Rapid City, South Dakota – Cassandra Palmier had intended to get her son the second and final dose of the measles vaccine. However, car problems made it difficult to go to the doctor.
So she jumped at the chance to get him vaccinated after learning that a mobile clinic would be visiting her neighborhood.
“I was definitely concerned about the epidemic and the measles,” Palmier, an Oglala Sioux Tribe member, said during the June event. “I wanted to do my part.”
So did her son, Makaito Cuny.
“I’m not going to be scared,” the 5-year-old said as he stepped onto the bus carrying the clinic and sat in an examination chair.
Makaito remained motionless as a nurse gave him the shot in his arm. “I did it!” he exclaimed, smiling at his mother.
The vaccine clinic was hosted by the Great Plains Tribal Leaders’ Health Board, which serves tribes in Iowa, Nebraska, and the Dakotas. It’s one way Native American tribes and organizations are responding to concerns about low measles vaccination rates and patients’ limited access to health care as the disease spreads across the country.
Meghan O’Connell, the board’s chief public health officer, said the organization is also collaborating with tribes interested in hosting vaccine clinics.
Elsewhere, tribal health organizations have launched social media campaigns, ensured that health providers are vaccinated, and contacted parents of unvaccinated children.
This spring, Project ECHO at the University of New Mexico hosted an online video series on measles for health care professionals and organizations that serve Native American communities. The presenters covered the fundamentals of measles diagnosis and treatment, culturally relevant communication strategies, and how tribes are dealing with the outbreak.
Participants also discussed strategies for increasing vaccination rates, according to Harry Brown, a physician and epidemiologist for the United South and Eastern Tribes, a nonprofit that works with 33 tribes along the Atlantic Coast and Southeast.
“It’s a pretty hot topic right now in Indian Country and I think a lot of people are being proactive,” he told reporters.
According to the Centers for Disease Control and Prevention, measles can survive for up to two hours in the air in an area where an infected person has been, infecting up to 90% of people who have not been vaccinated.
According to the CDC, 1,319 confirmed measles cases have occurred in the United States this year as of July 23. This is the largest outbreak in the United States since 1992. Ninety-two percent of the 2025 cases involve unvaccinated patients or those with unknown vaccination status. As of July 23, three people had died in the United States, and 165 were in the hospital.
According to O’Connell, data on Native Americans’ vaccination rates is imperfect, but it indicates that a lower percentage of them have received measles shots than the general population in the United States.
The limited national data on measles vaccination rates among Native Americans is based on small surveys of people who identify as Native American. Some studies indicate that Native Americans have slightly lower measles vaccination rates, while others show significant gaps.
Data from some states, including South Dakota and Montana, show that Native Americans are less likely than white children to receive vaccinations on time.
The national measles vaccination rate is significantly lower for Native Americans who primarily use the rural Indian Health Service. According to data collected by the agency during recent patient visits to 156 clinics, approximately 76% of children aged 16 to 27 months had received their first shot. That is a 10-percentage-point decrease from ten years ago.
However, IHS data show that its patients are at least as likely as other children to have received both recommended measles vaccinations by the age of 17. O’Connell said it’s unclear whether currently unvaccinated patients will continue to get their shots or remain unvaccinated.
Older children are likely to have a higher immunization rate because schools require students to be vaccinated unless they have an exemption, Brown said. He emphasized the importance of parents getting their children vaccinated at an early age, when they are more likely to be hospitalized or die from the disease.
Native Americans’ vaccination rates may be lower due to barriers to accessing shots and other health care, according to O’Connell. Those living on rural reservations may be more than an hour away from a clinic. Alternatively, they may lack reliable transportation, as Palmier did.
O’Connell also mentioned that some Native Americans distrust the Indian Health Service, which is chronically underfunded and understaffed. Patients may delay or avoid care if the agency runs the only nearby health care facility.
According to O’Connell and Brown, vaccine skepticism and mistrust of the entire health-care system are increasing in Native American communities, as they have across the country.
“Prior to social media, I believe our population was relatively trusting of childhood vaccination. And infectious disease has long had a negative impact on American Indians,” he said.
When European colonizers arrived in the late 1400s, they brought with them new diseases, such as measles, which killed tens of millions of Indigenous people in North and South America by the early 1600s. Native Americans have also experienced high mortality rates in modern pandemics, such as the 1918-20 Spanish flu and covid-19.
When measles cases began to appear near the Great Plains Tribal Leaders’ Health Board’s headquarters in South Dakota earlier this year, the board acted quickly. Nebraska health officials announced in late May that a child contracted measles in a rural area near the Pine Ridge Indian Reservation. Then, four Rapid City residents became ill later that month and into mid-June.
“Our phones really rang off the hook” when that news came out, said Darren Crowe, vice president of the board’s Oyate Health Center in Rapid City. He stated that parents wanted to know if their children were up to date on measles vaccines.
Crowe stated that the health board ordered extra masks, formed a measles command team that meets daily, and contacted parents when its online database indicated that their children needed a vaccination.
Brown praised the approach.
“It takes a concerted outreach effort that goes individual to individual,” he said, noting that his organization has assisted the Mississippi Band of Choctaw Indians and the Alabama-Coushatta Tribe of Texas in similar efforts.
Brown stated that reaching out to specific families can be difficult in some low-income Native American communities, where many people’s phone numbers change frequently due to the use of temporary prepaid plans.
Brown advised health workers to listen to parents and ask questions before discussing the importance of the measles, mumps, and rubella vaccine.
“Rather than trying to preach to somebody and beat them over the head with data or whatever to convince them that this is what they need to do, you start out by finding out where they are,” according to him. So, tell me about your vaccination experience. Tell me everything you know about vaccinations.
Brown said that when people are given helpful information in a nonjudgmental manner, they are more likely to agree to immunize their children.
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