Facilities across Indian Country have begun distributing a newly approved COVID-19 vaccine but the vast majority of tribal citizens will have to wait before they can be protected from a disease that continues to ravage their communities.

From Ojibwe territory in northern Minnesota to the largest reservation in the United States, the shipments of the coronavirus vaccine began arriving at Indian Health Service facilities on Monday. The doses are part of a first wave of distributions the agency will be receiving this month.

“The IHS has been a consistent voice and advocate for vaccine allocation across the Indian health system and tribal communities,” Rear Admiral Francis Frazier, a citizen of the Cheyenne River Sioux Tribe, said during a media call on Friday.

Altogether, the IHS expects to receive more than 64,000 doses by the end of December, officials said on the call. As part of Phase 1A of the the agency’s COVID-19 vaccine plan, all of the initial doses are being set aside for health care professionals and residents of long-term centers, such as those serving the elderly.

“This would allow IHS to vaccinate 100 percent of its health care work force and residents of long term care facilities not accounted for by the Centers for Medicare and Medicaid Services,” said Frazier, who leads the agency’s COVID-19 vaccine task force.

But with COVID-19 cases continuing to rise across Indian Country, the IHS does not yet know when the vaccine will be available to those other than elders and front-line workers. Still, Frazier and other officials are optimistic that the average tribal citizen will benefit in the coming months.

“As the vaccine supply increases, IHS, tribal health programs and urban Indian organizations will be able to prioritize their local populations based on factors such as age, existing health problems and other considerations that increase the risk of severe illness or death from COVID-19,” said Frazier.

“The IHS is well prepared and positioned to begin COVID-19 vaccinations,” Frazier added. “Our ultimate goal is to ensure that safe and effective vaccines can reach Indian Country as quickly and equitably as possible.”

The IHS began moving quickly to distribute the COVID-19 vaccine produced by Pfizer and BioNTech, two commercial companies whose emergency use authorization application was approved by the U.S. Food and Drug Administration on Friday evening. The IHS expects to receive 22,425 doses of the product, according to figures provided by the agency.

A second vaccine, produced by Moderna, is expected to receive emergency use authorization (EUA) later in the week. The IHS anticipates receiving 46,000 doses of this product, bringing the total number of COVID-19 vaccine doses in Phase 1A to 68,425, according to the agency.

“Swift and equitable distribution of this vaccine, and others that may also receive an EUA, will help slow and eventually stop the spread of the virus across our nation and tribal communities,” Stacy Bohlen, the chief executive officer of the National Indian Health Board, said on Monday.

The Phase 1A doses will be distributed to IHS facilities, tribal centers and urban Indian programs in 11 areas across Indian Country. The plan excludes Alaska, as the facilities in the Alaska Area have chosen to work with the state government, federal officials said on the media call.

IHS Area	Anticipated Pfizer Doses	Anticipated Moderna Doses
Albuquerque	975	2600
Bemidji	1950	2900
Billings	975	1700
California	975	5100
Great Plains	1950	3000
Nashville	975	3400
Navajo	3900	7900
Oklahoma City	5850	8900
Phoenix	3900	7300
Portland	975	2300
Tucson	0	900
TOTAL	22425	46000

The 11 areas will be allocated the COVID-19 vaccine roughly tied to the service population in their region. That means the regions with larger numbers of patients — the Oklahoma City Area, the Navajo Area and the Phoenix Area — will receive more doses.

The Oklahoma City, Navajo and Phoenix areas happen to be the regions with the highest rates of recent COVID-19 infections among patients. According to IHS data from December 12, the 7-day positive rates in these three areas is far higher than the national average.

“Today is a historic day in this fight against COVID-19,” said President Jonathan Nez of the Navajo Nation, where COVID-19 cases have surged steadily since the middle of November, following months of progress in slowing the spread of the disease.

“With the vaccine in hand for our health care workers and those living in nursing homes, it provides more hope and optimism for our health care workers who have worked non-stop and for all of our Navajo people,” Nez said on Monday. “We have to be mindful that this will be a long process and we cannot let down our guard.”

The Indian Health Service has begun distributing #COVID19 vaccine doses to Indian Country.

Will you take the #Coronavirus vaccine if offered to you by @IHSgov or by your tribal nation?https://t.co/3Qll1CUhG1#COVID19Vaccine #CoronavirusVaccine

— indianz.com (@indianz) December 14, 2020

Still, as the vaccine becomes more widely available, the IHS plans to utilize prior experience in protecting tribal citizens from viruses. The Pfizer/BioNTech and Moderna products are notable in that they require recipients to receive two doses to become inoculated.

“We’ve had practice with this, with the shingles vaccine, which is a two-dose series,” said Commander Kailee Fretland, a descendant of the White Earth Nation who is the deputy lead on the IHS COVID-19 vaccine task force.

“So our facilities have created education pathways of getting those patients back for their second dose, so this is something we are familiar with,” Fretland said on the media call on Friday.

According to Pfizer and BioNTech, their COVID-19 vaccine was found to be more than 90 percent effective during clinical trials conducted over the last few months. More than 43,500 people participated in the study, the companies said.

However, the companies have not provided details on the number of American Indian and Alaska Native people, if any, who participated. The same goes for Morderna, whose documents lump Native people into an “All Others” category.

“We know the task ahead poses many challenges, from tricky distribution logistics to coordinating vaccination events on tight timelines to data reporting every step of the way, however it is more important than ever to meet these challenges head on,” said CEO Bohlen of the National Indian Health Board.

“Tribes are ready to take on these challenges to protect the health of their citizens,” said Bohlen, who is a citizen of the Sault Ste. Marie Tribe of Chippewa Indians.

According to figures provided to Indianz.Com, the IHS user population is 1,662,834 as of 2019. The user population is defined as the number of American Indians and Alaska Natives who have lived within an IHS service delivery area and have received health care at an IHS or tribal facility during the previous three years.

The IHS service population, on the other hand, is a much higher number. According to the agency, 2,562,290 American Indians and Alaska Natives were eligible to receive services through the IHS in 2019.