The Rural Alaskan Towns Leading the Country in Vaccine Distribution

Reid Magdanz received the call on December 21st. He was at home in his little red house in the town of Kotzebue on the west coast of Alaska. It was the winter solstice, the shortest day of the year. The sun had risen around 1 p.m., but when Magdanz’s phone rang an hour later, the sun had already sunk back towards the horizon. He answered the call and, as soon as he was off the line, picked up his handmade beaver hat and headed out the door.

Magdanz was born in Kotzebue and grew up there. The city has about 3500 inhabitants, of which about seventy percent are Iñupiat. (Magdanz, who is thirty and white, alternates between building construction in the summer and working on Iñupiaq language revival projects in winter.) Kotzebue is thirty-three miles north of the Arctic Circle, meaning that sunlight is fleeting, even on days without it Solstice. In the weak winter sun, the shadows disappear and everything looks flat. On the afternoon of the twenty-first it was windy and below ten degrees Fahrenheit, but Magdanz didn’t feel too cold. He walked two blocks to the local hospital and went into a heated tent that had been set up outside. He said hello to some people he recognized: some people from the local freight and fuel companies. There was no line. It was over in twenty minutes. The way home was upwind and a little colder. At 2:30 p.m. he was back at work. “You are lucky,” said Magdanz, “to have the opportunity to get the vaccine.”

Cities in rural Alaska beat the rest of the country in vaccine distribution. In Manhattan, about seven percent of the population is fully vaccinated, and in LA County, it’s just under 10 percent. These states have been plagued by rollout mismanagement, congested websites, and supply chain issues: vendors in New York reported throwing away unused cans, and San Diego health officials tweeted about available appointments that needed to be filled. By now, Alaska has fired nearly eighteen percent of its population – a higher percentage than any other state in the nation. In Sitka, the small town in Alaska where I live, fifteen hundred people – out of a total population of eight thousand – have already received a second dose. We are well on our way to finalizing the vaccinations this spring. In many rural cities across the state, tribal health organizations, not the state government, are responsible for distributing vaccines.

Alaska has one of the lowest death rates from COVID-19 in the country. However, the deaths have followed a dark historical pattern. In 1900 influenza and measles decimated the western part of the state, with indigenous communities losing up to fifty percent of their population; Two decades later when the Spanish flu hit, Alaskan Native Americans made up 48 percent of the state’s population and more than 80 percent of the deaths. A century later, the Alaskan indigenous people disappear Almost forty percent of COVID-19 deaths– while only sixteen percent of the population. The death rate is almost twice that of other ethnic groups.

It is difficult to overestimate the level of isolation in these communities, which at various times have had some of the highest COVID-19 case rates in the country. To get to Akutan, a Unangax town of one hundred people along the Aleutian Islands, residents must fly to a neighboring island and then take a helicopter seven miles west. In Teller, a two hundred-person town in Iñupiaq on a Bering Sea spit north of Nome, residents rely on hunting and fishing to supplement their food supplies. The Alutiiq village of Port Lions in the northern part of Kodiak Island does not have a grocery store. Instead, residents can order staples like flour and sugar, which are delivered by air. In many communities, the nearest hospitals are often hundreds of miles and a flight away.

Tribes are sovereign nations and therefore set their own vaccine allocation and distribution priorities. In December, when the vaccines hit, tribal peoples were among the first to vaccinate elders 65 and older (despite federal guidelines suggesting an age limit of 75 years). The state of Alaska soon followed, and the rest of the country soon followed suit. Many tribal health organizations have also chosen to vaccinate both indigenous and non-indigenous populations. Some prioritize those who live in local households or work in essential services. Although they work with their local communities, tribal health organizations each have their own Guidelines and autonomy through which they can be vaccinated. In Unalaska, for example, the Qawalangin tribe decided to give priority to teachers and school staff and began vaccinating in January. The state just opened vaccines to teachers last week.

Large cities like Anchorage and Juneau, which are primarily served by the Alaska state government, are experiencing similar rollout issues as the bottom forty-eight. Vaccine appointments fill up instantly, Websites are difficult to navigate and authorized groups do not know where to go. In contrast, most communities served by tribal health organizations vaccinate their populations almost seamlessly. One reason for this is that the populations they serve are much smaller – often on the scale of tens of thousands or less. There is often only one healthcare provider in the city and everyone knows where to go and how to get there. Another reason is that Alaska’s native communities are underserved by the federal government while they are occupied. In response, tribal health organizations have worked hard to develop their own strategies to reach their diverse and geographically dispersed populations. Larger urban health systems face the logistical challenge of vaccinating their populations. Alaska’s native health systems have grappled with similar challenges for decades.

While Kotzebue is larger and more accessible than the surrounding communities, it’s still a bit remote – there are no roads into town, just flights. Like the rest of the state, the city received its first shipment of vaccines in December to the Maniilaq Association, the tribal health organization that serves Northwest Alaska. The vials were then delivered to the city centralized hospital, and key workers and elderly people across the area were invited to get the shot. Both natives and non-natives – like Magdanz, who qualified because he is a tribal worker – got into the first rounds. In mid-January, Kotzebue opened vaccines to anyone over the age of 16. By then, however, more than a third of the city had already received at least the first dose of the vaccine. In such a small community, almost every working adult qualifies as an essential worker.

Take, for example, Thomas Baker, the 26-year-old vice mayor of the city of Iñupiaq, who is also superintendent of a local construction company, member of the Kotzebue Tribal Council and writing teacher on the Chukchi campus of the University of Alaska, Fairbanks. Baker qualified for the vaccine four times. He was put down at the local Lions club, which had weekly bingo evenings and occasional dances in town during normal times. Now that he’s vaccinated, he’s looking forward to being around people again. “Not even a party or anything,” he said. “But just talk to your roadside neighbors or at the post office.”

Zazell Staheli Cummings, thirty-three years old and part of Iñupiaq, was offered the vaccine in early December. As one of only four dentists in Kotzebue, she works on the front lines and has seen patients during most of the pandemic. Cummings has three children: an eighth year, a third year, and a two-year-old who all stayed with a babysitter at home. (The public schools in Kotzebue, which had been closed for months, recently reopened for personal learning.) “If I were to teach someone else’s children, you would have all the patience in the world,” said Cummings. “But you know, when it comes to teaching your own children, it’s different.” She looks forward to having her children back in school and looks forward to taking them out of the house even more regularly once the rest of the community is vaccinated. She also hopes to spend time with her aana or grandmother again soon.

But does the widespread availability of the vaccine mean that everyone is actually choosing to receive it? Alaska is a Conservative state, and after centuries of abuse by the federal government, many local communities distrust vaccination programs. Last month, Alaska Public Media reported One reason so many tribal vendors could offer expanded access to the vaccine is because a third of health workers and elders turned it down.

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