FILE – Korene Atene, a certified practical nurse at Monument Valley Health Center, gets information from people lined up to get tested for COVID-19 outside the center in Oljato-Monument Valley, San Juan County, on Thursday April 16, 2020 | Photo by Kristin Murphy, The Associated Press, St. George News

PHOENIX (AP) — Mary Francis had no qualms being a poster boy for COVID-19 vaccinations in the Navajo Nation, once a hotspot for the virus. The Navajo woman’s face and words adorn a digital flyer asking residents of the Native American reservation to get vaccinated “to protect the shidine’e (my people).”

“I was happy to spread the information and just build that awareness and make people feel comfortable enough or curious enough to read the material,” said Francis, who lives in Page, near the Utah border, and handles care packages. and vaccination campaigns 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 vaccination rates have surpassed more populous counties, according to a recent report from the Centers for United States Disease Control and Prevention. Public health experts believe the trend has been fueled primarily by one group that has lost a disproportionate number of lives to COVID-19: Native Americans.

Tribal communities have been left more vulnerable to the virus due to underlying health conditions like diabetes and heart disease, as well as multiple generations sharing a home. Cases and deaths have piled up despite curfews, weekend shutdowns, mask mandates and business closures. In April 2020, the Navajo Nation – which encompasses parts of Arizona, New Mexico and Utah – said it had been hit harder by the coronavirus than any other tribe.

The devastating loss, especially of the elderly, prompted vaccination as an act of selflessness. Holly Van Lew, co-lead of a federal Indian Health Service task force rolling out vaccines nationwide, credits Navajo Nation officials for consistently pushing that message.

“It really comes from a different perspective,” said Lew, a clinical pharmacist at Phoenix Indian Medical Center. “Instead of ‘You should also get vaccinated against COVID-19’, (it’s) ‘We should all, as members of the community, protect each other.'”

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 make up nearly three-quarters of Apache County’s 71,000 residents and nearly half of Navajo County’s 110,000 residents. They are estimated at 10%-15% in three small counties, Gila, Graham and La Paz.

Arizona has 15 counties in total. The CDC determined counties to be rural if they had no substantial “urban cluster” or if they had a population of 10,000 to 50,000.

The overall percentage of people in these counties who were eligible for the vaccine and who were at least partially vaccinated between December 2020 and January of this year was 86.1%. It was 69.3% in urban counties, according to the report.

Nationally, urban counties outperformed rural counties by 75.4% to 58.5%.

A different picture emerges from state data. Dr. Bob England, former director of the Maricopa County Department of Public Health, said the state’s dashboard numbers lead to a calculation of an estimated rate of 70% in urban counties and 66 % in rural counties.

However, the Arizona Department of Health Services does not 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 lands.

“If I adjust the data that’s included in the CDC report but not on the state dashboard, then you can say 100% certainty that the only reason these rural counties were ranked higher only urban is 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 a low presence were Santa Cruz, near the US-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 approximately 46,000 people. Officials say that figure is due to Mexican workers as well as visitors. Seasonal produce warehouse workers, a major industry there, got the hit by county and University of Arizona Health Sciences-run mobile health units in border communities, said Jeff Terrell, director of county health.

“You look at the numbers that we released,” Terrell said. “If you also think about vaccination sites at the border. If you add that to the county – yes, I think that was a contributing factor.

For counties with large Indigenous populations, outreach included unique strategies. The IHS task force has collaborated with federal, state, and local partners on vaccination clinics and radio and print advertisements in Indigenous languages. They also met people where they lived. Public health nurses went door to door in tribal communities and vaccinated entire familiesVan Lew said.

Organizations like the Navajo and Hopi Families COVID-19 Relief Fund have held vaccination drives with t-shirts and gift cards. They’ve 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, program manager for the public health education fund.

“One of the most important steps in getting our communities back to health is getting vaccinated against COVID-19!” reads a quote on a poster of a smiling Begay. “I received mine and I feel good!”

Tribal vaccination campaigns have met with much resistance. No one knows this better than Hector Begaye, who was hesitant to get vaccinated but had to do so 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, encouragement and acceptance,” Begaye said. “In this line of work, even though we want people to be stimulated, we can’t force it down their throats.”

Written by TERRY TANG, Associated Press

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