Begay Auld says she wanted the same level of vaccine access she would have gotten back home. The Navajo Nation had expanded eligibility at its vaccination drives to anyone age 18 and older as early as mid-February. Plus, she adds, many of the Indigenous people living in the D.C. region are here specifically in service to their tribes in other parts of the country.

“I think the DMV falls in a very special arena in that a lot of us … are here to serve Indian Country and/or our specific tribal nations,” says Begay Auld.

“While we’re advocating for our tribal nations, we lose our access,” says Roth. “And it’s concerning.”

(The tribe Indigenous to this region, the Piscataway Conoy, is in a different situation. They are not federally recognized, meaning they don’t qualify for health care through the Indian Health Service. But the tribe has also been working to vaccinate its members, even as it battles a surge of positive COVID-19 cases over the past month.)

For Begay Auld, Roth, and others, the presence of a dedicated vaccine site would also have signaled that Indigenous people in the region are a priority—particularly since they have faced some of the highest rates of death nationally from COVID-19.

Roth also pointed out that after a year of watching horror unfold at home from afar, many Indigenous people in the region were eager to get the vaccine so they could go and support their relatives.

“Waiting means not being able to go home and see your family,” says Roth. “It means continued tremendous isolation from the community.”

Last week, the IHS and the University of Maryland-Baltimore began offering vaccines to tribal citizens and their families at a clinic in Baltimore. The vaccine site, created in partnership with the National Council of Urban Indian Health and Native American Lifelines, has been scheduling appointments for Wednesdays, Fridays, Saturdays, and Sundays, and the partner organizations are helping with transportation.

While the clinic presents a step forward for vaccine accessibility, some are questioning why the opportunity came about so late in the vaccine rollout. Indigenous people in the D.C. region have been asking for dedicated vaccine sites for months. When this opportunity finally became available in Baltimore, many of the region’s jurisdictions had already opened up vaccine eligibility to anyone over the age of 16— and mass vaccination sites were offering their plentiful appointments to walk-ins.

“The clinic is being held after everything’s already been opened up,” says Begay Auld. “It almost felt like a little too late … it’s not about putting the blame on one specific person or organization, but rather asking how we can move forward in a more cohesive manner to benefit the entire urban Native population here.”

In a press release announcing the vaccine site, Native American Lifelines Executive Director Kerry Hawk-Lessard highlighted that the site’s creation took months of advocacy.

“For months, we have fought tooth and nail to get vaccines for urban Indians in Maryland, D.C., and Virginia,” said Hawk-Lessard. “Any member of the hardest hit population shouldn’t have had to wait months for this lifesaving opportunity. This is also not what the trust responsibility for health care is supposed to be. As we are also serving record patients to address increased needs in behavioral health and domestic violence, we are glad to finally be able to vaccinate our community.”

The trust responsibility Hawk-Lessard referred to is the federal government’s obligation to provide health care to enrolled tribal members across the country. The IHS is underfunded across the country—and clinics and hospitals on reservations have been deprived of federal resources. But the lack of funding for urban Indians health is particularly stark: Even though most Indigenous people in the U.S. live away from tribal land, less than 1% of the IHS annual budget is dedicated to urban Indian health centers.

This lack of funding manifests in the D.C. region, where the Native American Lifelines clinic in Baltimore is the only IHS-funded clinic in D.C., Maryland, or Virginia. And it’s a referral and outreach center, which means it cannot provide medical services and many forms of patient care onsite. It offers behavioral health services, support groups and community events, and limited dental work.

“The U.S. government owes all of us health care in perpetuity, and that’s for the cession of millions of acres of land that now makes up the United States of America,” says Roth. “It doesn’t matter where we live. It doesn’t matter if we live on the reservation that they said we had to go live on or if for other reasons, like economic reasons or for family reasons, we’ve had to move to the city.”

It’s not uncommon for Natives who live in the D.C. area to fly home for medical care, or pair doctors visits with visits to see their families, according to Roth and Begay Auld.

Officials with the IHS say they began considering a vaccination clinic for American Indians and Alaska Natives in the D.C. area as early as January or February, but implementation was difficult in part because the Native American Lifelines clinic in Baltimore did not automatically qualify for vaccines.

“They needed to be more than just an outreach and referral center— they needed to have ambulatory care and the ability and capacity to store and administer those vaccines,” said Dr. Beverly Cotton, who directs the IHS Nashville process and led the process of creating the Baltimore vaccine clinic.

Cotton says she’s been hearing that the appointment-scheduling system has been convenient.

“This, I hope, is just a positive step in the right direction—that as vaccine availability opens up across the country, Natives living in this specific area have the opportunity to not only schedule their appointment, but maybe even get in a little bit sooner with the flexibility … that fits their lifestyle and work schedule.”

The IHS could not provide numbers of how many people have been vaccinated so far at the Clinic, but Francys Crevier, the CEO of the National Council of Urban Indian Health, says she believes at least a hundred people took advantage of the option within its first few days of offering vaccines.

Crevier herself was able to get vaccinated at the Native American Lifelines clinic.

“It was so nice to see my community … and to see some relatives that we haven’t seen in a long time,” said Crevier. “It felt really comfortable and it kind of just felt like a part of home.”

But Crevier says that expanding health care for urban Indians in the D.C. area beyond the pandemic doesn’t seem to be a possibility. A 2016 needs assessment conducted by the Urban Indian Health Program, a division of the IHS identified the region as one of 17 areas with the most need for a health center for Natives—but there hasn’t been funding to follow through with a new facility.

“After everyone gets their vaccine, [Native American Lifelines] will continue to try to meet the population needs with the same resources they have, and unless more resources are invested in the D.C. community for Native folks, I don’t see much changing,” says Crevier.

Rose Weahkee, the Director of the IHS Office of Urban Indian Health Programs, says the Urban Indian Health Budget received a $5 million boost for fiscal year 2021 and is working with local urban Indian health centers to try and address their needs given funding constraints. But, she says, there are still “tremendous unmet needs in urban centers.”

For Crevier, meeting these needs in the D.C. region is not only about fulfilling treaty obligations, but also about ensuring access to culturally-competent care.

We’ve had so many historical issues and traumas regarding health care specifically,” says Crevier. “We want to make sure that folks feel safe.”

This story has been updated with the correct spelling of Ani Begay Auld’s name.