Proceedings of a Workshop—in Brief

Strengthening Indigenous America: Building Resilience Through Disaster Preparedness, Response, and Recovery

Proceedings of a Workshop—in Brief

Indigenous American and tribal nations and communities represent an important component of the U.S. medical and public health emergency preparedness and response system, protecting and serving tribal and non-tribal communities in rural and isolated locations in response to disasters and public health emergencies. As public health threats grow in number, severity, and complexity, it will be important for Indigenous American and tribal nations and communities to have the necessary capacities, capabilities, and partnerships to address disasters and public health emergencies. Furthermore, Indigenous knowledge and practices are critical to improving preparedness and response systems. To this end, on July 8–9, 2024, the National Academies of Sciences, Engineering, and Medicine’s (the National Academies’) Forum on Medical and Public Health Preparedness for Disasters and Emergencies hosted a workshop¹ to explore opportunities to support the capacity of Indigenous American and tribal communities and nations to prepare for, respond to, and recover from disasters and public health emergencies.

Key concepts underpinning the workshop were the strength and resilience of Indigenous American and tribal nations, communities, and people. Dore A. Bietz, Tuolumne County, said, “We, as tribal communities, are resilient communities.” Fawn Sharp (Quinault Indian Nation), Sharp Global Development, LLC, addressed climate change in her keynote speech, and while noting its disproportionate impact on tribal communities, she reminded the audience that Indigenous American and tribal nations and communities “are strong, we are mighty, and we are resilient—it is in our DNA.”

Keola Chan (Native Hawaiian), Ka Pā o Lonopūhā, opened the workshop with a Native Hawaiian healing prayer. W. Craig Vanderwagen, East West Protection, LLC, and Henry Cagey (Lummi Nation), Lummi Indian Business Council, welcomed attendees and introduced the workshop’s objectives of highlighting best practices, addressing existing barriers, and identifying gaps where partners can provide additional support. Cagey declared that Indigenous American and tribal nations and communities need to use lessons learned in the COVID-19 pandemic and other recent disasters to understand what work needs to be done to improve preparedness and response capabilities and capacities. “For many it is about what we are going to do to strengthen our communities. We watched ourselves go through COVID-19. It was a terrible time for some of us, and a real awful time for people who really lost a lot that were not ready. Learning from that

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experience is something we are all here to do,” Cagey said. He discussed the importance of tribal sovereignty and expressed the hope that the workshop would offer ideas that participants could “bring home to your people, to your communities.” Asha M. George, Bipartisan Commission on Biodefense, expressed that U.S. policies and initiatives that address Indigenous American and tribal nations and communities are often specific to each context and as such can be difficult to navigate for those unfamiliar with tribal histories, politics, and language. She said it is important to not lose sight of those nuances.

This Proceedings of a Workshop—in Brief is structured thematically, rather than sequenced according to the workshop agenda. It summarizes the key points made by the workshop participants during the presentations and discussions and is not intended to provide a comprehensive summary of information shared during the workshop. The views summarized here reflect the knowledge and opinions of individual workshop participants and should not be construed as consensus or recommendations among workshop participants or the members of the Forum on Medical and Public Health Preparedness for Disasters and Emergencies or the National Academies.

TRIBAL SOVEREIGNTY IN THE CONTEXT OF DISASTER PREPAREDNESS, RESPONSE, AND RECOVERY

Several presenters spoke about the critical and required recognition of tribal sovereignty, understanding the unique complexities of Indigenous American history, and how tribal self-governance must be a key factor when considering disaster preparedness and response capabilities and capacities. Presenters also examined the effects of local, state, and federal policies and practices on the ability of Indigenous American and tribal communities and nations to prepare for, respond to, and recover from disasters and public health emergencies. Kymberly Cravatt (Chickasaw Nation), Chickasaw Nation Department of Health, noted that responses to disasters and public health emergencies can become rapidly complicated when multiple jurisdictional authorities such as states, counties, and tribal entities are involved. Jessica Erb, American Indian Health Commission, stated that other jurisdictions’ misapprehensions of tribal authorities in public health and emergency management and ignorance of tribal capabilities and expertise can result in poorer outcomes.

Erb explained that there are three sovereigns in the United States: the federal government, the tribes (whose powers are inherent and not derived from the federal government), and the state governments (which derive their power mostly from the 10th Amendment). She said there is still a need to build understanding among federal, state, and local government personnel regarding tribes’ sovereign powers to make public health decisions. Overall, Erb emphasized, it is important to be aware and to understand that different types of working relationships are needed among different tribal nations and different levels of government—and that these functional relationships need to be based on respect. Erb explain that tribal jurisdictions may exercise a wide range of governmental public health powers, including declaring public health emergencies, ordering mandatory isolation and quarantine, closing businesses and off-reservation borders, performing case and contact investigations, conducting data surveillance, and establishing priority groups and service populations for vaccine dispensing.

Jessica McKee, American Indian Health Commission, explained that during the 2009 H1N1 pandemic, some tribes in Washington State planned to provide vaccines to elders before children. Because this conflicted with Centers for Disease Control and Prevention (CDC) guidelines, local health jurisdictions that had been given responsibility for delivering vaccines to the tribes did not deliver those tribes’ vaccine allocations. After that pandemic, many meetings were held to discuss how to remedy the situation. McKee said that during the COVID-19 pandemic, federal, Washington state, and local government laws and policies better honored tribal protocols, contributing to the success of vaccination efforts. The State of Washington Department of Health consulted with tribal nations, then released a policy stating that tribes have the right to decide their own prioritization and service populations for medical countermeasure distribution. CDC also released guidance indicating that tribes have sovereign authority to determine vaccine distribution procedures in their COVID Vaccine Interim Playbook.

Nickolaus Lewis (Lummi Nation), Northwest Portland Area Indian Health Board, explained that the Robert T.

Stafford Disaster Relief and Emergency Assistance Act (Stafford Act) was amended in 2013 in part to provide federally recognized tribal governments the option to seek Stafford Act assistance independently of a state. He expressed that the Stafford Act now better reflects the sovereignty of tribal governments and acknowledges FEMA’s government-to-government relationship with tribal governments. The change also promotes tribal self-determination by allowing tribal governments to determine for themselves how they want to seek Stafford Act assistance, either independently of a state or through a state declaration. Lewis noted that to apply for Stafford Act assistance requires time and financial and personnel resources that many tribes may not have.

Sharp spoke about the history of tribal self-governance and its links to Indigenous leadership on environmental protection and climate. She highlighted the effects of changing federal policies throughout U.S. history on the ability of Indigenous American and tribal nations and communities to prepare for, respond to, and recover from disasters. Reflecting on her experiences as president of the Quinault Indian Nation during a time when multiple climate-related disasters were affecting the tribe and as president of the National Congress of American Indians during the COVID-19 pandemic, Sharp made the point that sovereign tribal nations need to advocate for themselves on an international level and build partnerships and coalitions to enhance their resilience to disasters and climate change. Sharp told a story of how tribal nations in the Pacific Northwest negotiated with a citizens’ initiative and with Washington State officials over the terms of a carbon-pricing mechanism and a climate-related funding bill. She said there is great potential in “monetizing the value of tribal sovereignty to not only bring our knowledge and science to bear, but there is an emerging economy on the horizon. A dynamic and prosperous prospect where nature is valued properly.” She said that tribal nations can enter global carbon markets on their own and that they are “bringing solutions to the table” globally.

EMERGENCY MANAGEMENT CAPACITIES AND CAPABILITIES

The workshop examined and discussed current capacities, capabilities, and needs of Indigenous American and tribal nations and communities in preparing for, responding to, and recovering from disasters. Workshop participants discussed how Indigenous American and tribal communities and nations understand and view emergency preparedness, response, and recovery; how emergency preparedness and responses can integrate Indigenous American and tribal knowledge and practices; and how local, state, and federal jurisdictions that work with Indigenous American and tribal communities and nations can improve emergency planning and operations. Drawing from discussions about the 2023 Lahaina fire, the 2015 Gold King Mine Spill, and COVID-19, Theresa Cullen, Pima County Health Department, reminded the audience that emergency preparedness, generally, should take an all-hazards approach and highlighted the tendency for issues to arise whenever multiple jurisdictions are responding to an event on tribal territory.

Dan Martinez (Confederated Tribes of Warm Springs), Confederated Tribes of Warm Springs, described logistical and capacity challenges that have made it difficult to respond to and cope with disasters. He highlighted the challenges the Confederated Tribes of Warm Springs have faced with water supply and the COVID-19 pandemic. Looking forward, Martinez spoke about climate change impacts and said, “My deepest concern is identifying what to do next in terms of cleaning our riverways and looking at solutions on protecting our traditional foods.” During the COVID-19 pandemic, Martinez found that it became time- and resource-intensive to transport tribal members back into their territory when they died from COVID-19 outside their territory and across state lines.

Multiple speakers discussed the importance of tribal nations’ using a command system when coordinating emergency responses with different agencies. Del Yazzie (Navajo Nation), Navajo Epidemiology Center, spoke about the role the Navajo Nation’s incident command system (ICS) played in the nation’s response to COVID-19. Yazzie said that within the public health branch of Navajo Nation’s ICS, four pillars were established—epidemiology, case management, community mitigation, and messaging. “We all had teams within these four pillars. We had co-leaders for the four pillars, one on the tribal side and one on the Indian Health Service side. That was unique and organized in a way to respond in a coordinated manner,” Yazzie said. “Every tribe is differ-

ent, but the addition of a public health branch into the ICS structure could be explored more,” he said.

Martinez spoke about the ICS the Confederated Tribes of Warm Springs used during the COVID-19 pandemic to work with the public health department, Indian Health Services, and Indian Affairs. He said, “We immediately went into operational mode, logistics, operations and putting those pieces together, we became very unique in sharing our ways of dealing with the command structure with other nations looking at our protocol.” Rear Admiral (Ret.) Kevin Meeks (Chickasaw Nation), Chickasaw Nation Department of Health, described Chickasaw Nation Emergency Management as a “department without walls,” meaning that when an incident occurs, emergency managers immediately coordinate with other tribal departments, surrounding jurisdictions, federal agencies, and volunteer and community groups to ensure resources and personnel are identified and coordinated.

Several speakers told stories highlighting the importance of risk communication capabilities and best practices for communicating scientific or disaster-related information. Yazzie said he learned that the word “epidemiology” can be alarming or confusing to Navajo (Diné) people, so now his team uses the Diné phrase naałnįįh naalkaah (“disease tracking”) to refer to epidemiology. Bietz told two stories of instances when fire evacuation instructions were more effective coming from tribal emergency personnel rather than outside agencies. One instance was the Rim Fire in 2013. “Our tribal community was in the evacuation warning area, and many did not understand the process or that law enforcement can make them leave. I remember explaining to the officer at the time what it meant to be told they had to leave their land. It was a hard sell, and thankfully we had our own fire department,” Bietz said. In another instance, a fire was projected to cross an area where tribal members lived. “I know the chairwoman and called her. She asked if I would come back to the tribal community because they did not want to leave, and [she] thought my words could help. I spoke from our tribal community and [said] it is better to leave with light versus middle of the night. Thankfully they understood the words and understood I had nothing to gain.”

Workshop discussions mentioned unique ways to contribute to the day-to-day resilience of these communities through focusing on addressing trauma issues and mental health, economic development, and career and educational pathways for tribal members, including in science, technology, engineering, and medicine, law, and other fields. For example, Lanor Curole (United Houma Nation), former tribal administrator for the United Houma Nation, discussed how something like focusing on tribal economic development can help build disaster response capacity. “If there is the ability to create tribal businesses that are able to do the response, and then they can actually be the ones handling their own recovery, there is a greater sense of control,” she said. Speaking about the fentanyl crisis, Lewis said, “When you see people get buried weekly, it is not about politics, it is about healing and trauma. We need to do better, because we are failing as a whole system.” A healthy environment and society would help tribal communities and their citizens be resilient in facing traumas and disasters.

RELATIONSHIPS THAT STRENGTHEN TRIBAL PREPAREDNESS, RESPONSE, AND RECOVERY

The workshop discussions highlighted the value of relationships, strategies for building mutually respectful and functional relationships, the role of relationships in preparedness, and the importance of sustaining relationships long term. Jillian Freitas (Native Hawaiian), University of Hawai‘i at Manoa, introduced the Hawaiian term pilina, meaning “relationship.” Freitas said, “What we call pilina [means] relationships when they are built and are transcendent beyond the individual level, so they exist beyond many generations.” Manley Begay Jr. (Navajo Nation), Northern Arizona University, emphasized the importance of making time to listen and learn from partners and jurisdictions that may be involved in emergency preparedness and response to improve mutual understanding of each other’s strengths and needs.

Theresa Cullen said, “There are two ways to think about preparedness—one is relational, and the other is obligational. It is not always the case that relationships are productive or helpful. Sometimes they are destructive. And there are advantages to having legal obligations, like treaty obligations, to fall back on when those inter-

personal trusting relationships are failing you, where they do not exist or [are] untrustworthy themselves.” Similarly, Teresa Montoya (Navajo Nation), University of Chicago, discussed the need to build obligational structures that “transcend or provide parameters around” relationships. She said that obligation goes “beyond mere consultation,” though sometimes consultation is viewed as simply a box to check. Instead, a “robust co-management plan” should be defined for each tribal nation’s relations with counties and municipalities such as with the example of tribal co-management of Bears Ears National Monument in a corollary public lands context.

Bietz said that relationships need to be established before an emergency occurs and discussed how the relationship between Indigenous communities in Tuolumne County and local public health officials facilitated contact tracing during the COVID-19 pandemic. “Our local public health partners appreciated we provided this to the community,” Bietz said. “We had already earned respect with other disasters and had fire and flooding and drought. They truly understood what our capabilities were.” Chan also emphasized the need to create training and guidance to enable responders to go into communities in a more cultural conscious way and to build these partnerships and relationships before disasters happen. Chan spoke about his community’s difficulties working with external agencies and the need to educate these agencies about his community during the response to the 2023 Lahaina fires. Cullen suggested that mentorship for non-tribal people working with tribal communities could be provided in order to better prepare for disasters. She said, “How do we make sure that federal and nonfederal people that are coming in to respond, who are not from the community, can get appropriate mentorship before they ever get there so that there is a rapid response?”

Cristina Toledo-Cornell, Brigham and Women’s Hospital, said that tribes may depend on state and federal partners to support their response capacity during an emergency. She shared that months before the COVID-19 pandemic, the Lummi Nation conducted tabletop exercises with state and federal partners to consider how different potential disasters that could affect the tribe, which prepared them for their response to COVID-19 before it arrived in their community. Erb noted that it is the responsibility of local, state, and federal jurisdictions to ensure that preparedness exercises appropriately incorporate and include tribal nations.

Meeks and several other speakers discussed the importance of relationships with communities outside tribal nations, sharing stories about COVID-19 vaccination campaigns. Meeks said, “What we observed [is] when the Chickasaw Nation prospers, the surrounding community and the rest of our state and sometimes the entire United States will prosper. When the surrounding communities prosper, the Chickasaw Nation prospers.” He described how non-tribal members from the surrounding counties and patients from more than 38 states traveled to the Chickasaw Nation to get COVID-19 vaccinations. He said, “We expanded our service because it was a public health emergency to see non-Chickasaws and non-Indians in our service area. If the community at-large contracts COVID, our Chickasaw people will be at a high risk of also becoming infected.” McKee also spoke about how tribes in Washington State offered COVID-19 vaccinations to non-tribal people to create a protective “bubble around the community,” including teachers, people who worked for the tribe, and migrant workers. Lewis spoke about how the Lummi Nation offered COVID-19 vaccination to surrounding community members, including teachers. “This started to change the way people looked at Lummi and tribes because they are saying ‘look at what they are doing. They are out here helping us.’”

INDIGENOUS KNOWLEDGE, BEST PRACTICES, AND TRANSLATION

One of the workshop objectives was to learn about ways to support the integration of Indigenous knowledge, preferences, and practices in preparedness, response, and recovery. Vanderwagen stated, “I believe tribes can bring best practices and models that can affect in a positive way the rest of America and elsewhere.” He noted, however, that best practices emerging from Indigenous communities “are not always recognized that way because they are small, and one thing we need to think about is how do we validate those as best practices because the rest of us in this country need those best practices.” Vanderwagen said that another priority is translating data into meaningful information that tribal leadership can use to benefit their communities and inform future generations.

Lewis noted that there are challenges in bringing cultural healing and tribal best practices up to the federal “evidence-based” threshold, especially in small communities. “We know tribal best practices work, but to be sustainable, they need to be evidence-based as well,” he said. One barrier he discussed is that funding through temporary grants makes it difficult to build on previous work; sustainable funding sources would change this situation. He also spoke about the potential for using successful programs as models that others can build on: “The struggle we are faced with is you have all these initiatives but they also do not have sustainability. How do you get tribal and cultural best practice and make it sustainable?” Montoya discussed a research project, led by Diné hydrologists and environmental science researchers at the University of Arizona and Northern Arizona University, that investigated environmental contamination following the Gold King Mine spill. She noted, “I think often times there is a false dichotomy presented that there is science on one hand and Indigenous knowledge on the other hand. You have to resist that temptation of putting these two at odds [with] one another.” Rather, Montoya argued that the tools of Western science, when applied appropriately and with community oversight, can be used to uphold Indigenous solutions such as food sovereignty projects.

Donald Warne (Oglala Lakota), Johns Hopkins Center for Indigenous Health, said, “Every time I see the term ‘evidence-based practices’ my question is always, whose evidence is it? If the practices have been working effectively in Washington, D.C., or in Boston, Massachusetts, does that automatically mean they will be effective in Kyle, South Dakota? Well, maybe, but maybe not. We need to have the ability to adjust our best practices and evidence base to local norms, local language, local culture.”

Several speakers highlighted the role of medicine people and cultural traditions in responding to the COVID-19 pandemic. Carol Goldtooth (Navajo Nation), Northern Arizona University, discussed how Diné philosophy, traditional culture, and medicine people influenced how tribe members understood and responded to COVID-19. She said, “Our people went back to the culture. They searched out the medicine people, and they did their ceremonies and prayers and songs which brought us back to some type of normality and balance in our lives. They were our first responders.” She continued, “I would like to recommend that medicine people become a part of any discussions and future planning that occurs. Listen to them and have them share their thoughts, they are very wise people.”

Begay further explored what would be needed for “a partnership between tribal governments, current health facilities, and medicine people.” He said that fostering such partnerships may require some basic understanding of the benefits of each party and “a lot of listening, understanding, knowledge about culture and language.” He said, “During COVID-19, there was a return back to medicine people. The young people found strength in the culture in the midst of a terrible time. We saw the medicine people taking their rightful place at our societies—at the front.”

Oren R. Lyons (Turtle Clan of the Onondaga Nation) spoke about the traditional food practices and ways of life that his family and tribe lived by when he was young in the 1930s and 1940s, and how these can contribute to disaster preparedness. He said, “Everybody did their own cooking, everybody did their own planting. As children, we played in the woods. We did not have to go in for lunch. We could find ways to feed ourselves in the woods.” He spoke about the rapid changes in society, environmental destruction, and climate change that are occurring, and he said we need to prepare by drawing on traditional Native ways. He continued, “My message to all of us right now is, prepare for the worst. Dig down, get back to basics, corn, beans, and squash. Our ceremonies are most important because we are a spiritual people.”

DATA AND RESEARCH FOR TRIBAL PREPAREDNESS, RESPONSE, AND RECOVERY

Workshop discussions examined innovative research collaborations with Indigenous American and tribal nations and communities, data sovereignty, and data governance within the context of disasters and public health emergencies. Multiple speakers discussed ways tribes can retain or gain access to data relevant to them or collected from tribal citizens as well as practical aspects of research, such as data management and institutional

research protocols. Others discussed the need for more research led by tribes, for tribes, and the need for more Indigenous people as principal investigators.

Meghan C. O’Connell (Cherokee Nation), Great Plains Tribal Leaders Health Board, discussed challenges tribes face in obtaining, retaining access to, storing, and using the data needed for disaster preparedness and response, as well as strategies for overcoming those challenges. “Health equity will not be achieved without access to data,” she said. “When I moved into public health, I realized that the lack of data that the tribes and TECs [tribal epidemiology centers] are able to access are significantly contributing to the health disparities that tribes and Native peoples have experienced for decades.” The Health Insurance Portability and Accountability Act (HIPAA) can present challenges, but “tribes and TECs are public health authorities for the purposes of HIPAA and can receive protected health information to do public health activities.” Data sharing has been a “huge issue and challenge” for tribal entities, she said, but her organization was able to sign a data-sharing agreement with the State of South Dakota, and that has been helpful in responding to reported diseases. By contrast, she said that data sharing in the medical field is easier, and tribal entities’ access to public health data needs to be similarly expanded to facilitate effective disaster responses.

Tim Collins (Sault Ste. Marie Tribe of Chippewa Indians), Alaska Native Tribal Health Consortium, said there is an urgent need to improve race and ethnicity data. When measuring the incidence or prevalence of disease in Indigenous communities, he reported that denominator values are often inaccurate for Indigenous populations. Carolyn A. Liebler, University of Minnesota, discussed issues with the 2020 census and their effects on population counts for the American Indian and Alaska Native federal race category. According to Liebler, for the 2020 census, the Census Bureau and the Office of Management and Budget made significant changes in how race and ethnicity write-in responses were coded as well as no longer requiring community affiliation and coding Hispanic origin differently. This led to a large increase in the “American Indian and White” group as well as “substantial changes across all the racial and ethnic groups.” A second issue, Liebler explained, is that the 2020 census applied a technique called differential privacy, a computerized algorithm that adds or subtracts a number drawn at random to population totals within counties in order to avoid disclosing individual data. Liebler showed an example of one state in which “the differential privacy algorithm made it look like one county in that state doubled its Native population and a different county in that state had zero Native people—they were really there, but it went to zero.” She said that those working with census data need to be aware of these issues and potentially seek to use other existing data sets to obtain needed population data.

Yazzie commented that “over 200 researchers” from academic institutions currently conduct research on the Navajo Nation. Although their data is returned to the tribal research office as required by the Navajo research code, it has been “a real challenge” to make use of that data. The nation has been working on data warehousing capabilities and computing resources. He also said that an expedited IRB review process for emergencies helped with the Navajo Nation’s COVID-19 surveillance and participation in the vaccine trial. Warne said that there are efforts among TECs to develop regionalized IRBs that multiple tribes can adopt, which could be particularly helpful for smaller tribes.

Curole spoke about how the United Houma Nation worked with five universities on a research project about the effects of and responses to climate change and coastal land loss on the tribe. Curole said the tribe had built positive relationships with certain universities and researchers, which enabled the tribe to “[take] the lead” on this research project and to bring in researchers they had previously worked with. Warne said, “I think it is a better model when the tribes are driving the priorities and agenda by determining who they want to collaborate with, and what we are seeing is that the universities that [have] more Indigenous faculty have better Indigenous engagement because of trust and lived experience.” Brenda Granillo, University of Arizona, spoke about how long-term relationship-building work contributed to the success of CDC-funded tribal public health emergency preparedness programs in Arizona. “We met with our tribal partners in communities, even where they live and work. We always sought input in any decisions we

made,” she said. “We realize that every tribe is unique, and interventions need to be tailored and culturally appropriate for that region.” Granillo also spoke about the efforts of the Arizona Tribal Executive Committee, which is comprised of five tribes in Arizona but represents all Arizona tribal preparedness programs, to mediate with the Arizona Department of Health Services and foster operational alignment and strategic planning for public health emergency preparedness.

Curole spoke about how research allowed her team to identify instances of “policy at odds with impact” in regards to weather events affecting the United Houma Nation, which is in a hurricane-prone area. When Hurricane Ida hit tribal communities in August 2021, Curole said, “it actually gave us the opportunity to observe community response in action. We looked at mapping the impacts, capturing the changes and timelines of response from government compared to the needs on the ground.” One important finding came from the research team’s efforts to map wind speed against the damage tribal citizens reported to their houses. They found that the greatest damage to houses did not necessarily occur in the areas with highest wind speeds. Instead, in some areas, houses are elevated off the ground to avoid flooding, leaving them more exposed to wind. FEMA’s “focus is on flooding, [which] overlays exposing the community to wind impacts. So that is certainly a policy issue that is not necessarily working in the favor of the community.”

Warne spoke about his experiences as co-director of the Johns Hopkins Center for Indigenous Health, where he said 80 percent of the employees are Indigenous people and the “vast majority” of employees work in the field with Indigenous communities throughout the United States and the world. Warne said, “we had a very good American Indian and Alaska Native participation in the [COVID-19] vaccine clinical trials, largely because our center was deeply embedded within the communities that participated. What we need is a trusted entity, and that is what we had in terms of having Johns Hopkins with this decades-long commitment and presence in the community.” He continued, “We had community input on priority concerns, and we were working with the Navajo Nation and they were deeply concerned because of the high rates of mortality. And it was interesting, we had higher rates of vaccination once we had the vaccine available.” Warne closed by discussing the importance of Indigenous people serving as principal investigators on research projects in Indigenous communities. He mentioned that Johns Hopkins is developing the world’s first doctor of public health in Indigenous health degree program, which is scheduled to be available online beginning in 2025.

Cullen said that developing and sharing a research agenda could point the way toward research, funding, and best practices for tribal communities in emergency preparedness and response. She said, “I think there is a huge research agenda here. It is not just data, it is also best practices.”

CONCLUDING REMARKS

In closing, Cagey explained current concerns with water supply and access on the Lummi Nation and noted that tribes often operate from crisis to crisis, making long-term disaster planning a challenge. He said convening tribal and partner representatives together, as in this workshop, provides a venue for discussions that otherwise might not happen.

Yazzie said, “There are a lot of discussions over the years that I have witnessed and that I have [been] a part of, and nothing really seems to move forward in a quick manner. No one really has the time to move the agenda forward after the meetings.” He suggested that “it needs almost a different working group to . . . follow through on the action steps.”

Cullen also spoke about the possibility of developing a playbook and amplifying successful programs and practices. She said, “I truly believe there is a playbook of best practices for emergency preparedness and response in tribal communities. There are many other tribes that have done really amazing work, and all the tribes do not have the capacity, just like all small public health areas do not have the capacity, so there needs to be leadership there and a commitment to pull this together.” Montoya said it would be valuable to develop tools that tribes could use more widely, such as a disaster response flow chart or a list of protocols for responding to different types of threats.

Vanderwagen emphasized the importance of building on the work and ideas presented throughout the workshop (see Box 1). He asked non-tribal workshop attendees to think about the tools they can offer to Indigenous American and tribal nations and communities. He said that while the workshop’s high-level discussions are important for mutual understanding, there must now be effort among decision makers to implement action at the local and tribal level.

DISCLAIMER This Proceedings of a Workshop—in Brief has been prepared by Ilana Goldowitz, Matthew Masiello, Shalini Singaravelu, and Lisa Brown as a factual summary of what occurred at the meeting. The statements made are those of the rapporteurs or individual workshop participants and do not necessarily represent the views of all workshop participants; the planning committee; or the National Academies of Sciences, Engineering, and Medicine.

*The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop—in Brief rests with the institution. The planning committee comprises W. Craig Vanderwagen (Co-chair), East West Protection, LLC; Henry Cagey (Co-chair), Lummi Indian Business Council; Manley A. Begay Jr., Northern Arizona University; Timothy Collins, Alaska Native Tribal Health Consortium; Kymberly D. Cravatt, Chickasaw Nation Department of Health; Theresa A. Cullen, Pima County Health Department; Jillian M. Nohealani Freitas, University of Hawai‘i at Manoa; Ripan S. Malhi, University of Illinois at Urbana-Champaign; Timothy Southern, South Dakota Department of Health.

REVIEWERS To ensure that it meets institutional standards for quality and objectivity, this Proceedings of a Workshop—in Brief was reviewed by Theresa A. Cullen, Pima County Health Department, and Teresa Montoya, the University of Chicago. Leslie Sim, National Academies of Sciences, Engineering, and Medicine, served as the review coordinator.

SPONSORS This workshop was supported by federal funds from the Administration for Strategic Preparedness and Response; Centers for Disease Control and Prevention; National Highway Traffic Safety Administration; National Center for Disaster Medicine and Public Health of the Uniformed Services University of the Health Sciences; U.S. Department of Defense; and U.S. Department of Homeland Security. Additionally, this project has been funded in part with federal funds from the Eunice Kennedy Shriver National Institute of Child Health and Human Development; National Institute on Aging; National Institute of Environmental Health Sciences; National Institute of Allergy and Infectious Diseases; National Cancer Institute; National Institute on Minority Health and Health Disparities; National Institute of Neurological Disorders and Stroke; Office of Behavioral and Social Sciences Research of the National Institutes of Health, Department of Health and Human Services, under Contract no. HHSN263201800029I, Task Order no. 75N98023F00030. This workshop was also supported by the American Burn Association; American College of Emergency Physicians; American College of Surgeons—Committee on Trauma; American Hospital Association; Association of Public Health Laboratories; Association of State and Territorial Health Officials; Council of State and Territorial Epidemiologists; Emergency Nurses Association; Healthcare Distribution Alliance; Healthcare Ready; Infectious Diseases Society of America; Mass General Hospital; The MITRE Corporation; National Association of Chain Drug Stores; National Association of County and City Health Officials; National Association of Emergency Medical Technicians; National Fire Protection Association; Sandia National Laboratories; Society of Critical Care Medicine; Trauma Center Association of America; and University of Nebraska Medical Center. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

STAFF Lisa Brown, Senior Program Officer; Matthew Masiello, Associate Program Officer; Shalini Singaravelu, Program Officer; Michael Berrios, Research Associate; and Rayane Silva-Curran, Senior Program Assistant.

For additional information regarding the workshop, visit https://www.nationalacademies.org/event/42764_07-2024_strengthening-indigenous-america-building-resilience-through-disaster-preparedness-response-and-recovery-a-workshop.

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2024. Strengthening Indigenous America: Building resilience through disaster preparedness, response, and recovery: Proceedings of a workshop—in brief. Washington, DC: The National Academies Press. https://doi.org/10.17226/28284.

Health and Medicine Division Copyright 2024 by the National Academy of Sciences. All rights reserved.