COVID-19 vaccination access, acceptability, and pandemic recovery in American Indian communities

The present study explored perspectives on COVID-19 vaccine acceptability, access, and strategies for pandemic recovery among rural and urban/suburban American Indian (AI) community leaders and members in California.

The qualitative study was initiated by a community-academic partnership with a large AI health organization and two universities and included virtual focus groups focused on COVID-19 vaccine acceptability (concerns, risks, benefits), initial vaccine rollout accessibility (vaccination site preferences, accessibility, strategies for improving vaccination), and recommendations for pandemic recovery. Reflexive thematic analysis was used to generate themes.

In Fall 2021, three urban/suburban (n = 9) and three rural (n = 9) AI focus groups in California were held virtually. A majority of participants were Tribal or community leaders (n = 12). Participants in both urban/suburban and rural settings reported preferences for Tribal or Indian Health Service clinics for vaccination and recommended culturally tailored COVID-19 educational materials, health services, and community events to promote pandemic recovery. Participants in rural groups provided examples of tailored community-led pandemic care but illustrated how health care access limited vaccination, how basic needs affected vaccine prioritization, and how gaps in data on AI communities limited local informed decision-making.

Findings demonstrate differences in the COVID-19 experience among AI adults living in urban/suburban and rural regions, including vaccine access and basic needs concerns. Findings also highlight local preferences in the pandemic community response and recommendations for culturally tailored health information, health services, and gatherings. Public health campaigns may require additional resources for AI communities to improve equitable distribution and uptake. (PsycInfo Database Record (c) 2026 APA, all rights reserved).