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As Demand for COVID-19 Vaccinations Drop, One Community Nears Herd Immunity

Natalie Krebs/Iowa Public Radio News
Rudy Papakee, the director of the Meskwaki Health Center, has been at the center of the Meskwaki Nation's COVID-19 response, coordinating testing and vaccinations and advising the tribal council on restrictions.

The number of Iowans who have been vaccinated against COVID-19 is still far below what experts say is needed for herd immunity, and demand for the vaccine is decreasing.

State officials say 88 of Iowa’s 99 counties have recently declined all or part of their vaccine allocation. But there’s one place in Iowa that is nearing the herd immunity threshold — the Meskwaki Nation.

In the waiting room of the Meskwaki Tribal Health Center, Genesis Ramirez gripped a digital timer, her legs swinging in a chair.

The 17-year-old just got her second dose of the Pfizer COVID-19 vaccine, but she didn’t do it just to keep herself safe.

Credit Natalie Krebs/Iowa Public Radio News
The Meskwaki Health Center has been hosting COVID-19 vaccination clinics since December. It offers those who get vaccinated a free t-shirt, mask, and reusable shopping bag.

"My family is very high risk, and I don't want to bring anything back to them where I can't help them," she said.

Ramirez isn’t a member of the Sac and Fox Tribe of the Mississippi, also known as the Meskwaki Nation. But she’s one of the 2,600 people who live or work on the tribe’s 8,100 acre settlement west of Tama.

She’s also one of the many members of her community who’s fully vaccinated against COVID-19.

"I’ve been waiting and I've been wanting to get a vaccine just so I can know...I did something to help," Ramirez said.

According to state data, less than half of adult Iowans have been fully vaccinated. That’s far short of what experts say is needed for herd immunity.

That number is much higher for the Meskwaki Nation, where officials estimate more than 70 percent of those eligible who live and work on the settlement are fully vaccinated.

"I'm actually a little surprised to be honest," said Rudy Papakee, the health director of the Meskwaki Tribal Health Center.

"I didn't expect our numbers to be this high this quick, I thought, eventually we'd start, you know — we'd hit a plateau, or we're trying to build upon those numbers," he said. "But we actually had, in my opinion, a pretty substantial number from the very beginning."

As the state’s only federally-recognized tribe, Meskwaki Nation leaders faced a unique choice last fall. They could get the vaccine through the state of Iowa or the federal government’s Indian Health Service.

Papakee said the tribe chose the feds.

"I just thought the connection with Indian Health Service was going to get much stronger," he said. "They made some promises right from the beginning that once we get it, we'll get it to your hands as quickly as we can."

Like some other tribes who have also chosen to go through the federal government, Papakee said that’s just what happened.

Doses started coming slowly in December. They vaccinated elders and health care workers first and quickly moved on.

But vaccine hesitancy was prevalent at the start. Even tribal leaders like Delonda Pushetonequa, who is the treasurer for the Tribal Council, initially turned down the vaccine in December.

"I was one of the people who said no," she said, "like, I don't trust the government to be able to give us a vaccine."

But Pushetonequa said the Meskwaki Settlement is a close-knit community with many multi-generational homes. She said this is what ultimately persuaded her to change her mind.

"I don't want to be that person who gets my dad sick, or any of my uncles, you know, who might not fare as well, if they were to get COVID," she said.

Pushetonequa said she believes this has pushed others to get vaccinated as well.

Credit Natalie Krebs/Iowa Public Radio News
Sara Augspurger, the clinic nurse manager at the Meskwaki Health Center, said most of the community knows and trusts the center's staff. They have used this to spread accurate vaccine information.

But officials said it’s taken more than that.

Sara Augspurger, the clinic nurse manager at the tribe’s health center, said the center’s staff works hard to spread accurate vaccine information and address concerns.

Augspurger said she’s careful not to push anyone who’s not ready.

"I also tell people, if you're not comfortable, then it's not time. You know, once you get comfortable with it, that's when you should get vaccinated," she said.

"And I've had four or five people be like, 'Nobody's ever said that to me. You know, I feel like everybody's forcing me, but that makes sense,’ and have actually turned around and gotten vaccinated," she said.

Papakee said he posts updates regularly in Meskwaki Facebook groups to address ongoing hesitations. He said he answers questions directly and tailors the experience of getting vaccinated to the community.

We created a post on social media that said, ‘If you've had the vaccine, what were your reactions?’ So it's no longer, ‘I read this on the news,’ or ‘I saw it on the internet.' It's your friend, your neighbor, your cousin, your relative," he said.

But Papakee said demand for the vaccine has started to decline. Meskwaki leadership launched a program three weeks ago for the settlement’s 500 tribal operations employees, which offers them a $100 Visa gift card for each COVID-19 shot they get.

Credit Natalie Krebs/Iowa Public Radio News
The Meskwaki Settlement is on 8,100 acres west of Tama. The Sac and Fox Tribe of the Mississippi is Iowa's only federally-recognized Native American tribe. An estimated 2,600 people live or work on the settlement.

That’s pushed their group’s vaccination rate to nearly 80 percent. It’s a program Papakee said he hopes to extend to all tribal members soon. He said his "golden number" is to get 85 percent of the community vaccinated.

On top of that, he said officials are also planning unveil other incentives, like making employees use their own sick leave if they get COVID-19 and are not vaccinated.

That's something the Iowa Department of Human Services has considered to increase its employee vaccination rate at its six facilities.

'This is just another thing that we've had to overcome'

As soon as the first COVID-19 case hit the Meskwaki Nation in March of last year, tribal officials put strict restrictions in place.

"We were the first case in Tama County, so we kind of became the epicenter for for a smaller outbreak here locally within our community,” Papakee said.

Credit Natalie Krebs/Iowa Public Radio News
Lawrence SpottedBird took over as executive director for the Meskwaki Nation near the start of the pandemic. He says restrictions were necessary to keep the community safe, but they've been hard on the community.

The seven-member Tribal Council issued a shelter-in-place order and mask mandate last March. At the same time, the Meskwaki Casino, the settlement's largest employer, shut down. It didn't open until June.

The Tribal Council lifted the shelter-in-place order last June, but the mask mandate for all tribal buildings and travel restrictions for employees will remains in effect until next month, when it will be up for renewal.

“We got a lot of elders who are precious as citizens of this nation, and we need to take the safeguards primarily for them for their protection — but just each other too," said Lawrence SpottedBird, the executive director of the Meskwaki Nation.

Data shows Native Americans have been disproportionally impacted by COVID-19 infections.

According to a report by the CDC last year, Native Americans and Alaskan Natives were three and a half times more likely to to test positive for COVID-19 than non-Hispanic whites.

But the Meskwaki Nation's numbers haven't matched up to these national reports.

Meskwaki health officials have confirmed 343 cases at their health center, believed to all be members or employees of the settlement, and six deaths.

"I think a lot of it is the mitigation strategies, we took very early in the pandemic, to help ensure that our community was protected," Papakee said.

But the pandemic has still taken a heavy toll on the small community.

Papakee said rates of depression and substance abuse have increased.

Credit Natalie Krebs/Iowa Public Radio News
Meskwaki Tribal Council Members Delonda Pushetonequa (left) and Judith Bender have voted to put COVID-19 restrictions on the tribe. They say it's helped curb the spread of the virus.

"If you're alone isolated and can't do what you're normally used to then sometimes other things fill the void," he said.

The tribe has had to scale back and even cancel traditional events, and the limitations on gatherings has been difficult for a community that is centered around social events and family.

“When we had to shut down, there were no more public spaces for these family gatherings," Pushetonequa said. "We didn't have our pow wow. We didn't have our walk-runs anymore, you know, any of our community events. And so everyone was isolated away from each other.

Tribal Council Chair Judith Bender's brother is one of the six community members who died from COVID-19. She said she's looking forward to opening up the community again, but is very cautious about doing so.

Credit Natalie Krebs/Iowa Public Radio News
A mask mandate remains in effect for all Meskwaki tribal buildings until June, when it is up for renewal.

"I want to be sure that we don't start gathering too soon. I want to make sure that we make the right decision," she said.

SpottedBird said the community has faced financial challenges from the shutdowns as well.

He said the Meskwaki Casino has had to rely on reserves and doesn't expect to be operating at a pre-pandemic level until 2023.

"So we came out last year, of course, like most people at a loss, but we're still operating, and we're moving forward," he said.

Pushetonequa remains optimistic about the future.

"We're pretty resilient, just because of, you know, our history. We've always had to overcome everything that's come our way," she said. "And so this is just another thing that we've had to overcome.”