Tribal Pharmacist Addresses Individual Concerns and Appeals to Cultural Values

Last winter in Tuba City, Arizona, residents of the Navajo Nation started lining up in their cars outside Tuba City High School at 5:00 AM to get their COVID-19 vaccines. Navajo elders and other eligible residents in the area waited for the drive-through clinic to open several hours later. At 8:00 AM, pharmacists and other immunizers, stationed in mobile health vans parked on campus, began to circulate and vaccinate patients sitting in their cars.

Vaccine uptake was high among residents of the Navajo Nation aged 65 years and older, said Reasol Chino, PharmD, assistant director of pharmacy at Tuba City Regional Health Care Corporation (TCRHCC), a tribal-owned health system. By July, more than 80 percent of older adult Navajo residents had received at least one dose of a COVID-19 vaccine. But uptake hasn’t been as high with younger members of the community. Among residents 12 years and older, fewer than 60 percent have received a first dose.

Chino, her colleagues, and trusted members of the community have employed various tactics to increase uptake among vaccine-hesitant members of the Navajo Nation. Yet all the strategies are based on a unified approach: finding out why a person hasn’t been vaccinated.

“You have to know why,” said Chino, who serves the Navajo Nation as a member of the Commissioned Corps of the U.S. Public Health Service. “Every individual is going to have a different reason that they are hesitant, and you have to address that specific issue, whether they think the vaccine was approved too fast or they are afraid of side effects. There’s not just one answer that you can give to everyone who’s hesitant.”

To that end, every week, a COVID-19 team at the TCRHCC hospital surveys the unvaccinated of the Navajo Nation to gain a window into their reasons for holding off. Based on what the survey reveals, the team tailors written materials on the vaccine for posting at the chapter house; (in tribal nations, chapter houses are similar to county seats).

The team also arranges for people who are trusted by Navajo Nation residents to record videos to post on social media and appear on Facebook Live in response to specific vaccine-related concerns.

“We have providers who have been here for 30 or 40 years,” Chino said. “If anyone [is hesitant and] has questions, they answer them in real time on Facebook Live.”

The key, Chino says, is to answer people’s specific questions about the vaccine—and appeal to their individual values. For example, in conversations with Navajo people who are hesitant to receive the vaccine, she points out that the vaccine protects everyone in the person’s household, not just the individual.

“Navajos are very family-oriented and most live in multigenerational homes with grandparents and grandchildren. So, you have to use that,” she said. “They are also very maternal, so the idea of family protection and not just thinking about yourself helps.”

Chino believes the COVID-19 team’s strategies have begun to work. “These communication strategies combined with people getting nervous about the Delta variant [have increased our vaccination rates]. Our vaccines here in the clinic had kind of hit a plateau, but now, when we have 60 patients scheduled, 120 end up coming in [to be vaccinated].”

—Sonya Collins
July 2021

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