Mahto In The Woods, 19, rides a horse on the Cheyenne River Reservation in South Dakota. In The Woods does not trust the U.S. government or the Covid-19 vaccine and has chosen not to get vaccinated. When he was 17 years old, he was in a serious car accident that left unable to walk and half his face paralyzed. He began riding horses to heal and is now an accomplished horseman and racer. He rides on his family's land along the Moreau River, the same land on which Crazy Horse and Sitting Bull used to camp. (photograph by Sarah Stacke)

When the COVID-19 pandemic reached the Great Plains in early 2020, the Cheyenne River Sioux Tribe set up checkpoints on all roads passing through the Cheyenne River reservation in a robust effort to protect tribal members. But over the past year, Indigenous leaders—from Alaska to Western New York—have made strides in vaccination rates.

The pandemic has hit Indigenous communities disproportionately hard, compounded by generations of historical trauma and mistrust. According to an independent study done by the APM Research Lab published in March 2021, Indigenous Americans have the highest actual COVID-19 mortality rates nationwide, accounting for 256 per 100,000 deaths in the United States.

Indigenous communities came to realize that the only way to beat the spread of infection was through community efforts, transparency, and access to the vaccine—and historic resilience.

"We survived massacres, wars with the U.S., the laws the U.S. made against us. We survived prejudice, racism, genocide, sterilization, and boarding schools," says Remi Bald Eagle, Intergovernmental Affairs Coordinator for the Cheyenne River Sioux Tribe. "This is just another thing to survive."

Here is how various tribes have responded to the vaccination effort.

Eagle Butte is the largest city on the Cheyenne River Reservation, a sovereign Lakota Nation in the state of South Dakota. The city is home to tribal headquarters. Like the rest of the U.S., Cheyenne River has reached a COVID-19 vaccination plateau. But in Cheyenne River, the root cause of hesitancy is lingering mistrust of the U.S. government tied to the history of betrayal. (photograph by Sarah Stacke)

The Grindstone family climbs down an embankment that leads to the Moreau River on their family land on the Cheyenne River Reservation, a sovereign Lakota Nation within the state of South Dakota. Mona Grindstone, second from right, has received both doses of the vaccine while her husband Earl, right, has so far chosen not to get the vaccine. Since the arrival of the COVID-19 vaccine early in the year, tribal leaders and members have been navigating differing opinions about its effectiveness, safety, and trustworthiness. (photograph by Sarah Stacke)

Cheyenne River Sioux Tribe

Like the rest of the U.S., the Cheyenne River Reservation, a sovereign Lakota nation located in South Dakota just south of Standing Rock, has reached a COVID-19 vaccination plateau in the wake of President Joe Biden's goal of ensuring vaccinations for 160 million Americans this summer.

The prevailing cause of vaccine hesitancy among some Indigenous communities is lack of trust due to a troubling history. In the 1960s and '70s, the Indian Health Service, the same U.S. government agency now distributing a significant portion of the vaccine on the Cheyenne River Reservation, sterilized 25-40 percent of Native American women of childbearing age, against their knowledge or approval.

"Mass sterilization to most people is just an event," Bald Eagle says. "But to us that's family that never made it here."

Cheyenne River Chairman Harold Frazier at Gunville Ranch on the Cheyenne River Reservation, a sovereign nation in South Dakota. Frazier says the hardest thing about the pandemic for his people has been not being able to see family. "The basis of our culture is family and it's really taken a toll on a lot of people," he says. Though Frazier has not gotten the vaccine, he encourages everyone living on the reservation, tribal member or not, to get it. He recognizes that vaccine hesitancy comes "mainly from the historical" relations between the tribe and the government, but also from lingering doubt. "A lot of the questions that people have" about the long-term effects of the vaccine, "we just don't have answers," Frazier says. (photograph by Sarah Stacke)

A small community on the Cheyenne River Reservation, Cherry Creek has been occupied for at least 270 years and is believed to be the oldest continuously inhabited place in the state of South Dakota. It is of great cultural and historical importance to Lakota people. (photograph by Sarah Stacke)

Infection control nurse Molly Longrake, left, and Vicki Hebb talk in the waiting room of the Cherry Creek clinic while Hebb waits the required 15 minutes after her Covid-19 vaccination. Cherry Creek is a small community on the Cheyenne River Reservation, a sovereign Lakota nation in South Dakota. Cherry Creek is believed to be the oldest continuously inhabited place in the state and is of great cultural and historical importance to Lakota people. (photograph by Sarah Stacke)

Kayla In The Woods, 27, with her children at Brisky's, a popular spot for recreation in Eagle Butte, the largest city on the Cheyenne River Reservation, a sovereign nation within the state of South Dakota. (photograph by Sarah Stacke)

Marcella LeBeau with her granddaughter, Dawnee LeBeau. Marcella, 101, is the oldest matriarch on the Cheyenne River Reservation, a sovereign Lakota nation in the state of South Dakota. Marcella and Dawnee are both fully vaccinated. "I do the best I can for myself and for my people," says Marcella who was a nurse for over 30 years. The day this photo was made was the second time Dawnee and Marcella were able to spend time together since the pandemic began. "It's part of our way to check in on each other a lot and that changed extremely," says Dawnee. When Marcella was born in 1919 she wasn't considered a citizen of the United States. Her great-grandfather fought in the Battle of the Little Bighorn. The fight was an overwhelming victory for the Lakota. (photograph by Sarah Stacke)

The gravesite of Sidney Keith, a Lakota medicine man, is located in the St. Joseph Catholic Church cemetery in Cherry Creek. The church was established in 1894. A small community on the Cheyenne River Reservation, Cherry Creek has been occupied for at least 270 years and is believed to be the oldest continuously inhabited place in the state of South Dakota. It is of great cultural and historical importance to Lakota people. In 1881, many Lakota who had fled to Canada after the Battle of the Little Big Horn, returned to Cherry Creek. After Sitting Bull's murder in 1890, many of his supporters fled to Cherry Creek. Throughout the 20th century, Cherry Creek was known to be strongly committed to traditional Lakota ways.(photograph by Sarah Stacke)		The photographs of Frank Cundill, a homesteader and politician, are housed at the Timber Lake and Area Historical Society in Timber Lake, a small community on the Cheyenne River Reservation in South Dakota. Originally from Iowa, in 1911 Cundill joined the migration of people settling the newly opened Cheyenne River Reservation. As soon as he arrived he began taking pictures of his surroundings and selling postcards of his work. The majority of the photographs in the Cundill collection were made between 1911 and the late 1920s. He died in 1965 (photograph by Sarah Stacke)

Access to the vaccine and reliable information about its effects have been key components to increasing the number of people opting to take the shot.

Since the vaccine arrived in late 2020, CRST Tribal Health infection control nurse and tribal member Molly Longbrake has traveled thousands of miles to provide the vaccine to those living in the farthest reaches of the roughly 4,000-square-mile reservation. Along with her team, Longbrake has also made house calls and spent time on the phone offering information.

"Education, education, education," is how she says the team address those who decline the shot, are on the fence, or ask for more information. "It's such a scary disease," says Longbrake, whose mother, Donna Rae Peterson, died from COVID-19. "Our main goal is to protect everybody."

But even as she moves to get as many people vaccinated as possible, the lingering doubts about potential long-term effects remain cause for concern. Among the questions raised by tribal members: What's it going to do a year down the road? Ten years down the road? Will it cause infertility?

Kivalina, Alaska

In the small, traditional Iñupiat Eskimo village of Kivalina on the northwest coast of Alaska, roughly 40 percent of the 400 residents have been diagnosed with COVID-19. Yet, with this startling number, vaccination rates remain a challenge with only an estimated 21 percent of the people in the village having received shots.

Although Alaska was one of the first states to make the vaccine available to the Indigenous population, the vaccine hesitancy reflects a community reeling from the aftereffects of a troubled history with the U.S. government and the inability to find places for COVID-19 positive cases to isolate outside their homes. Located on an eight-mile barrier island, Kivalina still struggles with the increased risk of widespread community transmission due to the village's remote location.

Sitting just 80 miles above the Arctic Circle, vaccines are delivered by plane as they become available.

Reba Adams, the assistant manager for a small grocery store called Kivalina Native, contracted COVID-19 during a large village outbreak that occurred in early January of 2021. This outbreak infected 44 people, roughly 10 percent of the entire village population. "I wouldn't know exactly where or how I got it because I work in a public place," says Adams. "My family who lives with us had it before me."

Adams was ready to receive the vaccine, stating she only wants to keep her kids and family safe. "I have motivation to get vaccinated because of my job and family," she says.

Elders in this community distrusted the speed at which the COVID-19 vaccine was approved for distribution, recalling the well-documented iodine experiment carried out by the U.S. Air Force in the 1950s. As many as 120 people—most of whom were Alaska Natives—were fed radioactive iodine to determine the drugs' effect on their thyroid glands. At the time, officials were acting on a belief that it might provide answers as to how Alaska natives could survive arctic winters.

That history, coupled with today's quick vaccine response to the pandemic, gave Enoch Adams, Jr., a reverend at the Kivalina Episcopal Church, cause for concern. He and his family have opted not to receive the vaccine yet.

"It takes years to develop a vaccine and this one was made in what, six months? There's too much uncertainty."

After a snow storm, Moses Adams (13) jumps into a fresh pile of snow while his siblings Reanna (10), Melanie (15) and mother Rojo watch.		Enoch Adams Jr. of the Kivalina Episcopal Church. Enoch has refused a Covid-19 vaccine stating that the vaccine had been "rushed" and that he and his family were going to wait for a one-shot vaccine to be introduced. Since the Johnson & Johnson vaccine has been introduced Enoch and his family have still refused to the vaccine saying that "It seems all 3 vaccines have the same characteristics as the flu vaccines available. The side effects are too risky. We've taken some in the past, but we ended up getting a really bad case of the flu from the shots. So we don't take those either. My Mom did take the flu vaccine once. She barely survived the side effects. Never again".

A Bearing Air plane is unloaded after landing with supplies in Kivalina, Alaska. Twice a day a plane from the nearby transport hub of Kotzebue comes in Kivalina, bringing supplies and travelers to and from the village. (Photograph by Brian Adams)

Lucy Adams in her home in Kivalina, Alaska. Like many elders in the community and despite contracting Covid-19 earlier in the year, Lucy has rejected the vaccine. (Photograph by Brian Adams)

The Covid testing sight at the airport in Kotzebue, Alaska. Residence and visitors traveling to villages in the region needed to provide a vaccine card, a negative test and approval from the tribal office before entering the village they were traveling to. (Photograph by Brian Adams)

The "56 Store" as locals call it, at night facing the Kivalina lagoon and the new road built leading to a new school under construction eight miles inland. Nina Swan, the owner of the store, said that her business was not affected by COVID-19.		A home facing the frozen coastline of the Chukchi Sea. Kivalina is located 80 miles above the Arctic Circle with a population of about 400. For decades, the village has been battling coastal erosion due to climate change and is expected to relocate in the coming years.

Northern Ute Reservation

At the Northern Ute Reservation, in Utah, home to nearly 3,000 members of the Ute Tribe, the community united to protect their elders. Vaccine efforts were boosted by social media posts, family prayer, and traditional medicine, resulting in 95 percent of elders obtaining shots.

"My main goal is to ease my people," says Henry Howell, a Northern Ute Sundance Chief. Along with his wife, Dondie, he worked nonstop gathering medicine and praying for their community while also maintaining their regular full-time jobs. "Many of our elders aged due to depression and fear. I visited and prayed with them three times a week."

Howell said that the lockdown during the height of the pandemic can be compared to the beginning of reservation times when mandates and resolutions restricted traditional ceremonies. Families were encouraged to hold ceremonies and prayers at home.

Ramalda Mountainlion poses with a stuffed big horn sheep in her home in Neola, Utah on the Uintah & Ouray Indian Reservation.(photograph by Russel Daniels)

Robinette Tapoof-Valles secures an eagle feather in her daughter, Kristen Tapoof-Kirk's headband in Fort Duchesne, Utah. During the lockdown, both mother and daughter had longed for traditional Ute ceremony and dance, and to dress in their handmade regalia with other tribal members. Strict tribal no-travel and curfew mandates locked down the reservation and forced Ute communities to cancel their annual powwow, Bear Dance, and Sundance.		Three generations of the Myore family pose for a group photo at the Northern Ute Powwow Grounds in Fort Duchesne, Utah. The family members include, from back row left to right, Kennaleigh Teague, Jaclyn Teague, Abby Ignacio and Janik Murray. In the front row, left to right, are Montaya Blackhair, Irene Myore holding infant KleoSue Serawop in a traditional cradleboard, and Ruby Teague. Irene Myore says COVID-19 reminded many Ute families about their cultural priorities: family and community.

Erias Nez, 16, and Donovan Loneman, 16, perform a Bear Dance step in Myton, Utah on the Uintah & Ouray Indian Reservation. Nez and Loneman have been Bear Dance partners since childhood. Ute families are large and it can be complicated to figure out who is related and how. The Bear Dance is a community dance that helps the youth figure out – who is and who isn't – biological family. It's a coming of age celebration. (photograph by Russel Daniels)

The Bear Dance is social ceremony that is seen as medicine, strengthening the community. Traditionaly Ute women ask the men to dance with them. Spring to Fall the Bear Dance travels to several other sister Ute communities in Utah and Colorado. Neola, Utah on the Uintah & Ouray Indian Reservation. (photograph by Russel Daniels)

(left to right) Markus Navanick, Corey Navanick, and Samuel Navanick line dance with Neesah Kanip, Spring Accawanna, and Estrella Nakai. Neola, Utah on the Uintah & Ouray Indian Reservation. April 6, 2021. The Bear Dance is prehistoric mating dance and is one of the oldest ceremonial dances in North America. The Bear Dance honors the bear emerging from hibernation and celebrates Spring. (photograph by Russel Daniels)

On the Northern Ute reservation, Bear Dance gatherings usually begin in May. This social ceremony honors the waking of the bear, celebrates the coming-of-age for young people, and recharges the community—while ushering in Spring.

This dance is medicine that Ute communities are eager to celebrate. As tribal members received their vaccines, they began to emerge from the mandated pandemic lockdown and fulfilled their desire to adorn themselves in traditional regalia.

"We are a sharing tribe," says Felecia Pike-Cuch, manager of the Ute Tribe Emergency Management team based at Fort Duchesne, Utah, on the Northern Ute Reservation. "The EM team stepped up to help assist and protect this tight-knit community; secured early COVID tests; organized and delivered supplies; sanitized tribal offices, homes, and schools; secured vaccines; and set up a public vaccination clinic in conjunction with Indian Health Services."

Currently, vaccines are offered to anybody within eastern Utah Tri-Counties.

Seneca Nation

In New York, the Seneca Nation of Indians is contending with vaccine hesitation issues as the rollout slowly continues to reach its saturation point.

Jade Maybee, who lives with her husband Brett and their two sons, became a nurse more than three years ago at the Olean General Hospital, and worked in the ward designated for treating COVID-19 patients.

"We had a very high period of cases in December 2020 into January 2021, where we typically have our flu season," says Jade Maybee. "And with COVID-19 there were a lot of people that had died, and it was around that time they started to push out vaccines to our community, starting with healthcare workers."

JC and Nicole Seneca are successful entrepreneurs at the Seneca Nation Cattaraugus Territory. Through their JC Seneca Foundation, they have helped support the community throughout the pandemic by funding vaccine popups, food drives, activities for youth and financial support for mothers and foster children.		Tami Thompson administers the vaccine to Firefighter Shawn John at the Cattaraugus Indian Reservation Health Center, Seneca Nation Cattaraugus Territory. The Seneca Nation Government had autonomy for who received the vaccine, taking into consideration recommendations from the CDC and Indian Health Services.

This push in vaccines helped to reduce the number of COVID-19 patients seen in her hospital, but Jade still worries about the unpredictability of the virus and its potential to spread if people don't get vaccinated. "As a nurse and a mother, and an Indigenous woman in this society, it's become even more important and more visualized in my mind how important it is to take care of not only myself and my health, but the health of my family in turn, which could affect the community around me."

Her husband Brett Maybee, who works as a media specialist with the Seneca Nation's media and communications center, is tasked with helping to break down the deep-rooted seeds of distrust that still linger within Indigenous communities. Part of that effort is to keep the community informed but also to acknowledge how easy it could be to oversimplify and say that people are wrong to mistrust the vaccine.

"There's just all of these things that were under the surface for decades upon decades that we are now forced to confront," he says. "We know a lot of people have passed away and died because of the COVID-19 virus and we haven't stopped thinking about it since it started. But what we can do differently now to help ourselves and our families survive…is get the vaccine."

Lacrosse is a historically ceremonial game in the Seneca Nation Allegany Territory. Hanging on a wall are traditional wooden lacrosse sticks, which are still made by craftspeople in the community. Indoor box lacrosse is a major activity on Seneca territory, with leagues for all ages. Many young athletes have attended college through lacrosse scholarships and some have gone on to play professionally. The Gasdo:wä' is a cultural and ceremonial headdress for men.		Whitney Nephew is a language learner who has raised her 5-year-old daughter, Mira, as a first language speaker, the first child with that skill in two generations at the Seneca Nation Cattaraugus Territory. Nephew and her husband Jordon Garrow support food sovereignty and the renewal of traditions within the community.

As the Chief Operating Officer for the Seneca Nation Health System, Shaela Maybee (no relation to Jade and Brett Maybee) is responsible for being a liaison between the Seneca Nation tribal leadership and the health system. "There was an anxious population ready to get vaccinated," she says. "I think the hardest part at the beginning was having such limited numbers, but it was really nice to work with the Seneca Nation council and executives who had that autonomy of sovereignty to decide who got vaccinated."

Prioritizing shots for those with comorbidities and elders was key to the vaccine rollout process. So was tapping fluent Native speakers to continue to provide answers to community members who need to feel reassured and comfortable with getting the vaccine. Shaela Maybee says the reward comes from seeing people actually get the shot.

"Lives are getting saved," she says. "People are less likely to have side effects, long-term, from COVID, and hopefully will avoid getting COVID altogether with getting vaccinated."

Sheyahshe Littledave, an author and enrolled member of the Eastern Band of Cherokee Indians, contributed to this story.