A watchdog recognizes the early release of a COVID-19 vaccine by the Indian Health Service

A federal watchdog has condemned the Indian Health Service’s early implementation of its plan for a COVID-19 vaccine for tribal health programs that serve some of the communities hardest hit by the coronavirus pandemic.

The Department of Health and Human Services’ Office of Inspector General released a report last week on the Indian Health Service’s implementation of its Memorandum of Agreement with the Centers for Disease Control and Prevention (which it entered into in November 2020) and its plan issued around the same time, outlining how it would deliver and administer vaccines.

“IHS failed to implement all of the provisions outlined in the MOA and its vaccine plan to ensure that the vaccination program was appropriately implemented at Tribal [health] programs,” said the report released last week, which covers the period from mid-December 2020 to the end of February 2021. “Although tribal programs were allowed to prioritize vaccines to protect their tribal members, The IHS, as a jurisdiction, had responsibilities described in [both] to ensure that the vaccination program is carried out appropriately.’

Tribal health programs authorized under the Indian Self-Determination and Educational Assistance Act of 1975 allow Indian tribes and tribal organizations to provide health care programs and services that the IHS would otherwise do. These are one of three IHS programs and provide care for most IHS beneficiaries, so they are expected to perform most of the vaccinations, the report noted. This is what IG looked at exclusively.

Specifically, IHS did not always provide tribal programs with the resources and assistance to ensure that they met reporting requirements regarding vaccine administration correct billing methods and entered into eligible dual-program agreements with states and IHS, the IG’s office found. “Due to these deficiencies, the administration of the COVID-19 vaccine program was adversely affected.”

Specifically, the IG’s office found that “total doses administered by tribal programs could not always be verified for the applicable time period, and administered doses were not always reported in a timely manner; some patients were billed directly for the administration of the COVID-19 vaccine; and some tribal programs may have received vaccine doses from their state (in addition to the doses they received from the IHS distribution).”

Elizabeth Fowler, then acting director of IHS, wrote back to the IG’s office that she agreed with their four recommendations and summarized the actions taken since the IG’s review period.

“While IHS has limited ability to enforce tribal compliance with vaccine program requirements, IHS agrees with the importance and need for tribes to comply with vaccine program requirements and use effective compliance tools and processes,” Fowler said. Since IHS received and reviewed the draft report, Roselyn Tso was sworn in as director of IHS.

American Indians and Alaska Natives have had disproportionately high rates of COVID-19 infection and death, and have been affected in other adverse ways by the pandemic. Inequalities related to food, water, housing, health outcomes and environmental conditions have been exacerbated by the pandemic, Lindsay Schneider, Joshua Sbika and Stefan Malin, associate professors at Colorado State University, said in June 2020.

They write: “As we see it, Native American communities face structural and historical obstacles linked to settler colonial legacies that make it difficult for them to resist the pandemic, even by taking advantage of innovative local survival strategies.”

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