In October of 2009, the Arizona Department of Health Services (ADHS) noticed a disproportionate number of H1N1 hospitalizations and deaths among American Indians (AI). Similar findings in other states led to the formation of a multidisciplinary workgroup that compiled surveillance data from 12 states. The preliminary results indicated that AI were twice as likely as the general population to be hospitalized with severe complications or die from novel H1N1 flu.
With such a great percentage of the AI population at risk for complications, the state determined it could double the amount of monovalent vaccine dedicated to the tribes without affecting the rest of the state's at-risk population. Therefore, the decision was made to allocate 10% of the state's H1N1 monovalent vaccine to its AI population, although American Indians make up only 4.9% of the state's population. The allocation was directed to the state's 37 registered tribal facilities/providers and divided according to their user populations.
To assist tribal nations in Arizona with their pandemic preparedness and response efforts, the state also allocated 10% of its Phase 1 and 2 Public Health Emergency Response (PHER) funding directly to its tribal partners. Phase 3 funding was distributed to three area Indian Health Service (IHS) offices and five other tribes that planned to provide independent healthcare (outside of IHS). In total, Arizona tribal nations have received approximately $2 million of state PHER funding.
Understanding the importance of collaboration in this effort, measures were taken to ensure that: tribal stakeholders participated in Joint Information Center (JIC) activities; tribal representatives were present at the JIC; and tribes were invited to participate in weekly conference calls. Throughout the response, tribal representatives received advanced copies of press releases, weekly talking points, media monitoring reports, and other important documents.
To further promote the vaccination campaign, ADHS collaborated with local tribes on a number of marketing and health-education initiatives. For example, ADHS worked with the Navajo Nation to produce a public service announcement (PSA) available in both Navajo and English. Newspaper ads also were placed with the regional Navajo Nation Newspaper. ADHS also collaborated with a key tribe, Fort Mojave, to place a promotional billboard on tribal land. Finally, numerous radio ads, television ads, billboards, newspaper ads, and movie theater ads were placed in rural areas across the state. Many of these rural media markets intersect with tribal populations and helped deliver key H1N1 messages to both tribal members and other Arizonans.
Although more recent data is not yet available, ADHS feels this initiative has definitely paid off. Of the 1.5 million doses of H1N1 vaccine allocated to the state, approximately 150,000 doses have been directed to its American Indian population; a population of roughly 250,000. Underlying medical conditions place people at increased risk of severe outcomes from novel H1N1 influenza. Because of the higher incidence of underlying medical conditions among American Indians, Arizona's approach in providing more vaccine to the AI population than simple population numbers would indicate helped them prioritize ACIP's at-risk groups more effectively.