PHOENIX (AP) — Mary Francis had no qualms about being a poster child for COVID-19 vaccinations on the Navajo Nation, once a virus hot spot. The Navajo woman’s face and words grace a digital flyer asking people on the Native American reservation to get vaccinated "to protect the shidine’e (my people)."
"I was happy to put the information out there and just building that awareness and in having folks feel comfortable enough, or curious enough, to read the material," said Francis, who lives in Page, near the Utah border, and manages care packages and vaccine drives for a Navajo and Hopi relief fund.
In a pandemic that has seen sharp divides between urban and rural vaccination rates nationwide, Arizona is the only state where rural vaccine rates outpaced more populated counties, according to a recent report from the U.S. Centers for Disease Control and Prevention. Public health experts believe the trend was mainly fueled by a group that lost a disproportionate number of lives to COVID-19: Native Americans.
Tribal communities were left more vulnerable to the virus because of underlying health issues like diabetes and heart disease, as well as multiple generations sharing a home. Cases and deaths piled on despite curfews, weekend lockdowns, mask mandates and business shutdowns. By April 2020, the Navajo Nation — which encompasses parts of Arizona, New Mexico and Utah — declared it had been hit harder by the coronavirus than any other tribe.
The devastating loss, particularly of elders, drove a push for vaccinations as an act of selflessness. Holly Van Lew, co-leader of a federal Indian Health Service taskforce rolling out vaccines nationwide, credits Navajo Nation officials with constantly emphasizing that message.
"It really comes from a different perspective. Instead of ‘You should get your COVID-19 vaccines too,’ (it’s) ‘We should all as community members protect each other,’" said Lew, a clinical pharmacist at the Phoenix Indian Medical Center.
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Native Americans make up significant portions of five of the seven counties designated as rural in the CDC report. A 2020 Census survey shows they account for nearly three-fourths of the 71,000 people in Apache County and almost half of the 110,000 residents in Navajo County. They are an estimated 10% to 15% in three smaller counties, Gila, Graham and La Paz.
Arizona has 15 counties total. The CDC determined counties were rural if they either had no substantial "urban cluster" or one with a population between 10,000 and 50,000.
The overall percentage of people in those counties who were vaccine-eligible and got at least partly vaccinated between December 2020 and January this year was 86.1%. It was 69.3% in urban counties, the report said.
Nationally, urban counties outshone rural ones 75.4% to 58.5%.
A different picture emerges from the state’s data. Dr. Bob England, former Maricopa County Department of Public Health director, said state dashboard numbers lead to a calculation of an estimated 70% rate in urban counties and a 66% rate in rural counties.
However, Arizona’s Department of Health Services doesn’t receive vaccine data from the Indian Health Service, which provides health care to more than 2.5 million Native Americans and Alaska Natives on and off tribal land.
"If I adjust data that’s included in the CDC report but not on the state dashboard, then you could 100% say with certainty that the only reason why those rural counties were ranked higher than urban is because of tribal participation in vaccination campaigns," said Will Humble, former department director. "There’s no way it could be anything else."
The two rural counties in the CDC report where Native Americans have little presence were Santa Cruz, near the U.S.-Mexico border, and Greenlee, which touches the New Mexico state line.
Santa Cruz had an extremely high vaccination rate of 146% among a population of roughly 46,000. Officials say that figure is because of laborers from Mexico as well as visitors. Seasonal workers in produce warehouses, a major industry there, got the jab through the county and University of Arizona Health Sciences-run mobile health units in border communities, said Jeff Terrell, the county’s health director.
"You look at the numbers that we’ve put out there," Terrell said. "If you think about the vaccination sites at the border as well. If you add that into the county — yes, I think that was a contributing factor."
For the counties with high Native populations, outreach included some unique strategies. The IHS taskforce collaborated with federal, state and local partners on vaccine clinics and radio and print ads in Native languages. They also met people where they lived. Public health nurses went door-to-door in tribal communities and vaccinated entire families, Van Lew said.
Organizations like the Navajo and Hopi Families COVID-19 Relief Fund have hosted vaccine drives with T-shirts and gift cards. They created TikTok videos, newspaper ads and even "influencer" posters for social media. The influencers are trusted tribal members like professional golfer Notah Begay III, who is Navajo, said Wendy Atcitty, the fund’s program manager for public health education.
"One of the most important steps of regaining the health of our communities is getting a COVID-19 vaccine!" reads a quote on a poster of a smiling Begay. "I received mine and I feel great!"
Tribal vaccine drives faced plenty of resistors. No one knows that more than Hector Begaye, who was hesitant to get vaccinated but had to so he could work for the Navajo and Hopi Families COVID-19 Relief Fund.
Even with all the incentives, he can’t convince everyone.
"All we can do is share our personal stories and encouragement and acceptance," Begaye said. "In this line of work, as much as we want people to be boosted, we can’t force it down their throat."