This article originally appeared on the NICOA blog.

Credit: NICOA

Immunization against childhood diseases is regarded as one of the greatest public health achievements in the United States and worldwide. The benefit of vaccinations has been particularly notable for American Indian and Alaska Native people, who have suffered disproportionately from infectious diseases compared with the general U.S. population. Vaccination coverage among American Indian children is higher than national coverage levels for most vaccines. This finding contrasts with overall coverage estimates among all American Indians, which usually are slightly below national coverage levels.

From 2006 to 2010, CDC researchers reported that although disparities existed between white and American Indian and Alaska Native populations in 2001 to 2004, the findings from the latest surveys showed the discrepancies were decreasing. For the last quarter of 2010, the immunization-rate disparity between American Indian children and white children averaged 11.4 percent for all vaccine series. Native children were also more likely than white children to be delayed at routine immunization milestones. By the three-month milestone, 77 percent of American Indian children had received a dose of diphtheria-tetanus-acellular pertussis vaccine compared with 91.5 percent of white children. Because of these delays, fewer Native children are up to date by 19 to 35 months.

A 2016 study by the CDC found that American Indian and Alaska Native adults aged 18 years and over were 10 percent less likely as their non-Hispanic white counterparts to have received the flu shot in the past 12 months. A 2000 study by JAMA Internal Medicine found that younger age and alcohol use were significantly associated with less frequent immunization among the Native population, while Medicare insurance, depression, health problems and taking medications predicted significantly higher immunization rates. American Indians age 65 years or older with cardiovascular disease or diabetes were more frequent recipients of the influenza and pneumococcal vaccine. Regardless of age or risk, inadequate vaccination rates were observed in elder American Indians.

Low vaccination rates among Native populations may be a result of mistrust of the medical community and a negative perception of health providers due to a history of institutional racism. Other barriers to vaccination include transportation difficulties, long waits for appointments, and poor patient-provider communication.

The opinions expressed in this article are those of the author and do not necessarily reflect those of the Diverse Elders Coalition.