Effectiveness of a COVID-19 Vaccine Rollout in a Highly Affected American Indian Community, San Carlos Apache Tribe, December 2020-February 2021

Abstract

COVID-19 has disproportionately affected American Indian Tribes, including the San Carlos Apache Tribe, which resides on 1.8 million acres in Arizona and has 16 788 official members. High vaccination rates among American Indian/Alaska Native people in the United States have been reported, but information on how individual Tribes achieved these high rates is scarce. We describe the COVID-19 epidemiology and vaccine rollout in the San Carlos Apache Tribe using data extracted from electronic health records from the San Carlos Apache Healthcare Corporation (SCAHC). By mid-December 2020, 19% of the San Carlos Apache population had received a positive reverse transcription polymerase chain reaction test for SARS-CoV-2, the virus that causes COVID-19. The Tribe prioritized for vaccination population groups with the highest risk for severe COVID-19 outcomes (eg, those aged ≥65 years, who had a 46% risk of hospitalization if infected vs 13% overall). SCAHC achieved high early COVID-19 vaccination rates in the San Carlos community relative to the state of Arizona (47.6 vs 25.2 doses per 100 population by February 27, 2021). These vaccination rates reflected several strategies that were implemented to achieve high COVID-19 vaccine access and uptake, including advance planning, departmental vaccine education sessions within SCAHC, radio and Facebook postings featuring Tribal leaders in the Apache language, and pop-up community vaccine clinics. The San Carlos Apache Tribe's vaccine rollout strategy was an early success story and may provide a model for future vaccination campaigns in other Tribal nations and rural communities in the United States.

Keywords: American Indian; Apache; COVID-19; vaccine; vaccine rollout.

Figure.

Comparison of (A) San Carlos Apache Tribe and Arizona COVID-19 epidemiologic curve from May 1, 2020, through February 27, 2021, and (B) COVID-19 vaccination coverage from December 12, 2020, through February 27, 2021. (A) New SARS-CoV-2 infections per 100 000 population diagnosed at the San Carlos Apache Healthcare Corporation (SCAHC) as compared with the state of Arizona per week, beginning May 23, 2020. Arizona cases reported from December 21-28, 2020, were averaged across all dates in that range because of inconsistent reporting. (B) Cumulative rate of weekly vaccine doses given per 100 population by SCAHC as compared with the state of Arizona, beginning December 2020. The population denominator includes the whole population, not just those eligible for the vaccine. Abbreviation: HCW, health care worker. Data sources: SCAHC and Arizona Department of Health Services COVID-19 data dashboard.