For the first several months of the pandemic, the residents of the Fort Belknap Indian Reservation in Lodge Pole, Mont., were spared by their seclusion in the plains of northern Montana. But when the coronavirus finally arrived, it hit hard.
The six-bed hospital was quickly overwhelmed, and dozens of patients had to be airlifted to Billings or beyond.
By December, 10 people had died, most of them venerated elders, devastating the close-knit community of 4,500. Health workers braced for more as the winter forced people into close quarters.
"If you get your electricity shut off or you run out of propane and don't have hot water, you're going to Grandma's house," said Jessica Windy Boy, who heads the Indian Health Service branch here.
But the worst fears never materialized. Instead, they helped fuel a highly successful vaccination campaign.
It's not just the Fort Belknap reservation that has managed to protect itself. Experts say Native Americans have a higher vaccination rate than any other major racial or ethnic group.
Those rates are difficult to determine, because many vaccine recipients do not provide their race or ethnicity when they get shots. But more than 100 million have done so. That data, collected by the U.S. Centers for Disease Control and Prevention, suggest that Native Americans are 24% more likely than whites to be fully vaccinated, 31% more likely than Latinos, 64% more likely than African Americans and 11% more likely than Asian Americans.
"The surprising success of Native Americans is encouraging, and I think it can serve as a model for broader vaccination efforts," said Latoya Hill, a senior analyst at the Kaiser Family Foundation.
The rumors, conspiracy theories and bitter politics that have stalled out the national vaccination effort appear to have gained less currency among Indigenous people.
"We were extremely aggressive with our vaccination rates very early," said Dr. Loretta Christensen, chief medical officer of the federal Indian Health Service, which provides care to more than half of the country's 5 million Native Americans. "We had that all on board already, certainly before the delta variant escalated."
"This has been just a tremendous effort across all of Indian Country to take care of our people," Christensen said.
Native Americans often live far from healthcare facilities. They face some of the worst poverty in the nation. And distrust of federal authorities runs deep.
For many experts, and even many tribal leaders, it was hard to imagine a group that would be more opposed to government-backed vaccines.
In a survey last fall — before clinical trial results showed vaccines to be safe and effective — only 35% of Indian Health Service field workers said they would "definitely" or "probably" get shots.
But tribal leaders understood that vaccines were the clearest way out of the pandemic. They took to the radio and social media to promote them, warning that elders faced the greatest danger in communities vulnerable due to high rates of diabetes, heart disease and obesity.
They reminded people of the damage COVID-19 had already wrought — killing Native Americans at 2 1/2 times the rate of white Americans — as well as of the smallpox epidemics of the 18th and 19th centuries that decimated many tribes. "I framed it in the way that the virus was a monster, just like any other monster that has come to plague the Navajo people and wreak havoc," said Jonathan Nez, president of the Navajo Nation. "I told them that you've got to have armor, and the armor is the vaccine."
By the end of 2020, as vaccines were becoming available, attitudes were changing. In a poll of Native Americans by the Urban Indian Health Institute, 75% of respondents said they were willing to get vaccinated. The primary motivation was "a strong sense of responsibility to protect the Native community and preserve cultural ways."
Fort Belknap — a 980-square-mile reservation established in 1869 for two formerly nomadic tribes, the A'aninin and the Nakoda — was the first of Montana's seven reservations to obtain ultracold freezers needed to store the Pfizer vaccine.
When the first doses arrived on Dec. 16, health workers were swamped with calls. A team of nine public health nurses, all raised in the community, took questions on the vaccines by phone and on Facebook Live, assuring everyone that there would be enough.
The centralized structure of the Indian Health Service, often criticized as bureaucratic, allowed the nurses to quickly sort patients by age and find detailed health and contact information.
Tribes that chose to get vaccines from the agency often received them sooner than those that got them from states. Federal officials ditched protocols, letting tribal leaders determine the order of vaccinations.
In an original move, Fort Belknap tribal officials extended eligibility to staff members of nearby schools that enrolled Native children.
"We saved lives doing that," said Windy Boy, the Indian Health Service executive.
Aiming to preserve their cultural heritage, nurses also put Native-language speakers ahead in the line. Tribal leaders got shots early to demonstrate that the vaccines were safe.
Among the 3,500 tribal members age 12 and above who are served by the Indian Health Service at Fort Belknap, 67% are fully vaccinated, according to the agency office in Billings.
The rate in neighboring Phillips County is 40%.
In the reservation's recent annual Milk River Indian Days parade, the public health nurses were declared grand marshals and waved from a float.
"We put on our ribbon skirts," said Allen, referring to colorful ceremonial attire. "Otherwise we're always in our scrubs."
