Officials are urging the US government to distribute designated funding amid the pandemic, but it’s blocked by red tape

This article is more than 5 months old

This article is more than 5 months old

Native American health leaders are urging the US government to distribute urgently needed equipment and funding to help contain the spread of coronavirus among tribal members, amid mounting concerns that the pandemic could overwhelm chronically underresourced tribal health services.

Tribes are reporting shortages of essential protective gear and testing services, as well as medical manpower and emergency planning expertise which were already severely lacking in many communities due to insufficient federal investment.

There are 574 federally recognized sovereign tribal nations located across almost 40 states within the geographic borders of the United States.

Native communities are disproportionately affected by health conditions that the Centers for Disease Control and Prevention (CDC) has specifically identified increase the risk of serious complications from Covid-19.

On Tuesday, the Navajo Nation, the largest territorial tribe with 350,000 members, shut down its casinos and resorts as part of broad emergency measures after a 46-year-old tribe member was diagnosed with the virus in Arizona. By Friday, 14 cases had been confirmed.

So far, only a handful of Covid-19 cases have been confirmed on tribal lands, but limited access to testing and real-time surveillance means the true number is likely to be much higher – and expected to increase rapidly in coming days.

In Washington, amid pressure from a handful of lawmakers to include Native Americans in the coronavirus aid package, $40m was designated for tribal health and Urban Indian Health Organizations (UIHO) as part of last week’s emergency federal relief legislation. The money, which is far lower than health leaders had requested, is to beef up surveillance, infection control and mitigation measures to confront the rapidly evolving Covid-19 crisis.

But while the states received the emergency funds immediately, the tribes are yet to receive a cent as it must go through the CDC.

“It’s not enough … a lot more funding is going to be needed across Indian country … we need resources, and supplies as quickly as possible, distributed directly to the tribes,” said Dr Thomas Kim, medical director of the California Rural Indian Health Board (CRIHB).

“During the H1N1 crisis, it was awkward, delayed and cumbersome to access supplies from the national stockpile. We hope this doesn’t happen again, because timing is critical,” added Kim.

A lot more funding is going to be needed. We need resources, and supplies as quickly as possible, distributed directly to the tribes Dr Thomas Kim

Tribal health organizations are not guaranteed access to drugs and medical supplies in the federal national stockpile.

“Lives are at stake,” said Francys Crevier, executive director of the National Council of Urban Indian Health (NCUIH). “We are gravely concerned about the timeline for funds and resources to Indian country … organizations are already seeing significant impacts to their already chronically underfunded budgets.”

At least 70% of American Indian and Alaska Natives reside in urban or suburban areas. One program in Seattle, Washington – the state with the second-highest number of confirmed cases – estimates monthly costs to rise by three-quarters of a million dollars during the pandemic.

Despite the Trump administration dismantling federal pandemic units, important steps have been made to improve community resilience in recent years.

In the wake of 9/11, the CDC created the public health emergency preparedness (PHEP) program to help states plan and prepare for unpredictable crises such as terrorist attacks and disease outbreaks.

The program has been a roaring success, according to the CDC website, with almost 100% of states ready to mobilize staff during an emergency, operate an incident command system, and have sufficient storage and distribution capacity for critical medical supplies.

But tribal nations have been excluded from PHEP program funds – despite pleas from the CDC’s own senior tribal representatives.

“Many tribes won’t have adequate, well-rehearsed emergency plans because the CDC repeatedly refused to include them in PHEP,” said Dean Seneca, a former senior health scientist in the CDC’s office for state, tribal, local and territorial support. “It was an ongoing battle, we fought tooth and nail to make tribes directly eligible for this support but the CDC always said no … too many tribes aren’t ready for this [pandemic].”

Last week, congresswoman Deb Haaland, vice-chair of the House committee on natural resources, co-sponsored legislation to overturn this inequality, which some fear could prove catastrophic for smaller tribes during the pandemic.

“The CDC is not working well with the tribes at all … we have to fix this. This is a national crisis and coronavirus is not going to discriminate against anyone and it’s vital every nation has the help it needs to weather this storm,” Haaland told the Guardian.

Facebook Twitter Pinterest Congresswoman Deb Haaland lobbied for money to be designated to tribes in the multibillion-dollar coronavirus aid package. Photograph: J Scott Applewhite/Associated Press

Haaland, the first Native woman to be elected to Congress, also lobbied for designated money for tribes in the multibillion-dollar aid package: “The $40m is an emergency supplement which the tribes needed yesterday … of course it’s not enough because the Indian Health Service (IHS) has been underfunded for decades, but we are determined to make sure tribes are specifically included in every federal package so people get the help they need.”

Covid-19 is exposing gaping political and healthcare chasms in countries across the globe.

The deep-seated deficiencies in tribal health services in the US – and inequalities in Native health outcomes – were already stark.

The US government is required to ensure adequate healthcare, education, housing, economic development and agricultural assistance for tribal nations, as part of its treaty obligations. But it has never adequately funded these treaty provisions, according to the National Congress of American Indians.

In 2016, the government spent $8,602 per capita on healthcare for federal inmates compared with $2,843 per patient within the IHS. A quarter of medical positions within the IHS – including doctors, dentists and nurses – are vacant, according to an investigation by the New York Times. In some areas, the vacancy rate is as high as 50%.

The mortality rates for chronic preventable diseases such as diabetes and lower respiratory conditions like asthma, emphysema and bronchitis are three to five times higher for Indians using tribal IHS hospitals than the rest of the US population.

The data from Asia and Europe clearly shows the elderly and those with these sort of pre-existing medical conditions are most likely to suffer serious complications – including death – from Covid-19.

The elderly play a unique role in tribal communities, according to Vanesscia Cresci, research and public health director at CRIHB. “Our elders are the keepers of culture and tradition, and often the last speaker of native languages, to lose them could mean losing a language, we have to keep them safe.”

In South Dakota, a housing officer in the Yankton Sioux tribe tested positive last week after traveling to Las Vegas with four other tribal members. He came into close contact with at least 14 colleagues and numerous community members before seeking medical help. His travel companions tested negative; others he had contact with were advised to self-quarantine, but weren’t tested.

“We don’t have a medical emergency plan … we’re taking precautionary measures on the fly,” said council member Derrick Marks. The tribe declared a state of emergency, and shutdown schools, tribal offices and social gatherings for the elderly.

The precarious situation has community elder Joan Jones, 58, a diabetic whose furnace the housing officer fixed a day before being diagnosed, scared. As well as caring for her diabetic husband, children and grandchildren, Jones works in a nursing home and helps coordinate a free meal service for the community’s poorest families still reeling from last year’s devastating floods.

“I’m staying home. I don’t want to infect anyone else, especially my family, we’re all worried.”