Montana tribes having success distributing COVID-19 vaccines

Nathan St. Goddard was skeptical when he first heard about the United States' vaccination effort.

"I didn't think I'd be able to get one," he said. "There was so much confusion on where to get it, how to get it, when to get it."

When St. Goddard, 40, heard the Blackfeet Community Hospital was vaccinating all tribal members over the age of 18, he was shocked.

The hospital is run by Indian Health Service (IHS), a federal agency that's long been criticized for its inadequate funding.

"People always joke about waiting in line at IHS, so I expected that with the vaccine," he said.

But St. Goddard was impressed with the vaccination effort. He signed up for an appointment and said he hardly had to wait. The process was so smooth, it reminded him of a conveyer belt.

The Blackfeet Nation has vaccinated more than 95% of its eligible population. The tribe isn't alone in its success. Every tribe in Montana is vaccinating its members at a fast pace, sometimes doubling or tripling the state's vaccination rate since tribal vaccinations are included in state data.

Montana has consistently ranked among the top states in its vaccine distribution. As of March 19, the state had fully immunized 17% of its eligible population, and 28% of the state's eligible population had received at least one dose.

Native American tribes used incentives, a centralized health care system and personalized outreach efforts to fast-track their vaccine rollout. Tribes have been so efficient that many tribal health clinics are vaccinating non-Natives, who otherwise wouldn't be eligible, the Great Falls Tribune reported.

Angela Troutt, the IHS Billings-area vaccine taskforce lead, said operating in a centralized health care system benefited tribes' vaccine rollout, as facilities could easily collaborate.

Each week, the Centers for Disease Control and Prevention allocates COVID-19 vaccines to IHS, which then distributes them across their areas. IHS' Billings-area location, which includes eleven Montana facilities, receives, on average, 1,200 Moderna doses, 1,170 Pfizer doses and 100 Johnson & Johnson doses each week.

Troutt said the Billings office distributes vaccines to its Montana facilities based on metrics, evaluating a facility's eligible population, vaccination rate and number of vaccines on hand. In the first eight weeks of distribution, Troutt said every site in Montana had a 100% vaccination rate, meaning no shots were wasted. So far, the IHS facilities across Montana have administered at least one dose to 29% of the eligible population, and 21% of the eligible IHS population is fully immunized.

As the task force lead, Troutt speaks with a contact at each facility weekly to discuss vaccine allocation.

Mary Lynne Billy, chief innovation officer at Indian Family Health Clinic, an IHS-funded urban Indian organization in Great Falls, said the clinics' direct relationship with IHS was a huge benefit.

"It's been an absolute success because we have a direct contact who we can go to if we need help," she said. "If we didn't have that direct connection, I don't know where we'd be."

When Montana began vaccinating people 70 years and older, many counties used online portals operating on a first-come, first-served basis for appointment sign-ups. But the system, which required computer literacy, was difficult for many seniors to navigate, causing frustration and confusion.

But tribes, who revere elders for their cultural knowledge, instead reached them to schedule vaccine appointments.

Chelsea Kleinmeyer, the Confederated Salish and Kootenai Tribes' (CSKT) community health division director, said each elder received a call when it was their turn to be vaccinated, and they also had the option to schedule appointments online.

Kleinmeyer said the tribes initially implemented a first-come, first-served online platform to schedule appointments but said navigating the online system was a "disaster," so the tribes decided to call people instead.

IHS' centralized online data system allowed tribal health clinics to sort their medical records, based on a given vaccination phase.

"You can pull a specific age group, then you can sort that by comorbidities, and then once you have a list, you assign a case manager and call every eligible person to get them an appointment," Troutt said.

The CSKT had, as of March 10, vaccinated more than 30% of their eligible population, and Kleinmeyer said the rollout was so successful that the tribes began vaccinating non-tribal members, including those who live with a Native American and teachers.

"We started vaccinating teachers in Lake County a month before they were eligible in Montana," she said. "I'm really proud we could offer teachers immunity — they were so grateful."

Kleinmeyer said the tribes expect to receive the one-shot Johnson & Johnson vaccines, which will likely be allocated to the reservation's transient population, including people who are homeless or incarcerated.

Tribes in Montana, like Indigenous communities nationwide, were hit hard by COVID-19, as the virus exposed existing social and economic disparities.

A Department of Public Health and Human Services report found that from March through October 2020, Native Americans in Montana accounted for 19% of the state's COVID-19 cases and 32% of deaths related to the virus. Yet they comprise 6.7% of the state's population.

Some tribal leaders said the devastation from COVID-19 contributed to the successful vaccine rollout. Frank White Clay, chairman of the Crow Tribe, said 61 community members died of COVID-19.

"Each death is a tragedy. Because we had such a high death rate on the reservation, once vaccines were available, we were quick to get shots. Everyone wants to protect our elders," he said.

More than 30% of the Crow Tribe's eligible population had received at least one vaccine as of March 18.

Every summer, the tribe hosts the Crow Fair, attracting visitors from all over the world. White Clay said events like the fair are important for tribal members, as they foster closeness, establish a sense of community and celebrate culture.

"We are a very outgoing tribe, so when we canceled events last year, it was hard on our population. Now, we tell people, 'You want the Crow Fair? Then get your vaccine,'" he said.

The Blackfeet Tribal Council also incentivized members, saying if COVID-19 cases continued to decline and members got vaccinated, the tribe, which had been closed since last March, could begin to reopen. At its peak in October, the Blackfeet Nation had more than 400 active COVID-19 cases on its reservation. The tribe lost 47 members to the virus.

That incentive motivated Nathan St. Goddard, who owns Johnson's of St. Mary, a campground near Glacier National Park. Because the tribe closed the parks' east entrance to prevent the spread of COVID-19, St. Goddard went a year without income.

"We were devastated," he said, adding that his family survived on savings. "For me, the shot was good for my family, my community, my tribe and good for business."

Now, with more than 95% of the eligible population vaccinated, the Blackfeet Nation has allowed businesses to operate at limited capacity and has opened the east entrance to Glacier National Park.

Hayley Chaon, a teacher at Longfellow Elementary, tried to get a vaccine through some pharmacy websites, but the appointment slots were filled.

While she isn't Native American, Chaon was able to get her COVID-19 vaccine at the Indian Family Health Clinic (IFHC), an IHS-funded urban Indian organization in Great Falls.

As of March 12, more than 75% of IFHC's eligible patients had received their first dose of COVID-19 vaccine and 60% were fully immunized. Because the rollout was so efficient, the clinic opened vaccination appointments for Great Falls Public Schools teachers, like Chaon, who have Native American students.

Billy, the chief innovation officer of IFHC, said she was thrilled to help teachers get vaccinated.

"We see it as our responsibility to the community," she said, adding that IFHC had vaccinated more than 80 Great Falls educators.

Mary Wren, a math teacher at East Middle School, said she was grateful to get her vaccine through IFHC. Ken Maddox, an East Middle School basketball coach and educator, died of COVID-19 in November, and Wren said his death devastated the community.

Wren had COVID-19 in November, and said the virus was "rough." She said contact tracing and infections had impacted her attendance, sometimes reducing her class of 25 to just four students. For her, getting the vaccine was crucial.

"I'm doing this for me, my family and my community. With the vaccine, I can be there for my students," she said.