OKPOLICY.ORG
On March 6, 2020, Oklahoma reported its first confirmed case of COVID-19 and declared a statewide emergency 10 days later. As the pandemic now enters its third year, Oklahomans continue grappling with the impact of lives lost and the immense disruptions it has created. OK Policy will be reflecting on the COVID-19 pandemic’s impacts and challenges. Our hope is that this will highlight opportunities for collaborative decision-making, future improvements, and prosperity for all Oklahomans.
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Indian Country has always suffered striking health disparities, chronic underfunding, and the delayed fulfillment of the federal government’s trust responsibilities to Tribal Nations. Taken in combination, this means Tribal Nations historically have lacked necessary resources to provide for many basic health services, let alone to tackle a global public health emergency, such as the COVID-19 pandemic. Despite this, Tribal Nations in Oklahoma were able to effectively utilize what resources were at their disposal to provide strong responses to safety measures and closures, even during the COVID-19 surges. Disparities should be addressed through better resources, data collection, and addressing long-standing discrimination and underinvestment.
Tribal Health Systems did well with available resources but had barriers to overcome
Tribal Nations took swift and robust action to address the COVID-19 pandemic. Oklahoma’s population includes more than 630,000 American Indians/Alaska Natives (AI/ANs), 39 tribes, and a diverse range of tribal health systems. Tribal sovereignty was demonstrated through a rapid public health response to COVID-19 across the state. Tribal health systems include Indian Health Services (IHS), Tribal Health Facilities, and Urban Indian Clinics. During the pandemic, they immediately implemented COVID-19 protocols, public testing, contact tracing, and COVID-19 vaccination centers. They also implemented telehealth options; created tiny homes for safe isolation and quarantine; and expanded public health, hospitals, medical laboratory spaces, and health services. For example, the Muscogee (Creek) Nation opened the Council Oak Comprehensive Healthcare in August 2021. The Tulsa-based facility includes a monoclonal antibody infusion center, available to both tribal and non-tribal patients.
In the earlier months of the pandemic, the Centers for Disease Control and Prevention reported that COVID-19 incidence rates were 3.5 times higher for AI/AN compared to non-Hispanic white Americans. By February 2021, AI/ANs were dying from COVID-19 at almost twice the rate of white Americans. While vaccines have made a positive impact in reducing case counts, Indian Country continues to be disproportionately impacted by COVID-19. Indian Country is not a monolith, and each tribe’s particular response played a vital role in addressing how severely impacted they were by COVID-19.
Historical patterns of chronic disinvestment and systemic discrimination have left AI/ANs particularly vulnerable to the COVID-19 pandemic
Indian Country has battled a history of anti-Indian public policies, underinvestment, misconceptions, and ongoing settler colonialism that has created a long pattern of harsh health conditions and discrimination that needs to be addressed. Nevertheless, Tribes continue to support tribal citizens and non-tribal citizens during health crises. A prime example of the historical pattern is the recently announced IHS budget, which was $1 billion less than anticipated and only half of what tribal leaders reported needing. While COVID-19 relief helped in the short term, IHS will have — yet again — less money to address historical health disparities and COVID-19. COVID-19 has shed light on a long legacy of neglect and oppression of Indian Country, as well as Indian Country’s tenacity in cultural and community strengths rooted in tribal self-governance. While AI/AN only make up a small percentage of the national population, the number of documented COVID-19 related deaths have devastated tribal communities. (Due to shortcomings in testing and data-related issues, these numbers likely understate the true death toll among AI/ANs.) The National Indian Health Board (NIHB) recently reported the COVID-19 death toll among AI/AN had passed 10,000 by February 2022.
There continues to be substantial gaps in the availability of AI/AN COVID-19 information in publicly accessible databases
Publicly available databases are missing comprehensive demographic information that would allow researchers to gauge the effectiveness of current public health approaches and help prevent and reduce health disparities within Indian Country. While the Oklahoma State Department of Health does provide a weekly epidemiology and surveillance report that includes gender and race/ethnicity by week, it does not include federal entities — such as IHS — in Oklahoma. Researchers also lack data specific to only Oklahoma on vaccinations administered by the IHS, which is the principal federal health care provider for AI/ANs. The Oklahoma Area IHS data covers Oklahoma, Kansas, and Texas. Southern Plains Tribal Health Board, an Oklahoma-based non-profit focused on tribal public health needs and policy, includes cases and deaths by tribe, but only for 19 of Oklahoma’s 39 tribes. With the lack of inclusive, comprehensive data, it is difficult to know exactly how many AI/ANs have tested positive or even died from COVID-19 in Oklahoma.
The pandemic has shown us that Oklahoma needs better data and tribal-state collaboration to address health disparities
Not only can better data collection pinpoint racial disparities during the COVID-19 pandemic, but it can also help guide response efforts, medical countermeasures, and prevention activities. Oklahoma can do better by respecting data sovereignty (the right of Native nations to govern the collection, ownership, and application of its own data) and working with tribes on data sharing. Oklahoma can also mandate and incentivize the collection and reporting of race/ethnicity for all COVID-19 cases and provide resources to do so. Another critical update to address health disparities is to include all health systems in the state in data collection. The overall lack of data about our state’s AI/AN population obscures the true burden experienced by Oklahoma’s tribes. In turn, this directly impacts the ability of local, state, federal, and tribal public health authorities to collectively address the disproportionate impact of COVID-19. Due to this lack of information, policymakers are unable to make data-driven decisions to make policies more equitable and allocate resources adequately to eliminate health disparities in Oklahoma.
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On March 6, 2020, Oklahoma reported its first confirmed case of COVID-19 and declared a statewide emergency 10 days later. As the pandemic now enters its third year, Oklahomans continue grappling with the impact of lives lost and the immense disruptions it has created. OK Policy will be reflecting on the COVID-19 pandemic’s impacts and challenges. Our hope is that this will highlight opportunities for collaborative decision-making, future improvements, and prosperity for all Oklahomans.
