Tribal health providers have figured out the key to Covid-19 vaccine success. Here's their secret

Medical staff at the Northern Navajo Medical Center administering Covid-19 vaccines in Shiprock, New Mexico. The Navajo Nation has a higher vaccination rate than most states.

(CNN)Native people have been disproportionately hit by Covid-19, experiencing higher rates of infection, hospitalization and death than White people in the US. But when it comes to vaccine administration, tribal health providers are often outpacing counties and states.

For the most part, the Covid-19 vaccine rollout in the US so far has been beset by long lines, glitchy websites and canceled appointments. Meanwhile, many tribal nations and health clinics have moved efficiently through their vaccine allotments and distribution phases -- with some already offering shots to Native people as young as 16.
"We have some real crushing challenges in Indian Country," said Stacy Bohlen, chief executive officer of the National Indian Health Board. "We have a perfect storm for a pandemic like this to really knock us down. But we are also very, very resilient people."
It's important to note that there are 574 federally recognized tribes, making it difficult to broadly characterize how the vaccine rollout is going across Indian Country. Native people get their health care from a patchwork system of Indian Health Service facilities, tribally-operated clinics and urban Indian health centers, and vaccination efforts have varied from tribe to tribe and state to state.
    Still, the successes of some tribal health providers offer lessons for communities struggling to vaccinate their populations efficiently. Here are some of them.

    They tailored their messaging to build trust

    From the beginning, vaccine hesitancy was a public health challenge for tribal health providers, especially given the federal government's history of unethical research and medical abuses committed against Native people.
    A recent survey of 1,435 American Indians and Alaska Natives from the Urban Indian Health Institute found that 75% of participants were willing to get a Covid-19 vaccine, largely out of a sense of responsibility to protect their communities and preserve their cultures. That suggests that culturally relevant messaging is key to building vaccine acceptance among Native people, the report's authors wrote.
    It's a strategy that the Cherokee Nation says has worked for them.
    The Cherokee Nation has administered more than 17,000 vaccines as of February 8, according to the tribe. About 141,000 Cherokee Nation citizens live within the bounds of the tribe's reservation in northeastern Oklahoma, suggesting an impressive pace so far.
    The tribe's "biggest confidence builder" in the vaccine has been its decision to put fluent Cherokee speakers at the front of the line, said Principal Chief Chuck Hoskin Jr.
    Cherokee speakers were among the first groups eligible for the vaccine, as part of the tribe's effort to save its language from the existential threat of Covid-19. Only about 2,000 people could speak Cherokee fluently before the pandemic. The virus claimed the lives of an estimated 45 speakers.
    By inoculating its most revered and treasured citizens first, the Cherokee Nation signaled to others who may have been on the fence that it believed the vaccine was safe.
    "That's done something to create a sense of optimism among our people and also to boost the confidence of other Cherokees who see these very revered Cherokee elders, in many cases who are fluent speakers, getting the vaccines and celebrating it," he told CNN.
    People wait in line at a senior care center on the Navajo Nation in Chinle, Arizona, to receive the Covid-19 vaccine on December 18, 2020.
    Navajo Nation President Jonathan Nez said that people were hesitant to get the vaccine early on, so he got the shot on camera to help build confidence in it. The tribe has also been answering questions Navajo people have over the radio and in twice weekly town halls, sometimes bringing in experts like Dr. Anthony Fauci.
    Also key to the tribe's confidence-building efforts are Navajo doctors and health care professionals, who are able to speak to citizens in their own language and alleviate any concerns about its safety.
    "Utilizing our way of life and teaching helps our Navajo people feel it's okay to take the shots," Nez said.
    About three out of four Navajo citizens are now interested in getting the vaccine, according to Nez. To accommodate that interest, the tribe has been holding mass vaccination events seven days a week.
    As of February 8, nearly one in three people on the Navajo Nation have received at least one dose of the vaccine and 4.3% have been fully vaccinated -- a rate higher than most states. It's a story of resilience and perseverance, Nez said, especially given how hard Covid-19 hit the tribe.

    They have the autonomy to decide who gets priority

    Tribes are sovereign nations with the autonomy to determine how to provide for the health care needs of their communities. For those that operate their own health systems, that meant being able to decide who should get priority for the vaccine.
    That autonomy allows tribes to adequately respond to the unique challenges they face, said Bohlen.
    For example, the Centers for Disease Control and Prevention recommended that initial phases of the vaccine distribution include people 75 and older because they are at higher risk of severe illness and death for Covid-19. But certain tribes might decide to expand those parameters because of the health disparities their populations experience.
    "Our life expectancy is so much lower than the general population that we have to be able to make the decision that maybe a 55-year-old is in fact an elder, if you're in a tribe where the life expectancy is 58," Bohlen said.
    Colleen DAmico, a clinical pharmacist with the Seattle Indian Health Board, administers a Covid-19 vaccine to nurse Shawn Thurman on December 21, 2020.