How Vaccine Politics are Failing Indian Country

Magical Millie’s Courageous Journey is a coloring book published by the Urban Indian Health Institute in Seattle that explains vaccines to kids.

“When the appointment was over, her mom wrapped her in a warm hug. ‘You were so brave, Millie,’ Mom said. Millie smiled her heart swelling with pride. ‘I feel strong, like the warriors Grandma is always talking about. Taking care of myself means I can take care of others — and that makes me a warrior, too.’”

To read more articles by Mark Trahant, go to: Marktrahant.substack.com

That should be the story’s end. Except we live in an era when the government itself is spreading misinformation about vaccines.

On August 10th President Donald J. Trump signed an executive order to “spread out” the immunization schedule for children. The president is matching the vaccine nonsense that has so defined the career of Robert F. Kennedy Jr.

From the scientific journal Nature:

The 10 August order calls for children to be vaccinated against fewer diseases than they currently are, and it recommends that combination shots, starting with the one for measles, mumps and rubella — commonly known as the MMR vaccine — be split into individual jabs that are spread out over time.

The order is “not in any sense grounded in science”, says Paul Offit, a viral immunologist and director of the Vaccine Education Center at the Children’s Hospital of Philadelphia in Pennsylvania.

And here is one of the crazy parts: There is not a single dose vaccine currently licensed for measles, mumps or rubella. It will have to be created, tested, and then made available.

The science (again from Nature).

“Previous research has shown that combined vaccines against multiple diseases can increase population-level immunity and decrease health-care costs, because families can visit the clinic fewer times to receive fewer shots, says Mark Jit, a health economist at New York University. For example, the proportion of people vaccinated against diphtheria, tetanus, pertussis and a bacterial infection called haemophilus influenzae type b increased by 8% in Belgium after the country introduced a jab that combined all four shots into one.

“In 2006, a research team reported that when combined jabs are available, children are, on average, immunized against diseases at a younger age. This means that children are protected earlier in life, rather than having to wait for separate jabs, Jit says. For diseases that spread quickly, such as measles, a delay of even a few months “can make a whole world of difference” in terms of whether kids get sick, he says.”

Dr. Franklin’s mistake

Five years ago the a Public Health pharmacist, Commander Aimee Young, promoted vaccines on the Indian Health Service web page.

“Vaccine hesitancy is used to describe the reluctance or refusal of patients or caregivers to vaccinate despite the availability of vaccines. This is not a new concern, and remains among the top 10 threats globally . Hesitancy has been around since the times of Benjamin Franklin, who lost one of his sons to smallpox in 1736 and publicly regretted not having him inoculated. The scientific understanding of how vaccines work, better ways of stimulating immunity through vaccines that are scientifically tested, and the safe manufacturing of vaccines have made tremendous progress since that time. Yet, nearly 300 years later, we are still talking about vaccine hesitancy.

“Research has shown that health decisions, such as to receive or to not receive a vaccine, are highly influenced by social and cultural factors, such as politics, past experiences with the health care system, family history, and balancing important public health concerns with individual rights.”

Another IHS post that same year promised a “golden age” for vaccines. Dr. Scott Hamstra, wrote:

“Let me tell you why I’m excited, hopeful and optimistic in 2021 despite the COVID-19 pandemic. Why? It’s because of the major advances in vaccine technology over the past 30 years. Progress has been so dramatic that it is safe to say we have entered the “golden age” of vaccines.”

Politics? Social and cultural factors? The very words that fit messages from Donald J. Trump and Robert F. Kennedy Jr. as they make vaccine hesitancy an official public policy.

If you search for “vaccines” on the Indian Health Service web page you get a list of agency officials who work on vaccines, but there’s no schedule, promotion or explanations. There are no Magic Millies.

ProPublica reported last year about the agency’s “stark turn.”

But this year, as Health and Human Services Secretary Robert F. Kennedy Jr., a vaccine critic, has put his stamp on federal immunization policy, IHS’ public messaging on vaccines has taken a stark turn.

In internal emails obtained by ProPublica, IHS officials have flagged terms such as “immunizations” and “vaccines” for additional scrutiny, deeming them risky “buzzwords” that require approval from agency public information officers to be used in social media posts, pamphlets and presentations for patients.

And if you search for vaccine information on the IHS web site — there is nothing new. There is a chilling atmosphere to even talk about vaccines.

Again, ProPublica.

“ProPublica didn’t want their names used, concerned it could endanger their jobs. One physician said the new IHS restrictions on vaccine-related speech factored into her decision to leave the agency this year.

“I can’t keep people safe,” she said in an interview just before she quit. “I don’t have any of the words anymore to say anything I need to say.”

I am not bound by any funding concerns and it’s unlikely I will have a “job” again so I can say this flat out: Vaccines work and we should not be setting up a generation of young people for needless deaths. The phrase “unvaccinated” next to a death report is a damning indictment.

Then again, that last paragraph should not be controversial. But as ProPublica pointed in the federal government today using the word “vaccine” is risky.

Then and now

A short history

In 1968, there were 152,000 kids with mumps. Then by the early 2000s only a few cases. Today mumps is again on the rise.

A piece by Johns Hopkins Bloomberg School of Public Health:

“This executive order echoes previous efforts from the administration to reshape the American vaccine landscape, including the dismissal of all members of the CDC’s Advisory Committee on Immunization Practices—the group of experts that develops vaccine recommendations—and issuing new recommendations to drop routine vaccinations for flu, COVID-19, rotavirus, and others. Both of these changes were halted by a federal judge in early 2026. This latest effort to alter the immunization schedule did not come with any new evidence on vaccines.”

I was thinking about the practical application of the Trump executive order, breaking up vaccine doses into single shots. That means trying to get more appointments in an Indian Health System where scheduling is not easy because of staffing shortages. More parents are confused by the mixed messages and might just give up. That would be a mistake.

Johns Hopkins conclusion:

“Vaccination shouldn’t be political, but we live in a time when there’s all kinds of signaling about health positions based on politics. This order is a great example of why that can be very dangerous.”

The story of measles is especially important now. Two people have died this month in Pennsylvania and the CDC reports there are 2,777 “confirmed” cases (so that number is probably much higher) while all of last year there were 2,289 cases. Some 94 percent of those cases involved “unvaccinated” or “unknown” status.

Vaccination works.

Here’s the kicker is this, from the Associated Press:

In November, international health officials will meet to determine if the U.S. and Mexico have lost their measles-free status. The U.S. eliminated local measles spread in 2000 by maintaining high vaccination rates, which have fallen in recent years to below the 95% coverage needed to prevent outbreaks.

The United States in 2000 was declared “measles free” because there were so few cases that resulted from the high rate of vaccination.

Indian Country has two additional major problems. First, we don’t have as much data as we need (How many people are vaccinated regularly? How about staff?). But from those regions where do have good data, we know there is a lower rate of vaccination. That leaves communities vulnerable.

Tribal Health, an Arizona enterprise, reports on its web page:

“2025 has seen the biggest measles outbreak in the U.S since 1992. 165 people have been hospitalized; 3 have died.

“Most of the 2025 cases involve unvaccinated patients – and unfortunately, Native communities often have lower vaccination rates than the overall U.S. population. There are a few reasons for this and they’re reasons that play a role in many Indigenous health barriers: unreliable transportation, living an hour or more from the nearest clinic, and high provider turnover and shortages. Families that want to keep children vaccinated on schedule may not get the information they need and or be able to visit a clinic when the right resources are there.

“So it’s not surprising that some state statistics, including from South Dakota and Montana, show that Native Americans are less likely than white children to be vaccinated on schedule. The national measles vaccination rate is significantly lower for Native Americans who use the mostly rural Indian Health Service. About 76% of children 16 to 27 months old had gotten the first shot, according to data collected by the agency during recent patient visits at 156 clinics. That’s a 10- percentage-point drop from a decade earlier.”

Then infectious diseases have a long, deadly history in tribal communities. Every once in a while I read through the agency reports of the Bureau of Indian Affairs from decades ago. A 1923 report from Fort Hall, Idaho, shows infections and death from what are now preventable diseases, ranging from influenza to measles and mumps.

The agency doctor, Henry Wheeler, described himself as a “humiliated physician” when he turned in his illness and mortality reports.

“It has been out of management for the benefit of the sick so long that we have ceased to call it a hospital. The medical report said there were two hospitals, one at the school, and other at the agency. But the school hospital had no nurse so it closed. More and more people have given up and sought medical treatment in town. Others chose not to go, no matter the reason. The doctor said a real hospital would be expensive but the current set up he dismissed as a ‘white elephant.’

“The constant demand for a hospital there was many times greater than ever it was here, and yet the elephant was permitted to die from starvation for the reason that it cost so much to keep.”

Of course the counter story is that the Indian Health Service is no longer the only game in town.

Tribal health departments and clinics are promoting the heck out of vaccines. Billboards across the Navajo Nation, for example, are urging people to get their annual vaccinations.

Across the country, there are drive through vaccine clinics. Immunization days. And back to school shots in August are a great start.

One of my favorite things about the Alaska Federation of Natives meeting in October is a vaccination booth where you can quickly get up to date.

And there’s always Magic Millie.