American Indian and Alaska Native Elders Are Now Leaders in Pneumococcal Vaccination

During this month in which we celebrate National Indigenous Peoples Day, there’s encouraging health news about American Indian and Alaska Native (AI/AN) elders.   

A recent AARP Public Policy Institute report found that influenza, pneumonia, and shingles vaccinations increased among adults ages 50 and older in 2020, though disparities continued. Even so, AI/AN adults ages 50-plus had the highest rates of pneumococcal vaccination, at 47 percent. Following the AI/AN adults’ rates were those of white (46 percent), Black (32 percent), Asian (30 percent), and Hispanic (25 percent) older adults.

The high vaccination rate was surprising since AI/AN elders face numerous health care access challenges. Not only is the Indian Health Service (IHS) system underfunded, but research shows that AI/AN elders are less likely than other older adult populations to seek medical care, have a routine source of care, or trust their providers and health care organizations.

The finding was even more striking when compared to influenza vaccination rates. AI/AN elders tied with Hispanic older adults for having the lowest rates for that vaccine in 2020 (50 percent). Their rate was well below that for white older adults, 62 percent, the highest of all groups. With respect to shingles vaccines, AI/AN elders trailed both white (33 percent) and Asian (29 percent) older adults while coming in higher than Black (17 percent) and Hispanic (15 percent) older adults.

Pneumococcal Rates among AI/AN Elders

Of course, 2020 could have been an anomaly. To determine if that was the case, we calculated pneumococcal vaccination rates from previous years. Between 2016 and 2020, National Health Interview Survey (NHIS) data, which we used for our original analysis, did show a generally progressive narrowing of the gap between AI/AN and white adults ages 50 and older. Then in 2020, the 50+ AI/AN vaccination rate first exceeded the 50+ white vaccination rate—highlighting a trend, rather than representing an anomaly.

We also looked at IHS data and found reports of even higher rates of pneumococcal vaccination among AI/AN elders. From 2016 to 2020, IHS reported the rate of AI/AN adults ages 65 and older who have ever had a pneumococcal vaccine remained consistently strong, at around 83 percent. This rate reflects reports from IHS facilities, which are limited in number and may not be completely representative of the care that AI/AN elders receive. Even so, it shows the strong willingness of AI/AN elders to receive the pneumococcal vaccine.    

What’s Behind The Higher Rates?

The 2020 AI/AN pneumococcal vaccination rate is especially good news since the pneumonia prevalence among AI/AN adults was four times higher than the general population, and pneumonia is a leading cause of death among AI/AN elders.

Yet despite the encouraging news, the reasons behind it are not yet clear. We were unable to find, for example, any evidence of a concerted public or private effort to promote pneumococcal vaccination in this population. It is also unclear why pneumococcal vaccinations rates are relatively high among AI/AN elders while influenza vaccinations rates remain low. Nevertheless, the increase in pneumococcal vaccinations over time could indicate the presence of unknown, but effective, drivers that should be explored for future vaccination efforts.

Further discussions with AI/AN elders, clinicians, and other health workers can help determine what is driving these rates and how these rates might be affected by COVID-19. Whatever the constellation of factors, these vaccinations are preventing disease and ultimately saving lives.