In southwestern Alaska’s Yukon-Kuskokwim Delta, which has some of the nation’s worst water and sanitation service and most overcrowded housing, vaccines proved to be valuable safeguards against the worst ravages of the COVID-19 pandemic, according to a new study.
The study, by experts from the Yukon-Kuskokwim Health Corp. and the Centers for Disease Control and Prevention, tracked COVID cases, hospitalizations and vaccination status of the region’s mostly Yupik residents throughout 2021.
It found that vaccination was 92% effective in preventing hospitalizations over the year, as well as being extremely effective at preventing cases serious enough to produce symptoms.
“They’re very effective, and so it’s great to see that. While we suspected that they would be, it’s always good to confirm that with local data,” said lead author Brian Lefferts, director of the Yukon Kuskokwim Health Corp.’s office of environmental health and engineering.
Over time, as antibodies waned and the virus mutated into new strains, even those who were vaccinated did get the symptomatic cases of the disease, the data showed. However, those who received booster shots had their protection restored, data showed.
Effectiveness of the initial vaccination series against symptomatic COVID cases went from a high of about 91% in the first five months of 2021 to 37% from late September to early December of 2021, the data showed. However, for those who received booster shots in the latter part of 2021, the rate of protection against symptomatic cases shot back up to 92%, the data showed.
“As we started to roll out vaccines in 2020, you could instantly see the cases start to decline,” Lefferts said. Even as case numbers rose over time, “amongst people who were vaccinated, we saw that the hospitalization rates remained really, really low,” he said.
While COVID vaccines become politically contentious elsewhere, vaccination was generally well accepted in Yukon-Kuskokwim Delta, Lefferts said.
Vaccines, once developed, were distributed quickly by tribal governments and other Native organizations in Alaska and elsewhere. In the Yukon-Kuskokwim Delta, where there are no road connections between communities, health officials mobilized Bush planes, snowmachines and other methods of shipment in what was called Project Togo. The initiative, named for the legendary lead dog in the famous 1925 serum run to Nome, brought vaccines quickly to remote sites.
Of the 48 Alaska communities that are classified by the Alaska Department of Environmental Conservation’s Village Safe Water program as being unserved or underserved with piped water and sanitation service, most are in Western Alaska and about a third are in the Yukon-Kuskokwim Delta.. Unserved communities have less than 55% of households hooked up to running water or sewer service; underserved communities have a somewhat higher rate of piped homes or have some kind of sewage-haul system.
Additionally, the region was singled out by the Alaska Housing Finance Corp. in a 2018 report as being the most burdened in the state by overcrowded housing.
With sparse running water and large family groups packed into tight and inadequate housing spaces, Y-K residents have long been more susceptible to infectious diseases such as respiratory syncytial virus, or RSV, which is particularly dangerous for infants and young children. As the COVID-19 outbreak became a pandemic, the standard advice about frequent hand washing and maintenance of social distancing was hard to follow for Yukon-Kuskokwim residents. Approximately 26,000 people live in the 50,000-square mile delta region, according to state data; about 6,300 are in one hub city, Bethel, the rest live in more than four dozen villages.
The state House member who represents the region, Rep. CJ McCormick, D-Bethel, said the Yukon-Kuskokwim experience with COVID and vaccination provides some lessons for other parts of the country with health challenges from water, sanitation or housing shortcomings.
There were some people in the region who were hesitant to get vaccinated, McCormick said. “I think that extends from historical trauma,” he said, referring to past mistreatment of Indigenous people by authorities.
But overall, the health providers did an excellent job communicating with residents and limiting COVID’s damages, said McCormick, who works for YKHC outside of his state position but made clear that he was speaking as a legislator and as a former Bethel City Council member who served on that body during the worst part of the pandemic.
That is a lesson for other parts of the country facing health challenges from water, sanitation or housing shortcomings, he said. “Foster cooperative relationships with health professionals,” he said. “A lot of people have adversarial relationships, and that’s really disappointing and detrimental to everyone.”
Meanwhile, he said, he is continuing to push for improvements in living conditions.
The federal Infrastructure Investment and Jobs Act has directed $3.5 billion over five years to the Indian Health Service for national improvements to water and sanitation systems in tribal areas; more than $2 billion of that is expected to go to Alaska, where problems are most severe and technical and practical challenges most daunting.