The tribe in Oklahoma is facing a problem that is likely to become more commonplace across the country: how to vaccinate everyone not eagerly lining up for a shot.
TAHLEQUAH, Okla. — As people across the United States jockey and wait to get vaccinated, a surprising problem is unfolding in the Cherokee Nation: plenty of shots, but not enough arms.
“We’re running out of people to vaccinate,” said Brian Hail, who helps oversee the tribe’s vaccination efforts. He winced as he pulled up the day’s schedule one recent morning: Vaccinations were open to basically everyone across the reservation, but 823 appointments sat unclaimed.
It is a side effect of early success, tribal health officials said. With many enthusiastic patients inoculated and new coronavirus infections at an ebb, the urgency for vaccines has gone distressingly quiet.
Now, the tribe is confronting what looms as a major hurdle for the entire country as vaccine supplies swell to meet demand: how to vaccinate everyone not eagerly lined up for a shot.
It is a dizzying public health challenge that cuts across the country. It encompasses persuading skeptics, calling people who do not realize they are now eligible, and making vaccines accessible for homebound patients, overstretched working families and people in rural areas and minority communities.
The Cherokee Nation has administered more than 33,000 doses at nine vaccination sites across its reservation, which spreads from cities through rural woodlands, cattle pastures and poultry farms in northeastern Oklahoma. After vaccinating health care workers, Cherokee-speaking elders and essential workers, the tribe opened appointments to anyone who qualifies, tribal member or not, living in its borders.
Still, hundreds of slots have gone unfilled, health officials said. Cherokee-speaking vaccine schedulers hired to set up appointments are waiting for their phones to ring.
“Those initial waves of people that really wanted and needed the vaccine — we worked through that,” said Mr. Hail, deputy executive director of external operations at Cherokee Nation Health Services. The tribe counts 141,000 citizens on the reservation and 380,000 worldwide. “We’re struggling to get people to come in.”
Dennis Chewey, 60, gave his brother and sister the tribe’s vaccination hotline and urged them to call. Mr. Chewey’s wife was at high risk because of her job as a casino housekeeper, and he knew several people who had died, including a health worker who had helped him treat his diabetes. But none of them had called.
“They’re leery of taking it,” Mr. Chewey said, a few minutes after he and his wife, Clara, got their second dose at the tribe’s gleaming new outpatient clinic. “They’re my family. I can’t make anybody do anything.”
Public health teams across the country are refocusing their energy and resources on bringing vaccinations to people.
They are plunging into New York neighborhoods to reach homebound people, and visiting rural communities where unreliable internet makes it difficult to sign up for appointments or log into vaccination websites. They are driving long dirt roads to reach families without the cars or gas money to visit vaccination clinics.
The Navajo Nation, which says it has vaccinated roughly 70 percent of its citizens, sent public health workers into rural corners of the high desert to vaccinate as many as 5,000 people close to their homes. The Cherokee Nation is planning “strike teams” of nurses with single-dose Johnson & Johnson vaccines.
The Osage Nation, in northeastern Oklahoma, is vaccinating about 200 people a day at a clinic that has the capacity to give 500 shots. It tried two mass vaccination events at its casinos, but the results were disappointing.
So the tribe bought two 30-foot “medical R.V.s” that will roll into smaller towns like Hominy and Fairfax to reach the 30 to 40 percent of tribal elders and essential workers who did not volunteer to get vaccinated. It is a house-by-house campaign against misinformation and wariness, waged with long conversations and patience.
“You kind of grind it out,” said Dr. Ronald Shaw, medical director of the 23,000-member Osage Nation. “We tried to remove every obstacle to people who were sitting on the fence.”
The coronavirus has been particularly devastating for Indigenous communities. It has killed American Indians and Alaska Natives at nearly twice the rate of white people, and inflicted a cultural crisis by killing the elders who pass down language and traditional teachings. The economic toll of the pandemic has pummeled Native economies already racked by high poverty and unemployment.
The vaccine rollout in Native communities has been a surprising source of strength, especially as vaccinations of other communities, such as Black and Hispanic Americans, continue to lag behind white populations.
Working through the Indian Health Service and long-established networks of tribally run clinics, tribes are outpacing much of the country, already giving shots to healthy adults and eligible teenagers. Some have even thrown open the doors to nontribal members inside their borders.
In all, about 1.1 million vaccines have been distributed through the Indian Health Service and 670,000 have been administered. Still, health care advocates said frustrating gaps remained. Many Indigenous people in big cities and areas without tribal health centers had struggled to find vaccines.
Now, Native health workers are desperately hoping to get through to people like Nora Birdtail, 64, one of a shrinking number of Cherokee-speaking elders. Their names are marked down in a leather notebook that was created to inscribe their importance to Cherokee heritage and culture. Today, the notebook is a register of loss — of at least 35 lives and numberless stories cut short by the virus.
Even as hundreds of elders got vaccinated, Ms. Birdtail resisted. She is vulnerable to the coronavirus from a stroke. Her job as a teacher’s aide brings her into close contact with children at the Cherokee Immersion School, where in-person classes are expected to resume soon.
But Ms. Birdtail is scared of getting vaccinated, largely because she once passed out after getting a penicillin shot years ago. The government’s legacy of medical malpractice in Indian Country — a history of coercive treatments, shoddy care, forced sterilizations and more — has also instilled a deep skepticism about taking a government-supported vaccine.
“It made me think back to the Trail of Tears, how they all got sick,” Ms. Birdtail said. “I don’t trust it.”
The number of Americans willing to get vaccinated has grown as people watch family and friends, politicians and Dolly Parton roll up their sleeves. But about 18 percent of American adults said they would probably not or definitely not get vaccinated, according to a recent survey by the Census Bureau.
Nationwide, people’s embrace of the vaccine has split sharply on partisan lines, with a third of Republicans saying they would not take the vaccine and another 20 percent saying they were unsure, according to a CBS News/YouGov poll. Ten percent of Democrats said they would not take the vaccine.
Across Cherokee Nation, people who jumped to get vaccinated said they wanted to protect themselves and, more important, safeguard their community, elders and children who are still not eligible to get shots.
Those who hesitated said they still had too many questions — about the vaccines’ efficacy, side effects and the speed they made it to market. The three vaccines that have received emergency authorization in the United States have been shown to greatly reduce serious illnesses and deaths from the virus, and all went through layers of review by the government and outside scientists.
But those assurances had yet to reach a trailer in the community of Dry Creek where Fred Walker, 65, has to haul his drinking water from a neighbor’s home. Mr. Walker is disabled and worries about the virus. But he has avoided the vaccine because he fears it could damage his health. He said no health workers had reached out to schedule an appointment or answer his questions.
“Nobody’s said anything about it,” he said.
Others just seemed to want a nudge. At a Walmart providing shots, unvaccinated shoppers said they were not so much opposed as just waiting. For more information. For a doctor’s recommendation. For more people to take it.
Even in places where vaccine appointments abound, some people worry about stealing a spot. Shelldon Miggletto, a Cherokee citizen and economic development director for the 4,000-person town of Stilwell (“Strawberry Capital of the World”), has held off because he does not want to cut in front of someone with asthma or diabetes. Similar issues have cropped up in Alaska, where vaccine slots went unfilled because people did not realize they were eligible.
The nurses who run the Cherokee Nation’s vaccination program are obsessed with how to reel in more people. They are planning to vaccinate eligible students at Sequoyah High School. There is talk of vaccinations at barbecues, and T-shirts for the newly vaccinated. The health service has called and sent out mass texts asking unvaccinated members whether they are willing to come in.
One of those messages found Sherry Garrett, 68.
She and her husband had harbored deep suspicions about the vaccine and had planned to refuse it. But then her sister died in July after what her family believes was an undiagnosed case of Covid-19 months earlier. Someone at Walmart coughed in Ms. Garrett’s face. And when a Cherokee health worker called to offer a slot, Ms. Garrett said she relented, and convinced her husband, Larry, to come along.
As they sat in a half-empty monitoring area, waiting the requisite 15 minutes after Larry’s first dose, Ms. Garrett said she now saw getting the shot as part of who she was: “I’m Cherokee, so I have to do it.”
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