Natives reluctant to test vaccines

Tribes face challenge of overcoming trust gap

FLAGSTAFF, Ariz. — The news came during a hopeful time on the largest Native American reservation.

The number of daily coronavirus cases was in the single digits, down from a springtime peak of 238 that made the Navajo Nation a U.S. hot spot. The tribe, wanting to ensure that a COVID-19 vaccine would be effective for its people, said it would welcome Pfizer clinical trials on its reservation spanning Arizona, New Mexico and Utah.

Right away, tribal members accused their government of allowing them to be guinea pigs, pointing to painful times in the past when Native Americans didn’t consent to medical testing or weren’t fully informed about procedures.

A Navajo Nation review board gave the study quicker approval than normal after researchers with Johns Hopkins University’s Center for American Indian Health made the case for diversity. Without Native volunteers, how would they know if tribal members responded to vaccines the same as others?

“Unfortunately, Native Americans have effectively been denied the opportunity to participate in these clinical trials because almost all of the study sites are in large, urban areas that have not done effective outreach to Native Americans,” said Dr. Laura Hammitt of Johns Hopkins.

About 460 Native Americans participated in the trials for the vaccine by Pfizer and its German partner BioNTech, including Navajos. The enrollment reflects a growing understanding of the role that people of color play in vaccine development and the push to rapidly deploy it to curb infections among populations that have been disproportionately affected by the virus.

Yet few of the country’s 574 federally recognized tribes have signed on for the studies, a hesitation often rooted in suspicion and distrust. Many tribes also require several layers of approval for clinical trials, a challenge researchers aren’t always willing to overcome and don’t face in the states.

While vaccines from Pfizer and Moderna Inc. roll out across Indian Country, others are being studied.

In the Pacific Northwest, the Lummi Nation and the Nooksack Indian Tribe plan to participate in a vaccine trial from another company, Novavax Inc. A Cheyenne River Sioux researcher plans to enroll Native Americans and others in South Dakota in the Novavax trial and another by Sanofi and GlaxoSmithKline.

The Pfizer trials among the Navajo and White Mountain Apache tribes enrolled 275 people, about 80 percent of them Native American, Hammitt said. It wasn’t as many as researchers had hoped for, but she said it’s enough to compare immune and antibody responses in Native patients to others.

Vaccine trials nationwide have been moving quickly, which doesn’t always align with tribal guidelines on considering research proposals.

“It must be done with respect for tribal sovereignty and knowing that each individual has truly been given informed consent,” said Abigail EchoHawk, director of the Urban Indian Health Institute in Seattle.

It helped that Johns Hopkins has a decadeslong history with the Navajos and Apaches, including other clinical trials. Hammitt said the Navajo Human Research Review Board was receptive to a quick review of the vaccine trials because of the devastating impact of the pandemic.

In South Dakota, the Cheyenne River Sioux tribal health committee initially pushed back on Dr. Jeffrey Henderson’s proposal for trials of the Novavax vaccine. Henderson, a tribal member, was sent into the community to gauge support.

He expects to get approval from a newly seated tribal council, but for now he plans to set up a mobile unit outside the reservation.

In Washington state, the Nooksack tribe is set to begin enrolling volunteers in the Novavax trials Monday, said Dr. Frank James, the tribe’s health officer.

“I expect a slow start to it, and we have to get a few brave people who are comfortable with it and then people to follow,” he said.

The nearby Lummi Nation is moving forward with a three-part review and approval process for the Novavax trials.

The Associated Press Arvena Peshlakai and her husband, Melvin, volunteered to participate in coronavirus vaccine trials on the Navajo Nation. As coronavirus vaccines were being developed around the world, few Native American tribes signed up to participate.