MOORHEAD, Minn. — Ever since Minnesota began distributing coronavirus vaccines to the public, Mahnomen County in northwestern Minnesota has consistently run ahead of the pack, vaccinating at rates that far surpass most of its peers. As of this week, a full 85% of people 65 and older in the county have been vaccinated.
Mahnomen’s unique status as the only Minnesota county entirely within the borders of a Native American reservation is a key factor behind the county’s rapid move toward broad community vaccination. Public health leaders at the White Earth Nation and Mahnomen County credit that high vaccination rate to close collaboration between the tribe and the county to efficiently get those doses to residents.
Shipments of the COVID-19 vaccine are reaching Mahnomen County through several different channels. The state of Minnesota is allocating vaccine to tribal and county public health departments, as well as clinics operated by the Sanford and Essentia Health systems. The federal government is allocating vaccine to the Indian Health Service clinic at White Earth, and local Thrifty White pharmacies through its retail pharmacy program.
Broad distribution: ‘The right thing to do’
The White Earth Reservation is a patchwork of tribal and private land — and the people who live there are a nearly equal mix of Native Americans and non-Native people. That raised the question, early on, of who the tribal public health department should vaccinate.
The answer: Everyone.
"Vaccine wasn't limited to people who were enrolled members or who had a way to prove they had Native Nation blood,” said tribal public health medical director Dr. Carson Gardner.
“Anybody who lives here on White Earth lands and met the other criteria was offered vaccine. We discussed that at length and decided that was the right thing to do."
And because White Earth is a sovereign nation, it has the authority to set its own parameters for who is eligible to be vaccinated.
So, right now, anyone who is over the age of 18 and lives within the White Earth Reservation’s boundaries — including all of Mahnomen County — is eligible to be vaccinated for COVID-19 through the tribe’s public health department.
White Earth's access to vaccine supply, and tribal leaders’ willingness to share, has been a boon to all local residents, said Sarah Kjono, director of the Norman-Mahnomen Public Health department.
"They've been able to get some pretty large allocations for the population size, and we welcome that," she said. "Now anyone who has a primary residence on the reservation, or sometimes people who work in the county, as well, are able to get vaccinated. That's a real benefit.”
Nationwide, the distribution of the COVID-19 vaccine began, in part, with Minnesota’s Native American tribes. Health care workers on reservations in Minnesota — including White Earth — were among the first in the country to be vaccinated, after the two-dose Pfizer shot was given emergency authorization in the first half of December.
The Indian Health Service office in Bemidji, which serves tribes in Minnesota, Wisconsin and Michigan, was among the first IHS offices in the nation to receive the vaccine, and the next day, it was being administered to health care workers and elders in the clinic near the village of White Earth.
The 11 tribal nations in Minnesota have the option of receiving vaccine directly from the federal government through the Indian Health Service, or through the Minnesota Department of Health. White Earth and six other tribes have chosen the latter.
The state Health Department declined to provide a breakdown of the vaccine doses it’s allocating to Native nations, but said about 16,000 had been distributed to tribal health sites as of Tuesday, Feb. 16. By the end of January, the federal Indian Health Service had distributed more than 10,000 vaccine doses to tribal health centers across the state.
Because tribes have opted to work with the state on vaccine distribution, the federal Department of Health and Human Services said Minnesota is among several states receiving an additional allocation of vaccine. The federal government declined to provide details about the state’s “sovereign nation supplement,” and the state Heath Department said it had no information about the extra allocation.
According to a U.S. Department of Defense report, the supplement came about after Operation Warp Speed, the federal government’s vaccine procurement and distribution program, identified potential inequities in states where tribes elected to received vaccine from states instead of the federal government.
As a result, a proportional supplement of doses was allocated to those states.
Tribes’ vaccines benefit broader community
The Minnesota Department of Health has prioritized tribal nations in its distribution since COVID-19 vaccines first became available.
"Tribes will get allocations, probably a lot higher than the rest of the state, because of the vulnerability of the population, the fact that they're the hardest-hit of all of the populations in the state," said MDH’s American Indian health program director, Jackie Dionne.
Some might interpret the prioritization as tribal nations getting preferential treatment, Dionne said. But the government has a long history of underfunding tribal health care and services, which has led to high rates of chronic disease.
Those health disparities have made Native people significantly more vulnerable to the worst effects of the coronavirus.
"People see this as a population prioritized because of race and not because of situations and circumstances,” Dionne said. “We need to turn that narrative around.”
Outside Mahnomen County, other Minnesota counties have also benefited from tribal vaccine programs, and their partnerships with tribal health departments.
The Grand Portage Band of Ojibwe, in far northeastern Cook County, has vaccinated nearly every tribal member and nonmember on its reservation.
"This week is the first week that we declined a shipment (of vaccine), because we're at a point now where we pretty much have vaccinated or will have vaccinated everyone that wants to be vaccinated,” said Grand Portage Health Service Director Jenn Sorenson.
Cook County’s vaccination rate recently became the highest in the state. As of earlier this week, more than 35% of its residents have been vaccinated, surpassing Mahnomen’s rate by just a few percentage points. Several other Minnesota counties located partially on or adjacent to reservations have similarly high rates.
Tribal nations are receiving the Moderna vaccine through the state, because it’s easier to store and distribute — which has meant that some tribes with smaller populations have received an larger allocation of vaccine per capita than others because of the way the vaccine is packaged.
"You can only ship Moderna in batches of 100," said Dionne, "And so if you're one of the smaller tribes, you're getting a higher percentage than some of the bigger tribes."
‘You know everybody on a first-name basis’
Each county health department in the state is also receiving its own allocation to distribute, according to MDH guidelines. And while the volume of vaccine helps move counties’ progress forward, local leaders say collaboration and communication ensure they are able to take advantage of the multiple vaccine streams.
To maximize those efforts, White Earth officials operate a joint coronavirus task force with Mahnomen County. It ensures the distribution is streamlined.
“We know that there's no duplication of effort,” said emergency manager Ed Snetsinger. “I think that's very important whenever you have a new response. It is a cooperative effort, (and) I think it's gone quite well.”
Tammy Carlsrud, a nurse from Norman-Mahnomen Public Health, has worked in the emergency operations center alongside tribal officials since the pandemic began. She said the team has gotten to know each other well, over the course of the pandemic.
“We've come to trust each other so much, and we just have such good cooperation and collaboration.” Carlsrud said. “For a while there, early on, it was always county versus tribe, and I felt like I had to walk such a careful line. But now I feel like we're just one group of people working for the betterment of all the folks on the reservation.”
Tribal and county public health staff have worked side by side to administer vaccines. And as in many rural communities, there's a familiarity that means everyone knows who's gotten a shot.
"You know everybody on a first-name basis," Kjono said. "That can be great, and sometimes it can be, ‘Oh boy, you know, so-and-so's calling me again on my personal cellphone, asking when can they get their vaccine.’”
Those connections have been critical to making the vaccine accessible to as many people as possible. White Earth officials contacted all the tribe’s elders, to make sure they could get a vaccine at a clinic or in their home.
At one point, Kjono heard from two older women who were worried about driving to a vaccine clinic during the recent cold weather. So she contacted a local sheriffs deputy, who's also the mayor of a small town.
"He called me back about an hour later and said, 'We got it figured out, and I even got a backup person to help me if it gets too busy,’” Kjono recalled. “You know, you can't quantify a lot of these stories about rural Minnesota, how we just make things work and happen."
That goes for the relationship between the county and the White Earth Nation, too, she said. As they've navigated the pandemic together, the trust and collaboration they've built are likely to last well beyond that final dose of vaccine.
MPR News reporter Dan Kraker contributed to this story.