Disproportionately Experience Orphanhood Due to COVID-19

On October 7, 2021, the American Academy of Pediatrics published a study on caregiver deaths by race and ethnicity. The study highlights stark COVID-19 disparities in American Indian/Alaska Native (AI/AN) communities.

According to the study, 1 of every 168 AI/AN children experienced orphanhood or death of caregivers due to the pandemic compared to 1 of every 310 Black children, 1 of every 412 Hispanic children, 1 of every 612 Asian children, and 1 of every 753 white children experienced orphanhood or death of caregivers. AI/AN children were 4.5 times more likely than white children to lose a parent or grandparent caregiver.

Native communities face some of the harshest disparities in health outcomes of any population in the U.S. and are disproportionately impacted by the COVID-19 pandemic.

Download Graphic

About the Study

The study was a collaboration between the Centers for Disease Control and Prevention (CDC), Imperial College London, Harvard University, Oxford University, and the University of Cape Town, South Africa. Published in the Oct. 7 issue of the journal Pediatrics, it was jointly led by CDC’s COVID Response and Imperial College London, and partly funded by the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health (NIH), as well as Imperial College London.

Read More

Updated CDC Guidance for Pfizer-BioNTech COVID-19 vaccination

On Tuesday, January 4, the Centers for Disease Control and Prevention (CDC) issued two new recommendations on guidance on the administration of the COVID-19 vaccine technology from Pfizer-BioNTech. This guidance follows after the Food and Drug Administration (FDA) gave similar recommendations. The updated recommendations include the following: recommendations include the following:

  • Those who received the Pfizer-BioNTech COVID-19 vaccine as their primary series are not recommended to get a booster after 5 months.
  • Children 5-11-years-old who are moderately or severely immunocompromised should received an additional primary dose of the Pfizer-BioNTech vaccine 28 days after their second shot.

Additionally, following a recent Advisory Committee on Immunization Practices (ACIP) meeting, CDC is endorsing ACIP’s recommendation that people 12-17 years old should receive a booster shot 5-months after their initial Pfizer-BioNTech vaccination series. Currently, this vaccine is the only COVID-19 vaccine authorized for adolescents aged 12-17.

CMS and OSHA Issue New Rules and Standards Around COVID-19 Vaccination Requirements

On November 5, 2021, the Occupational Safety and Health Administration (OSHA) under the U.S. Department of Labor announced new emergency temporary standards to protect nearly 85 million workers from the spread of COVID-19. These standards come in alignment with the Administration’s previous policies requiring federal employees and contractors to be fully vaccinated, as well as the recent Centers for Medicare and Medicaid Services (CMS) rule that health care workers at facilities participating in Medicare and Medicaid be fully vaccinated. 

OSHA’s COVID-19 Vaccination and Testing Emergency Temporary Standard (ETS) will follow the same time frame as both the CMS rule and the Administration’s previously implemented policies – by January 4, 2022 all contractors and employees covered under these vaccination rules must have completed a full series of vaccinations or have received a single dose vaccination. These rules take precedent over any state or local ordinances, and OSHA further clarifies that their standard does not preempt the CMS rule. 

The OHSA COVID-19 Vaccination and Testing (ETS) for employers with 100 or more employees is as follows: 

  • Require full vaccination of employees by Jan 4, 2022. If an employee is not fully vaccinated by then, employees must provide a negative COVID test on at least a weekly basis. The ETS does not require an employer to cover the cost of the tests but they may be required to do so through other agreements or laws. 
  • Pay employees for the time taken to get vaccinated. If needed, employers must also give sick leave to those who need to recover from side effects. Compliance for this must be met by December 5, 2021. 

The CMS COVID-19 Omnibus Vaccine Rule (IFC-6) is as follows: 

  • By December 5, 2021, all facilities must have processes and plans in place for vaccinating staff, providing exemptions and accommodations and tracking and documenting staff vaccinations. All eligible staff must also have received at least one dose of a multi-dose vaccination, or the single dose vaccination by this date. 
  • By January 4, 2022, all covered staff at eligible facilities must have completed a multi-dose series of vaccination or be fully vaccinated. For this rule, CMS considers fully vaccinated to be 2 weeks post completion of either the single or multi-dose inoculations. 


For more information, please see:  

Fact Sheet: Biden Administration Announces Details of Two Major Vaccination Policies 

OSHA Publication 4162: Summary of COVID-19 Emergency Temporary Standard 

FAQ: CMS Omnibus COVID-19 Health Care Staff Vaccination Interim Final Rule 

FEMA Public Assistance Funds Available to UIOs for COVID-19 Vaccine Administration Activities

On November 5, 2021, in response to the Centers for Disease Control and Prevention (CDC) recommendation that children ages 5-11 receive the Pfizer COVID-19 vaccine, the Federal Emergency Management Agency (FEMA) announced that its Public Assistance program will reimburse 100% of eligible costs associated with administering vaccines to children and adults until December 31, 2021. The funding will continue after December 31, but the reimbursement percentage may change. Urban Indian Organizations (UIOs) operating medical facilities are eligible for this FEMA funding that will be provided on a reimbursement basis for eligible vaccination activities, including:


  • Vaccination facilities including community vaccination centers, mass vaccination sites and mobile vaccinations including necessary security and other services for sites.
  • Medical and support staff including contracted and temporary hires to administer vaccinations.
  • Training and technical assistance specific for individuals storing, handling, distributing, and administering of COVID-19 vaccinations.
  • Personal protective equipment, other equipment, supplies, and materials required for storing, handling, distributing, and administering COVID-19 vaccinations.
  • Transportation support such as refrigerated trucks and transport security, for vaccine distribution as well as reasonable transportation to and from the vaccination sites for children and families with limited or no mobility to get to a vaccine site.
  • Onsite infection control measures and emergency medical care for children and families at vaccination sites.
  • Communication efforts that keep the public informed including public messaging campaigns, public service announcements, flyers, newspaper advertisements, websites, translation services, in-person community engagement, and call centers or websites to assist with scheduling appointments or answering questions for children and their families.

NCUIH worked with FEMA’s Public Assistance Division early in the pandemic to get questions answered about the agency’s available resources for UIOs and open the lines of communication with FEMA officials.


With the start of the 2021-22 school year around the corner and some schools starting this week, the entire country is again facing thousands of local decisions about under what conditions schools will reopen, in view of the major upheaval caused by the delta variant of coronavirus.  This strain is highly contagious, on the same level as measles and chickenpox, therefore public health officials are urging strict enforcement for mask wearing, physical distancing and vaccination.  To increase support for vaccines we must double down on containment and mitigation measures, including extensive testing, isolation, use of masks and social distancing of 3 feet at school campuses, under CDC guidelines.  To quote Dr. Rachel Levine, Assistant Secretary for Health at HHS, “We must cocoon a child surrounded by vaccinated adults.” This means that all teachers must be vaccinated, and children must wear masks while in school.  We all play a role and what the pandemic has taught us is that we are all interconnected.

Other Vulnerable Groups

Amidst these decisions weighing heavily on the minds of elected officials and public health officers, one piece of good news is that Pfizer will be seeking another Emergency Order Authorization in the fall for its new COVID-19 vaccine for children ages 5 to 11 years old.  (Younger than 5-yrs-old groups will take longer, because of the size of clinical trials and the cautious approach to de-escalate dosage when treating toddlers and infants).

Dr. Anne Edwards with the American Academy of Pediatrics reported on a national call with HHS and the CDC that pediatricians are seeing a lot of respiratory illness in medical offices, the ICU and regular hospital beds.  She and all medical staff strongly encourage everyone in the 12-and-older age group who are eligible to get vaccinated.  Studies show that no one is more trusted than Pediatricians, therefore the physician should take the time during medical visits to clear up any questions for the family.  We all need your help as trusted leaders in your community.  Dr. Amy Mullins, from the American Academy of Family Physicians, added that when confronting vaccine hesitancy, data shows that there is no single public message that will always overcome.

In addition, evidence about the safety of COVID-19 vaccination during pregnancy has been growing, including in the early months of pregnancy.  There is a trove of surveillance data, according to Dr. Peter Marks from the Federal Drug Administration (FDA).  Pregnant and recently pregnant women are more likely to get severely ill compared with non-pregnant people.  These data strongly point to the conclusion that the benefits of receiving a COVID-19 vaccine outweigh any known or potential risks of vaccination during pregnancy.  During the week of August 11, the Centers for Disease Control advanced this information and posted recommendations on their website.  Learn More.

Vaccine Boost

The FDA recently authorized a third dose or boost of the MRNI-type vaccine for those people who are immune-compromised, ages 15 and over.  Further, the evidence and rationale for taking this next step tells us that if a patient is only taking two medications for the underlying health condition, there is very little risk when taking a third dose.  The Advisory Committee on Immunization Practices (ACIP) will have to issue final guidance on this matter.

When administering immunizations, providers may wish to separate the administration of shots, especially when dealing with live viral vaccines and fever is present).  Soon the CDC will disclose real world evidence.

We ALL need your Help and the enlistment of public and private employers to take extra steps, such as time off from work to get vaccinated and providing free rides to vaccination sites.