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Native American tribes were among the hardest hit by COVID-19, losing tribal elders to the virus—and with them irretrievable pieces of their culture and heritage. But no group in America has done more to assure their communities are vaccinated and protected. We speak to Rebecca Nagle, activist, journalist and host of Crooked Media’s This Land podcast about how Native American tribes took on the collective responsibility of vaccinating their communities and what our country can learn from them.

Transcript

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Dr. Abdul El-Sayed: New Delta cases finally start to trend downward, but deaths are up 28% over the last two weeks. The Biden administration imposes new employer vaccine mandates through OSHA to tackle the pandemic. And its flu season again, and scientists worry that flu could make a comeback as society makes its own. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. I don’t have to tell you this, but we’re in the midst of yet another major COVID-19 wave. Hospitals in states all over the country are filling up. In Idaho, they had to announce this:

[clips] And we begin with breaking news. The Idaho Department of Health and Welfare activated crisis standards of care . . . hospital beds, medicine and equipment like ventilators may be given to those considered most likely to survive, not the most critical, with the goal of saving as many lives as possible.

Dr. Abdul El-Sayed: Crisis standards of care is a euphemism for rationing everything from hospitals to clinicians to medications. It’s no coincidence that Idaho has a 45% vaccination rate. As we continue to contend with the COVID-19 pandemic and the vaccine resistance that’s perpetuating it, we’re hearing an awful lot about trust.

[man] No, I, I wouldn’t take it.

[reporter] What makes you say that?

[man] It’s just so many things going on these days that you really can’t trust other people.

[woman] There is a lot of mistrust, unfortunately, due to the history we have seen.

[2nd woman] I would probably wait for a while to see what are the repercussions, if any.

Dr. Abdul El-Sayed: Folks say that they don’t trust the government or public officials, they don’t trust large organizations or scientists, they don’t trust expertise in general. They tell us that because they can’t trust those institutions or experts, they can’t take a vaccine for a disease that’s killed 650,000 Americans in less than two years. In the spirit of empathy, I try to understand where folks are coming from. There’s a lot to be skeptical about. In fact, the same mega-corporations we rely on to manufacture and produce these vaccines have spent billions of dollars lobbying the same politicians who are supposed to regulate them. And it’s hard to trust the experts when the nature of expertise is to be cautious. Ignorance tends to be way more confident, and confidence, well, confidence sells. There’s a reason we call con men ‘conmen,’ the con part stands for ‘confidence.’ Some people have legitimate reasons not to trust, beyond the history of the biomedical establishment’s exploitation and marginalization of Black people in this country, nearly every Black person I know has a story of discrimination at the hands of the health care system. That’s not long-gone history, that’s today. But for all the reasons Black folks have to distrust, they don’t tend to be the folks out there protesting masks or vaccines. And then there’s the Native American community, I don’t think I need to explain how the United States government has betrayed the trust of the Native community time and time again, treaty after treaty, but right now, despite decades—no centuries—of actions that could destroy the trust these communities have in the vaccine, Native Americans aren’t protesting vaccines. In fact, they’re the most vaccinated people in the country. And not only that, but when governors in states like Montana drop their mask mandates, they use their tribal sovereignty rights to uphold them. This is despite the fact that the same government that has betrayed Native Americans, completely manages their health care system via the Indian Health Service, and right now they’re underfunding that system at pennies for every dollar they should be spending. Poll after poll shows, and picture after picture of anti-mask protest confirms, that vaccine resistance runs deepest in conservative-leaning white men, the very people who have the most to trust. After all, nearly all of our national institutions, the ones these folks say they don’t trust, were built by and for people like them—just take a look at the picture of the signing of the Declaration of Independence. Which poses a perplexing quandary, why is it that the folks who have the most to trust about our institutions tend to trust them the least? I think it might have less to do with the institutions themselves, and more to do with the problem they’re trying to solve. 650,000 thousand people have died of COVID-19 in this country. They’ve disproportionately been Black or brown, though. In these communities, nearly everyone I know has lost someone or knows someone who’s lost someone. The reality of COVID isn’t just in the statistics, it’s in the stories of real people these communities have known and have lost. Though COVID is increasingly affected rural white communities where vaccination is less common, it hasn’t penetrated in the same way. Those 650,000 people who’ve died, haven’t as often been sisters or brothers or mothers or fathers or friends. The imperative to act to stop it, just isn’t as clear. Instead, things like masks or vaccines are just an inconvenient imposition on your life, rather than the thing that could save your life. The irony here, of course, is that the very people protesting loudest are the ones who’ve been most protected by institutions they’re protesting. For a long time, public health and medical science assumed that the average person was a 70-kilogram man. We calculate everything from the body mass index thresholds to crash dummy testing, around white people’s proportions. For decades, our government overtly invested in housing, public health, quality air and water, in predominantly white communities, from which it actively and intentionally excluded people of color. If you’re white in this country, the high probability is the government never broke a treaty with or exploited your ancestors’ bodies. And if anything, the government is trying to impose masks or require vaccines, to protect you. Today, I wanted to step back to understand what trust looks like in a community that has every reason not to trust. So I invited Rebecca Nagle, a citizen of the Cherokee Nation and host of Crooked Media’s podcast, This Land, to update us on the why and how of Native American vaccination and what we can learn from it. We also talked about the new season of This Land, her podcast, which explores how big money interests are trying yet again to violate Native American treaty rights. After the break.

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Dr. Abdul El-Sayed: Of course, you need no introduction to our listeners, but if you could introduce yourself to the tape.

Rebecca Nagle: Sure. [speaks in Cherokee] Hi, my name is Rebecca Nagle. I’m a citizen of Cherokee Nation, living in Tahlequah, Oklahoma.

Dr. Abdul El-Sayed, narrating: Rebecca Nagle is an activist, journalist, and host of Crooked Media’s This Land podcast. Throughout this pandemic, she’s used her voice and platform to advocate for the Native American community who’ve been hit exceptionally hard. We interviewed her last season and I wanted to check back in to hear more about how Native American tribes have been fighting back against COVID, and to learn more about her new season of This Land and what it means for the future of the fight for Native American rights.

Dr. Abdul El-Sayed: Welcome again to our show, Rebecca, and of course, we’d be remiss not to mention the second season of your incredible podcast, This Land, just dropped. And if you haven’t been listening, then you’re just not paying attention. And I hope that with this conversation, you’ll appreciate and understand exactly why so many of the issues that we talk about, whether on this pod or on Rebecca’s pod, are so intertwined and linked about who gets to have health and what the rights to that health and health care are actually based on. Last time we talked, we were in the midst of the early months of the pandemic and we talked about the terrible toll that COVID-19 had taken on the Native American community. Can you tell us where we are today in terms of the nature of the pandemic and the space where Native Americans are, and how far have we come?

Rebecca Nagle: Yeah, so the data is pretty shocking. So as of early, 2021, 1 in 475 Native people in the United States had died from the coronavirus. That’s twice the death rate of white people. And I would argue it’s actually probably higher because the way that the government collects data around Native people, and public health across the board, is inadequate. And a lot of Native people, specifically the Urban Indian Health Institute, were really calling that out early on in the pandemic. So, you know, you had entire states and cities that were collecting racial demographics and putting Native people in the ‘other’ category. And there’s also a lack of conversation and communication between those jurisdictions and tribes. You know, even the places that maybe are including information about Native people aren’t also checking those folks’ tribal affiliation, so there’s not, for people not living on their tribal land, great data for those tribes. And so the rate, sadly, is probably even higher. And I think one of the hardest ways that our communities have been impacted is that our, the majority of Indigenous languages in the United States, like I think above 90%, are what’s called endangered. But basically, like in my tribe, the majority of our speakers are over 60, and a really disproportionate number of speakers make up our deaths. And so it’s that loss of cultural knowledge, of language, is part of just the sadness and the grief of losing loved ones and community members.

Dr. Abdul El-Sayed: I really appreciate you highlighting the way that, that a culture can get decimated by a pandemic like this, because oftentimes when we talk about a disease, generally, we talk about it in sterile medical terms. And even the numbers that we use to quantify it don’t really capture the impact that they have in families, communities, and in this case, on tribes. And so much of the, you know, we forget that so much of the ideas we embed are a function of the language that we speak and we use to communicate them. And with the loss of a language, one also loses full ways of thinking and in communicating ideas and embedding meanings in the way that we talk and we speak and we share ideas. And someone who grew up in first speaking Arabic, and then and then learning English and now forgetting getting a lot of my Arabic, it’s always remarkable to me the ways that ideas can move and the ways that they’re presented in different ways when they’re communicated in different languages. And it is, it is so tragic and frankly heartbreaking to hear about the loss of so much of culture and meaning with so many in the community. You know, what’s interesting is, as we’ve talked about this pandemic, one of the most frustrating things about the nationwide response has been that there has been a lot of effort put into empowering the means of ending this pandemic at the local, state and national level, but people are choosing not to do the things that they need to do, and that’s somewhat reversed in the Native American community. One of the fascinating things that we’ve seen is that despite the lack of health care and resources offered to the Native American community, when it comes to mask wearing, for example, or when it comes to vaccinating, the uptake in the Native American community has been extremely high. And to the point where, frankly, we’re watching as tribes are leveraging their sovereignty to promote public policies that are protective even in states that are choosing not to do that thing. Can you speak to what and why so much effort has gone into this, and maybe the dynamics of collectivity, that are empowering Native Americans to do the right thing when it comes to the pandemic, even despite the lack of resources, and how that contrasts to a lot of the dumpster fire that we’ve seen when it comes to COVID-19 and choices that are being made around it in the rest of the country?

Rebecca Nagle: Yeah, absolutely. So I think one thing that’s important to note is that Native Americans have the highest vaccination rate in the United States. And we also got our, I would say that our vaccine rollout was really efficient. And so here in Oklahoma, many Oklahomans could access the vaccine through a tribe before they could access the vaccine through the state or through their local health department. And so my tribe really early on was not just offering vaccines to all of our citizens, but to anybody who lived within the jurisdiction of our reservation. And so, you know, and I can speak from my personal experience, you know, I get my health care through Hastings Hospital, through my tribe’s health system and when I became eligible to get the vaccine and I was in the last group because I’m young and other reasons and so I got a text message with a number. I called the number. I made an appointment. I went in and got my vaccine. It took about 30 minutes and it was super, super easy. Also, I think we saw the same thing with testing and contact tracing. So I had a couple times I was exposed to COVID and I needed to get tested and it was really nearly impossible to do that through my local health department but my tribe throughout the pandemic has had really easy to access, drive-through testing. So you just pull up, get tested and get your results within a couple of days. And with the local health department, you had to make an appointment, you had to wait a week for your results. I actually, unfortunately, I had COVID last January and it was the same thing where I got tested at my tribal health facility. You know, I went to urgent care. I got a chest X-ray, I got a follow-up chest X-ray. I had a public health worker for my tribe call me every day to check in on my status and my symptoms, and then also let me know when I was out of quarantine. And then it was ironic because like a week after I got out of quarantine, I got a phone call from the Oklahoma Department of Public Health checking in on me. And so I really saw the huge difference between Oklahoma’s public health response and my tribe’s. And I think, I think a lot of tribes have really been leaders. I think Navajo Nation made a lot of early headlines because they were hit very hard in the early days of the pandemic but I think that they also deserve a lot of credit for having a really strong response when it comes to testing, when it comes to masking, they have a color coded system. So we’re all like, OK, well, where is the pandemic and how do we need to act, and are we here or are we there, and we’re having to, there’s not that guidance, I would say, from the US government. You can see that in Navajo Nation, where they have different stages based on science and based on their case numbers. And what’s happening now is that a lot of tribes are in red states and so they’re having to fight back. So like here in Oklahoma, we have a public ban on mask mandates. We have hospitals that are putting up tents. So the hospital in Stillwater is putting up tents in their parking lot because our hospitals are overwhelmed or actually our public health department is not, and has not been, publishing data on hospital capacity in the state. And so hospitals started doing it because they wanted the public to know that they were full, and they’re at the point where if you get in a car accident, you need to be scared about whether or not there is a bed for you. Like that is where we are in Oklahoma. And the health department is not doing that. And so what Cherokee Nation is doing is we’re asserting our sovereignty. We are flouting the mask mandate, we have a mask mandate. And the tribe is also working with local school districts, local school districts that are defying the state’s ban on mask mandates, our tribe is donating masks. And so, you know, I think similar things have happened in other states. I know tribes in South Dakota have put up roadblocks and really tried to prevent people from coming on to the reservation to spread coronavirus. And so that battle between states who are not taking this pandemic seriously and tribes is still playing out, unfortunately. But I do think that there’s a lot of evidence that tribes have really led the way. And public health within Indian country is horrifically underfunded. IHS is horrifically underfunded, but it is a singular system and so even that really, really underfunded system, because it’s where we all access our health care, it was a really easy way to get health care for COVID and to get the vaccine. You know, I didn’t have to run it down through a health department or through my primary care doctor or through Walgreens or CVS. I just went to the place where I always get my health care to get my vaccine.

Dr. Abdul El-Sayed: Yeah, there’s a lot of conversation right now about public trust. And it strikes me that a lot of people will point to the government and, or major corporations and say, well, I don’t know that I can trust them, I should go it alone and instead trust Facebook posts from my cousin’s former dog owner’s best friend’s cousin. And when you think about that, right, there is probably no singular community in the United States that has less to trust from the federal government in terms of treaties made and treaties broken, than the Native American community. And yet we’re seeing this remarkable investment in collective action to take on this pandemic. How has the community thought about both its trust in the systems that have created this vaccine and produced the science, but also its sense of collective responsibility within itself and the responsibility to save lives? But also—as we talked about earlier—you know, to save culture and to save identity in the midst of this pandemic—how has that conversation taken hold in the community?

Rebecca Nagle: Yeah, absolutely. You know, one thing my tribe did that I think served two purposes is that, you know, like every other jurisdiction, we had phases of who was eligible for the vaccine first and in the first category were our fluent language speakers, which was about protecting our language and protecting that cultural knowledge. But I think it served this dual purpose because most of our fluent language speakers are the matriarchs of their family, they’re the uncle, they’re really looked up to in their families and their communities and so those first images of Cherokees getting vaccines were a lot of people that are held in very high regard, you know? And so I think that, I think that, you know, it’s interesting in the early days of the pandemic where, now it’s changing, but where people, you know, young people thought that they were safe and there were these kind of mixed messages of like, well, do we really want to be on lockdown for older people? And I think that there’s just a lot more, I guess, cultural emphasis on taking care of and respecting our elders in very, very, very broad terms. But, yeah, I mean, I think that we in the United States have this very individualistic view of everything, from COVID to climate, and I think even sometimes on social media, the way that it becomes like where you are pro-vax or anti vax or you’re a masker or you’re not, you know—really the things that would move the needle the most would be good public policy, not individuals. You know, it’s like of course, it comes down to, like I just feel like we, we’re not going to individual responsibility our way out of this pandemic. And yet that’s still where a lot of the public conversation is.

Dr. Abdul El-Sayed: I appreciate that and I take that point. You know, I think in a lot of ways there has been such a an unwillingness to speak truth to frustration and mistrust on the part of the administration, that we end up unfortunately sending mixed messages. You think about the situation with the third booster, right, the implicit message to somebody who is not vaccinated is that if you need a third shot, when initially we had told you that you needed two, that the shot may not be as good as they told us, see. Right? And that’s the implicit message that comes out of that. And I think we haven’t paid as much attention to the fact that if we were forthright from the very beginning and just said, look, you know, for those institutions that can mandate this, you ought to mandate this just like we mandate every other vaccine, that we have to be empathic in our public response, but also honest about the collective consequence of our failure to vaccinate. Perhaps we’d be in a different place. I want to switch tack and I want to talk a little bit about your latest season of your podcast, because it speaks to a lot of the infrastructure underneath, or the legal infrastructure underneath, the really quite tenuous relationship between the United States and sovereign Native American nations. Can you tell us a little bit about the case at hand that frames this season and what it implies about what all of us really ought to know about these relationships? And frankly, I hate to say it, but in our willingness to ignore our complicity in allowing a lot of the injustices that exist to continue and to perpetuate.

Rebecca Nagle: Yeah, absolutely. So the second season of This Land follows a string of custody battles over Native children that through some surprising twists and turns, turned into a federal lawsuit that is now threatening everything from tribal sovereignty to civil rights. And so it started about four years ago when a white couple named Chad and Jennifer Brackeen, who live in the suburbs of Fort Worth, wanted to adopt a Native toddler that they had been fostering. But his tribe, Navajo Nation, had found a Navajo home that wanted to adopt him and there was this federal law called the Indian Child Welfare Act that said that that’s where the child should go. The Indian Child Welfare Act was passed in 1978 after a national survey found that 25-35% of all Native children had been removed from their families and tribes as part of a federal program. And also just the implicit bias and racism of child welfare agencies, where the thinking was that Native children were just better off in white homes. And so this couple filed this federal lawsuit saying that ICWA was tearing their family apart, they were the real home for this child, he had bonded to them, it would harm him for him to be moved. But we actually dug in and investigated and found that they actually won custody of the kid in Family Court quite easily and quite quickly and it’s because they had some really odd company for a custody battle, a corporate law firm whose clients include Walmart and Chevron AND the attorney general of Texas. And so what we really dig into is what actually happened to these kids and to these families, but also who are the big money and power players behind this lawsuit, and why did they get interested? You know, ICWA has been around for 40 years and compliance has always been an issue but in most of its history, it hasn’t been that controversial. And then all of a sudden in the past decade, it has been challenged more times than the Affordable Care Act. And what we found is that there’s this really odd group of bedfellows who are using it as a vehicle to attack all sorts of things from tribal sovereignty to civil rights.

Dr. Abdul El-Sayed: As we think about this new administration—and I don’t know if you can call new anymore—there’s been a lot riding, particularly after the trauma of the Trump years, on all the things that folks have wanted the Bush administration to do. As we reflect on this moment, the conversation we shared about COVID-19 in Indian country, the case and the implications it has for so much of the broader infrastructure that we discussed, the powers and the moneyed interests behind fighting and litigating that case—what do you want to see from this administration, and do you feel like they have the opportunity to deliver?

Rebecca Nagle: Absolutely. So, you know, some things that have been good about this administration, you know, I think the historic appointment of Deb Haaland as the Secretary of Interior, she’s the first Native person in the entire history of the United States to have a cabinet position. And that position in particular is of particular significance to Native people because the Department of the Interior has done a lot of harm. They were the department that oversaw boarding schools. They were the department that oversaw the federal Indian adoption project that I just talked about. And so to have Native leadership there, I think is a step. It’s not the end, but it’s a step towards repairing that nation-to-nation relationship between sovereign Indigenous nations and the US federal government. I would also say I think one thing that was measurably different is we saw in the early COVID packages, tribes were included, but it was after a lot of behind the scenes fighting and horse trading. Basically, we had some strong allies in Congress, including Republicans, who were like, we’re not voting for this if it doesn’t include tribes, and tribes weren’t included in the original big package. And we didn’t have to have that same kind of fight with the most recent COVID bill that passed under Biden. But of course, there are so, so, so much more that needs to be done. One of the big things that’s happening right now is the construction of another oil pipeline called line three through Minnesota, which goes through Ojibwe treaty territory. And, you know, pipelines are significant for people, there was a lot of talk around like drinking water and the Dakota access pipeline but I think one thing that people don’t realize is that we have land rights within our reservation boundaries, but oftentimes we have treaty rights that extend beyond that and if there are projects that make it so that there aren’t fish or there’s not wild rice or there’s not clean water, that impacts our hunting and our fishing rights. This pipeline is in violation of treaty rights. And President Biden actually has the authority, just like Obama did with the Dakota access pipeline, to stop it. And he hasn’t done that yet. So I think that’s one clear thing that the administration can do. Another really big thing that needs to happen, and this goes back to public health and funding, is that a lot of programs that benefit Native people—and they’re not handouts, I think it’s really important to say that the money that the federal government provides to tribes for things like education, for health care, for self-governance, that’s not a handout. Like in the creation of the United States. United States got billions of acres of land in exchange for certain promise and in many of those treaties, there is an obligation to take care of the health and the well-being of Native people. And our federal health program, which is called Indian Health Services, is not fully funded. When I looked at the numbers in the early days of the pandemic, so it would have been in February of 2020, it’s funded on 16 cents on the dollar of what is actually needed to provide health care to Native Americans. And then the other thing that’s really important about IHS is unlike other entitlement programs like Medicare and Medicaid, it’s discretionary funding. And so it goes up and down with just general budget cuts and so it’s an entire health care system that has to operate on the whim, the political whims of Congress. So I think another really big thing is that those programs that are in treaties, that are the obligation of the federal government, that they move from being discretionary funding, well a, to being fully funded and then b, being moved from discretionary funding to the same way that we fund Medicare and Medicaid, where it’s an entitlement program. And if you’re entitled to it, you get it. You don’t have to worry about what the politics of Congress are that year.

Dr. Abdul El-Sayed: Yeah, I really appreciate you laying out that agenda and those goals. And there is a lot of work that all of us have to do to recognize our responsibility in calling out the injustices as we see them and in paying attention to the challenges that arise for Native Americans in this country. And I think that a great place to start is a, if you haven’t listened to Season 1 of This Land, that’s a great place to start. And if not, I mean, if you have, then then go ahead and listen to Season 2. Rebecca Nagle, thank you so much for taking the time. Thank you for your leadership and your voice and for sharing with us a perspective on the way that this pandemic has evolved in the Native American community, the way that the community has come together and shown us how to engage in collective public health action, and in uncovering and reporting out this incredibly important story at the heart of the interests allied against Native American rights. Thank you again.

Rebecca Nagle: Thank you so much for having me.

Dr. Abdul El-Sayed: As usual, here’s what I’m watching right now. 1,655 Americans are dying every day as Delta continues to rampage in unvaccinated communities across the country. Cases are higher than they’ve been since March. And yet there may be good news on the horizon. Throughout this pandemic, deaths have largely lagged behind cases as, of course, the virus takes time to manifest in the body and take a life. Though deaths continue to spike, up nearly 30% over the past two weeks, new cases appear to be declining. This is in keeping with the trend we’ve seen for Delta in other countries, which can best be described as an upside down V. Its spikes as hard as it declines. It declines as hard as it spikes. That said, our timing couldn’t be worse as kids are going back to school, the weather begins to cool down, and cultural events like college football make a full return. All of these could interrupt that reduction in cases. We have yet to see if this downward trend will hold. The Biden administration, for their part, is doing all they can to make sure it does, as they announced a sweeping new set of policies taking aim at Delta, in addition to increasing the manufacturing of testing, increasing funding for COVID-safe protocols in schools, and expanding support for COVID-stricken hospitals, they’re going all in on vaccine requirements. They’ve ramped up vaccine requirements for federal government employees and contractors, health care providers at clinics and hospitals that take Medicare or Medicaid, and all businesses with 100 or more employees. Honestly, it’s about damn time. That Delta Serge I told you about, it probably wouldn’t even have happened if we’d hurried up and gotten vaccinated already. Instead, millions of people have made bad choices. But here’s the thing, the government has a broad responsibility in times of crisis to act for the public good. In pandemic times, that means producing, disseminating and, yes, compelling vaccines. Predictably, conservatives are up in arms. How many more people have to die before we get the point that this isn’t about politics, it’s about basic public health? Finally, it’s flu season again. Last year, public health officials warned of a possible twin-demic of COVID-19 in the flu. But as it turned out, it was one of the least deadly flu seasons on record, largely owing to the lockdowns aimed at COVID-19. This year, though, lockdowns have mainly been replaced by vaccines. And epidemiologists worry that without lockdowns in place, we could see a real resurgence of the flu. Which leads me to remind you, please, get your flu shot.

That’s it for today. On your way out, do me a favor, go to your podcast app and rate and review our show. It really goes a long way to getting it to other folks. And your review does a lot to counteract those anti-vaxxers who keep coming on and reviewing us with one star. If you really like us, though, go on over to the Crooked Media store and pick up some merch. We’ve got our new logo tees and mugs, our Safe and Effective shirts, and our Science Always Wins shirts and dad caps.

Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher, our associate producer is Olivia Martinez. Veronica Simonetti mixes and masters the show. Production support from Tara Terpstra, Lyra Smith and Ari Schwartz. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, and me: Dr. Abdul El-Sayed, your host. Thanks for listening.