The federal agency that provides health care to 2.6 million American Indians and Alaska Natives is outpacing many states in its efforts to deliver COVID-19 vaccines to those it serves, despite the challenges posed by reaching remote communities.

The Indian Health Service has distributed nearly 1.22 million doses of COVID-19 vaccines to its 349 health care facilities located in 36 states across the country.

“This milestone was reached ahead of schedule despite severe weather making travel to health care facilities difficult across much of Indian Country and leading to shipping delays,” said Rear Admiral Michael Toedt, the chief medical officer at IHS. “Very shortly, we expect that everyone who needs a vaccine will be able to receive it.”

IHS officials offered an update Thursday about their efforts to vaccinate Indian Country.

Toedt said many IHS and tribally operated healthcare facilities have begun moving into the second phase of vaccine distribution, a phase that includes teachers, child care workers, critical workers, those with underlying conditions, homeless shelter residents, incarcerated individuals, corrections workers and older adults who weren’t included in the first phase.

The most recent seven-day positivity rate for Natives is 4.5 percent, down from 5.4 percent a week earlier and below the 5.6 percent positivity rate for all of the United States.

But Natives continue to suffer from disproportionate rates of hospitalizations and death rates due to COVID-19. They are 3.6 times more likely to be hospitalized as a result of the coronavirus than white people and 2.5 times more likely to die from COVID-19.

Toedt attributed his department’s success at delivering vaccines to the work of IHS staff, tribal healthcare workers and other organizations that have worked to educate Native people about the importance of the vaccine and the low risk of adverse effects associated with it.

He said IHS has had great success calling upon local tribal healthcare providers, Native language speakers and elders to deliver public service messages about the importance and relatively safe nature of the vaccine.

“We’ve also found real strength in having our tribal partners be that voice,” he said.

Indeed, a January 28 report by the Urban Indian Health Institute found that 74 percent of Native people surveyed saw vaccination as a responsibility to their community and 75 percent were willing to receive the vaccine.

However, 25 percent of those surveyed were unwilling to receive a COVID-19 vaccine, and 89 percent of those unwilling to get vaccinated had concerns about the vaccines’ potential side effects. Even 75 percent of those willing to get vaccinated had concerns about potential side effects.

In addition, 39 percent of respondents reported difficulty traveling to their clinic for an appointment.

Loretta Christensen, the chief medical officer for the Navajo Area of the IHS, said it has been difficult administering vaccines across the 27,000 square-mile Navajo Nation, the largest reservation in the U.S. But with the help of elected tribal leaders, local healthcare workers and community health representatives, IHS has managed to reach even the most remote Navajo communities, administering nearly 5,000 vaccines to people in or near their homes in those areas.

She said honesty and transparency in public messaging about the importance and relatively low risk associated with the vaccine has been essential. IHS has delivered nearly all of its public messages in both English and Navajo.

“Developing that trust with the people you are serving is vital,” Christensen said. “We have spent a great deal of time on that relationship with our Navajo people to encourage them to be vaccinated.”

IHS has even begun reaching out to Navajo tribal citizens living beyond reservation borders, encouraging them to return with their families to be vaccinated, she said.

Toedt said the challenge of getting vaccines to its healthcare facilities has been, at times, significant.

Commander Kailee Fretland, deputy lead for the IHS COVID-19 Vaccine Task Force, described federal healthcare workers having to deliver vaccines by helicopter to a clinic on the floor of the Grand Canyon and enlisting the help of local Coast Guard units to help deliver vaccines to tribal communities in Michigan and Wisconsin.

Other IHS workers have had to drive across multiple states, at times traversing dangerous ice- and snow-covered highways, to get to healthcare facilities separated by hundreds of miles, she said.

And IHS isn’t alone in facing enormous challenges delivering vaccines to remote Native communities.

In Alaska, tribal healthcare workers from Maniilaq, a small village in northwest Alaska, have delivered vaccines to 12 villages near the town despite the lack of roads, said Sen. Lisa Murkowski (R-Alaska), speaking Monday at an event hosted by the National Congress of American Indians.

“These medical teams are flying out on small bush planes,” Murkowski said in her Congressional response to the annual State of Indian Nations.

“They’re getting picked up by snow machines, and then they’re pulled by sled to the homes of the elders, where the shots are put in the arms,” said Murkowski, who serves as vice chair of the Senate Committee on Indian Affairs.