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How to Make a Deadly Pandemic in Indian Country

From the 1918 Spanish flu to Covid-19, broken treaties have been the foundation of health crises among Native people.

MARK RALSTON/AFP/Getty Images

In 1868, four years after the Navajo Nation was forcibly removed from its homelands in what is known as the Long Walk, the nation signed a treaty with the United States. In exchange for Diné citizens agreeing to “make the reservation herein described their permanent home” and allow their children to be assimilated through an “English education,” Congress and President Andrew Johnson agreed to make annual payments to the tribe and, through the federal government’s trust responsibilities, provide essential services—health care chief among them. In the 152 years since, the government has yet to meet its obligations. Where health care and infrastructure costs should have been met, the Diné have instead been forced to largely fend for themselves while America gladly put their ceded land to use.

This is not unique to the Navajo Nation. There is in fact no way to understand any tribal nation in its contemporary context without engaging with this history of displacement and treaty rights—there’s nothing that isn’t touched by it. Still, it has been largely absent from mainstream media coverage of the pandemic’s devastating toll across Indian Country, and the Navajo Nation in particular.

Reporters and TV trucks drove through Arizona, Utah, and New Mexico to explain to their audience what was happening in this corner of their nation. Navajo Nation President Jonathan Nez briefly became a fixture in mainstream media. The op-ed section of The New York Times featured multiple Diné voices. Celebrities like Mark Ruffalo and Ellen Degeneres used their platforms for public service announcements. There was even a brief sidebar storyline in which people heaped praise upon Irish donors, who sent nearly $1 million to the Navajo Nation as a form of goodwill for a similar effort undertaken by the Choctaw Nation during the infamous Irish potato famine.

These narratives all focused on the material conditions that many Diné people were facing, often zooming in on the painful stories of lost human lives and heartbroken families as a way to jar readers awake. An emphasis was placed on those who lacked running water, lived in multigenerational homes, and had been denied access to necessary health care. The subtext was clear: How could this be happening in our country?

What almost every piece failed to do was provide an answer that went beyond vague allusions to congressional “underfunding.” Any talk of treaty rights—and a clear explanation of what breaking these rights meant—remained absent as ever. These publications reported that some communities in Navajo Nation and elsewhere lack access to broadband and running water. They covered the statistics about wealth disparities. But these conditions are often treated as predetermined and permanent, as if they came from nowhere, when they are the active legacy of a colonizing nation forgoing the legal agreements it signed with a tribal government.

This is how the cycle of Native invisibility works. The United States signed treaties with hundreds of tribal nations, offering specific resources and services for the land. America has failed repeatedly to abide by its own laws, and once again, tribal nations are pointing this out. But these treaties remain an afterthought to too many in Congress and in the mainstream media, and consequently the American public, because acknowledging the treaties means acknowledging that they are the foundation of cyclical crises in Indian Country. The pandemic is just the latest example of this cycle playing out in real time.


The 1918 Spanish flu epidemic wreaked havoc in Indian Country, killing an estimated 24 percent of the Diné population. In South Dakota, the Pine Ridge Reservation accounted for 13 percent of the state’s deaths, despite the Oglala people only making up 5 percent of the population. Entire Alaska Native villages, like that of Point Possession, were decimated. On the whole, Native people suffered a death rate that was reported to be four times the global average.

This trend extended to more recent tuberculosis outbreaks in the 1980s, 1990s, and early 2000s, when the infection rate among the general Native population was over four times that of the rest of America. Starting in 2007, there was a reported syphilis outbreak in a southwestern tribe that required intervention from the Centers for Disease Control and Prevention and the Indian Health Service. And over the past half-century, diabetes, which was previously never reported as a public health issue in Indian Country, has skyrocketed to become the fourth leading cause of death for Native peoples, afflicting Native citizens at almost double the rate among the non-Hispanic white population.

The coronavirus pandemic is no different. By mid-May, the Navajo Nation, with 23.04 cases per 1,000 people, surpassed New York with the highest per capita rate of infections in the entire nation. By the end of May, a reported 248 people had died from the virus. (The following month, the White Mountain Apache Tribe passed the Navajo Nation in per capita infections, with a rate of 64.6 cases per 1,000 people.)

In late May, the Journal of Public Health Management & Practice published an article that was produced by four public health experts, including Dr. Desi Rodriguez-Lonebear, a UCLA sociology professor and citizen of the Northern Cheyenne Tribe. Reviewing publicly available data on Native communities in Oklahoma, the article found that lack of indoor plumbing and running water, combined with language barriers, were the top indicators as to why Indian Country was being hit so hard by the coronavirus.

“It’s a preliminary paper, but we also wanted it to be maybe made readily available,” Rodriguez-Lonebear told me. She explained that none of the paper’s findings were particularly shocking—washing your hands has been centered as an essential personal hygiene practice, so it tracks that the lack of running water and indoor plumbing would contribute to higher rates of infection. Similarly, with much of the public health messaging being distributed in English, tribal citizens that mainly speak and read their language were at a disadvantage. “Oftentimes, you know your findings aren’t super novel,” Rodriguez-Lonebear said. “But it’s important to have them to back up the narrative and the policy changes.”

But crucially, the article did not stop there. It also pointed to the reason why these conditions existed. “Funding investments in tribal public health and household infrastructure, as delineated in treaties and other agreements, are necessary to protect American Indian communities,” the authors concluded.

A Washington Post piece detailing the centuries-long history of epidemics striking Indian Country harder than American communities did not mention the factor of broken treaties or trust responsibilities once, concluding merely that “European colonialism and capitalism continue to test the health and resilience of native communities.” A CNN article looking specifically at chronic underfunding of health care facilities also failed to include a corresponding analysis of the legal agreements that secured health care for tribal citizens. A splashy feature in The New York Times made sure to note that “several factors—including a high prevalence of diseases like diabetes, scarcity of running water, and homes with several generations living under the same roof—have enabled the virus to spread with exceptional speed,” without pointing to the reasons for those factors.

“Tribes are in mainstream media more than I have seen in my life,” Rodriguez-Lonebear told me. “But there is maybe a sentence or two, if you’re lucky, about how Covid transmission rates are a symptom of generational health disparities and generations of invisibility and lack of investment on reservations.”

She called this a “hugely missed opportunity.” “It’s like, ‘Oh, gosh, these poor Indians, they’re just dying, how terrible,’” Rodriguez-Lonebear continued. “Yeah, it is terrible, but tell me why it’s terrible. You have to confront white supremacy, white guilt, and the foundations of this country having been built on Indigenous erasure in order to understand why it’s so terrible.”

Tristan Ahtone, editor in chief of The Texas Observer and the president of the Native American Journalists Association, attributes this to the fact that mainstream media outlets are not writing for the Native communities they cover. “One of the hallmarks of mainstream and legacy media outlets is that they want to tell you about how Covid-19 has impacted the Navajo Nation, but they also need you to understand what your relationship is with Navajo Nation and how they fit into your world as a non-Indigenous person,” Ahtone told me. “How do these people exist in our world?” The resulting coverage “has a very ward-of-the-state sort of feel,” he said.

“The crucial context isn’t necessarily that Congress has underfunded, or chronically underfunded, IHS,” Ahtone told me. “The crucial context is that tribal nations ceded millions of acres of land in exchange not only for, usually, a place to live but also access to things like health care. That crucial context is what continues to be missing, and that complete misunderstanding of that nation-to-nation relationship is what drives this us-versus-them framing.”


In March, I had the opportunity to speak with Representative Deb Haaland just as reports started coming out of Indian Country that laid bare how destructive this pandemic could be for Native communities. At the time, Haaland, one of two Native women in Congress, was working with her fellow legislators to ensure that programs like the IHS would be adequately funded, staffed, and equipped to deal with the then-blooming pandemic. But the initial proposal from the White House made clear just how little the current administration weighs its treaty obligations: After Haaland and her cohorts on Capitol Hill, including the National Congress of American Indians, estimated that tribal nations and related programs would require $20 billion in relief, the White House responded with $0.

The callous counteroffer struck a chord with Haaland and others who had already been trying to rectify underfunding prior to the pandemic. It spoke to an apathetic attitude toward tribal communities that long predates the Trump administration, particularly as it related to the weaponization of disease. “It was hard not to think about the disease that came when the Europeans came to this continent—the smallpox-covered blankets that they delivered to tribes to purposefully destroy entire communities,” Haaland told me. “The government and other efforts were purposeful in trying to destroy entire communities.”

After negotiations landed on a more reasonable but still lowball figure of $8 billion, the resulting fracas over how Cares Act funds would be appropriated and distributed only added to the notion that the federal government ultimately views its treaty responsibilities as optional, at best. (Despite the legislation being passed in March, the Treasury Department did not begin distributing the funds to tribal nations until May, leaving tribes in the cold for nearly three months.)

“Think about why a lot of tribes are in the predicament they’re in right now,” said Haaland. “It’s because the U.S. government hasn’t lived up to its trust responsibilities.”

This isn’t any kind of a secret: In 2003, and then again in 2018, the U.S. Commission of Civil Rights issued reports that laid out in painstaking detail how Congress and the White House continued to fail Indian Country. Housing, health care, and infrastructure funding is inadequate; the tribal consultation process, be it on a pipeline or a border wall, is porous; and attempts at divining any transparency or clarity that might answer why these failures remain is muddied at best. (As Andrew Curley, a Diné professor of geography at the University of Arizona, told me this spring, these systems, more than just an act of deprivation, are also an act of theft: They force tribal nations into a kind of hostage scenario, where extractive industries like coal and resource mining become the only available economic vehicles for Native nations. It forces tribal governments seeking sovereignty and statehood to make harmful short-term plays for their long-term survival.)

Despite the structural conditions that created particular vulnerabilities among its citizens, the Navajo Nation has been recovering over the past two months. As reported by the Navajo Times, cases have leveled off since the peak in mid-May, thanks in large part to the Navajo government’s strict curfews and mask mandates.

But as the U.S. is is well aware, the virus has not disappeared. State governments recklessly reopening their communities have led to a spike in cases across the nation, including in neighboring Arizona. Tribal nations near national parks are still concerned about vacationing outsiders bringing the virus into their communities and threatening their elders and at-risk loved ones. And as everyone tries to get a grip on this virus, treaties and sovereign land, like that of the Mandan, Hidatsa, and Arikara Nation or the Mashpee Wampanoag Tribe, remain under attack by the American government.

There is little use to reporting on rates of infection and death among Native citizens if the mainstream media fails to contextualize the systemic roots of the crisis. Why report on chronic underfunding in the IHS and subsequent poor community health conditions on a reservation if one is not also willing and able to point out that the IHS exists because it was a resulting term of the treaties struck between tribal nations and the U.S.? That a breach of that agreement is, as the Supreme Court recently held, a violation of the law? These are stories about theft and lawlessness that have had an obscene human toll. And that is the context that the disastrous coronavirus response deserves to be viewed through. It is nothing new or unexpected. But it is, all the same, a rejection of the bedrock documents that the Constitution declares as the “supreme law of the land.” The tragedy that has been visited upon the Navajo Nation and other tribal nations was centuries in the making. The cycle will remain unbroken until there’s an honest accounting of how we got here, and how we’ve been here before.