Alaska Native Communities Advancing Vaccine Uptake

PROJECT SUMMARY
Alaska Native and American Indian (ANAI) communities are experiencing a disproportionate share of SARS-
CoV-2 infection and its sequelae in the US. As of September 2021, ANAI people had a cumulative incidence of
9,256 COVID-19 cases per 100,000, compared with 5,445 among non-Hispanic Whites. The current rate of
COVID-19 associated deaths per 100,000 population is 220 among ANAI people, compared with 137 among
non-Hispanic Whites. Widespread vaccination remains the best strategy to control COVID-19 morbidity and
mortality, but the US has one of the lowest vaccine acceptance rates in the world with wide regional variability.
Little research has attempted to understand or address barriers to COVID-19 vaccination in ANAI people,
despite unique geographical, historical, and cultural factors that could influence vaccine uptake in this
population. We have formed a consortium of Tribal health leaders from across Alaska to better understand
vaccine attitudes and intentions, including hesitancy, and to increase vaccine uptake in Alaskan ANAI
communities. In conjunction with community advisors, we will develop and implement a theory-driven
intervention that is grounded in ANAI values of relationality and respect. First, we will use vaccination tracking
data to assess current rates of vaccine uptake and analyze preexisting quantitative and qualitative data
regarding vaccine attitudes, intentions, and behavior among ANAI people in rural and urban areas of Alaska.
We will also conduct a survey in southcentral Alaska to inform intervention design. Second, we will work with
statewide Tribal health leaders and regional Community Advisory Boards to create educational information,
stories, and messages keyed to the beliefs and perceived norms that drive vaccine behavior. This content will
be incorporated into an eHealth toolkit for use by community members and specially trained community
vaccine advocates, laypeople who volunteer to provide information and motivational/emotional support to their
friends, families, and communities. Third, we will launch the intervention in the southcentral region of Alaska
and evaluate effectiveness using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-
AIM) framework. Refinements based on program data and participant feedback will be made, then the refined
intervention will be deployed in two rural regions of Alaska and evaluated. This project will add to the limited
evidence base regarding adult vaccine attitudes, intentions, and behaviors among ANAI people. It holds the
potential to increase vaccination in a hard-hit population and build support for future vaccination as
SARS-CoV2 continues to evolve. Our findings will have broader applicability to vaccine outreach and
engaging ANAI communities in leveraging peer relationships, their social networks, and eHealth to promote
health education and behavior change.

Grant Number: 5R01AI170946-04
NIH Institute/Center: NIH
Principal Investigator: Julie Beans