The Centers for Disease Control and Prevention (CDC) in the US has reported that American Indians and Alaska Natives (AI / AN) are 3.5 times as likely to get Covid-19 as non-Hispanic whites and four times as likely to be hospitalised. Those who are sick also tend to have different characteristics and experience more severe symptoms than the general population. These findings are not surprising as AI / AN populations are a marginalised group in healthcare in the US. Covid-19 relief and vaccine roll-out should prioritise the AI / AN groups.

Understanding the impact of Covid-19 on the AI / AN community has many difficulties. Covid-19 hits those with underlying conditions such as diabetes, heart disease, and cancers harder. The AI / AN population has a higher risk of having these pre-existing conditions. The CDC reported that native Americans are twice as likely as whites to have diabetes, at 16% prevalence compared with 8% prevalence in non-Hispanic whites. A study published in the journal Cancer Epidemiology and Biomarkers Review by Melkonian and colleagues found that lung and colorectal cancer incidence are statistically significantly higher in the AI / AN population than whites. However, the health measure disparities known in AI / AN don’t entirely explain the unique characteristics of Covid-19 in the group, such as a higher-than-expected rate of infection in the younger population. This is partly because patient characteristics in Covid-19-positive AI / AN populations are largely missing. The CDC data showed that over 90% of Covid-19-positive AI / AN patients do not have information on underlying conditions. It is difficult to determine if the trends observed in the AI / AN population are due to higher rates of underlying conditions or other causes, which makes it difficult to develop effective public health measures to stop transmission.

Figure 1: US, Comparison of Incidence of Covid-19, Lung Cancer, and Colorectal Cancer Between American Indians, Alaska Natives and Non-Hispanic Whites.

Source: GlobalData; SEER Statistics Review 1975-2017; Melkonian et al., 2019; CDC                                                                                                                       © GlobalData

Note: Cancer incidence in non-Hispanic whites obtained from SEER; cancer incidence for American Indians, Alaska Natives obtained from Melkonian et al., 2019; both are rates adjusted to 2000 US standard population.

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A successful roll-out of Covid-19 vaccines in the AI / AN population is going to be key to control the pandemic for this at-risk group. Public opinion regarding the acceptance of the vaccine within the tribal populations have been both positive and negative in the last year; however, news from this week shows an overwhelmingly positive attitude towards the vaccine currently. The Urban Indian Health Institute conducted a survey on Covid-19 vaccine perceptions and 75% of the respondents said they are willing to receive the vaccine. That is higher than the general US population, where 60% say they would definitely or probably get a vaccine, according to the Pew Research Center. The high level of acceptance of the vaccine could be due to partnerships involving the tribal populations early in the vaccine development phase. For example, the Johns Hopkins School of Public Health and the Center for American Indian Health teamed up to ensure there were opportunities for Native Americans to participate in the Pfizer Covid-19 vaccine clinical trials, in order to be able to study the safety and effectiveness of the vaccine in the population. GlobalData expects herd immunity to be reached when around 70% of the population either have recovered from the infection or have received vaccinations. If vaccine rollout can indeed reach 75% of the AI / AN population, it is hopeful the pandemic can be successfully controlled.