Native American communities were hit especially hard by COVID-19. According to the National Center for Health Statistics (2022) and Hurwitz et al. (2023), Native Americans were more likely to suffer serious effects from the virus during the pandemic than any other group in the United States, including Black and Latino Americans. As COVID-19 vaccines became available in 2021, many tribal colleges and universities (TCUs) stepped up to protect not only their staff and students, but their communities as well. With vaccine misinformation on the rise and public confidence low, the Extension Foundation offered funding to TCUs through the Extension Collaboration on Immunization Teaching and Engagement (EXCITE) initiative to support adult immunization education. As trusted members in their communities, extension agents and educators provided accessible, evidence-based vaccine information while fostering stronger ties between extension departments, local communities, and healthcare systems.

Since 2021, more than one third of TCUs have participated in EXCITE projects and launched community-driven outreach campaigns grounded in cultural values. The projects were conducted on a local level and extended beyond campuses into tribal communities, incorporating storytelling, prayer, social media, and community events to deliver science-based information in culturally resonant ways. These institutions worked to address a wide range of recommended adult immunizations, demonstrating the value TCUs can add to health and wellness initiatives thanks to a deep understanding of their communities’ needs, values, and cultures.

Methods and Approach

EXCITE funding was awarded through a non-competitive process to all institutions that applied, allowing each TCU to design and implement projects that would resonate locally. TCUs focused on culturally grounded messaging, often delivered by elders, faculty, athletes, or other individuals seen as trusted figures. The institutions often embedded vaccine education within existing community gatherings such as powwows, farmers markets, or ribbon skirt workshops. All the participating TCUs reported that they saw great value in creating a positive and welcoming environment at their events by utilizing storytelling, prayers, and/or smudging as a way to ensure that participants were ready to receive the immunization information. Personal testimonials and short videos featuring recognizable community members helped put a face to the science and humanize the messaging. These campaigns often began on campus but quickly extended into the surrounding community through social media and educational materials. Institutions shared the resources they created throughout the cooperative extension system, allowing other teams to learn, use, adapt, and/or build upon the work being done across the Land-Grant university system. This approach allowed for even greater reach and impact nationwide.

TCUs quickly recognized the importance of external partnerships. Many teams partnered with pharmacies, state or local health departments, or other healthcare providers to ensure that vaccines were readily available to individuals seeking them. Institutions also partnered with a number of local nonprofit organizations that helped with engagement and resource sharing. They partnered with other departments and student-led groups. These partners helped to establish trust and boost engagement efforts. 

Culturally Rooted Approaches in Action

TCUs undertook a variety of strategies to educate their staff, students, and communities about adult vaccines. Keweenaw Bay Ojibwa Community College (KBOCC) in L’Anse, Michigan, and Bay Mills Community College (BMCC) in Brimley, Michigan, partnered with Michigan State University to build capacity. The EXCITE project allowed the three institutions to collaborate and deepen relationships, fostering a positive partnership that continues today. By working together, the three institutions were able to pool their time and resources for greater impact. The EXCITE project was an opportunity to also increase trust between the Michigan Inter-Tribal Land-Grant Extension System and Land-Grant universities. They collaborated to ensure that culturally relevant and impactful immunization education messages would reach tribal members of all ages across Michigan. One of their biggest successes was a ribbon skirt workshop that reached 77 people from nine tribal nations. In May of 2021, Michigan State University received three years of additional CDC funding to continue vaccine education in partnership with KBOCC and BMCC.

Char Weingarten and Kit Laux helped make Keweenaw Bay Ojibwa Community College’s ribbon skirt workshop a smash hit.

United Tribes Technical College (UTTC) in Bismarck, North Dakota, understood the need within Indigenous communities for messages to come from trusted sources. UTTC reported that “through our applied neuromarketing testing, the UTTC team learned that testimonials that incorporated a cultural aspect and storytelling were highly engaging and remembered more easily than videos that contained facts about the importance of vaccines.” The team at UTTC built upon that concept and utilized a variety of key messengers from across the campus to share their experiences with vaccinations and how they came to make their decisions around immunization. These key messengers included the college president, the basketball coaches, the elementary school principal, and other students and elders. UTTC created 37 videos and 64 social media messages that were shared through various platforms, radio, and billboards across the entire state and beyond, with a reported reach of over 40,700 people.

UTTC president Leander Russ McDonald appeared on a college billboard encouraging community members to vaccinate.

The Institute of American Indian Arts (IAIA) focused on vaccination outreach and messaging through its students. This included producing educational testimonial videos featuring students who had received their vaccines and positioning these students as ambassadors to other Indigenous communities. These videos emphasized the ease and safety of vaccination, which resonated particularly well with Indigenous audiences who responded favorably to hearing from vaccinated students. These students were seen as the best conduits of information to other young people within their group. The videos that were created were shared on IAIA’s website, Facebook, Instagram, and X, allowing for widespread distribution with minimal expense.

IAIA utilized students to get the message out about vaccinations.

 As a part of their second phase of EXCITE work, IAIA organized vaccination clinics, which were held on the institute’s campus, with six vaccination events slated for the grant period. In collaboration with the New Mexico Department of Health contractor, the Foothills Pharmacy, and other clinics, they were able to offer COVID-19, influenza, Tdap, shingles, and pneumococcal vaccines during cultural events such as the IAIA fall powwow, the spring powwow, the institute’s open house, and their holiday art market. All of these events were open to the public and attracted hundreds of attendees from nearby pueblos, including Cochiti, Santo Domingo, San Felipe, Santa Ana, Tesuque, Nambe, Pojoaque, and San Ildefonso. The convenience of walk-in availability was appreciated, and incentives like gift-card drawings (funded separately) encouraged participation. The events were promoted through social media, newspaper ads, and email blasts, contributing to their success.

The College of the Muscogee Nation in Okmulgee, Oklahoma, was instrumental in engaging its community through campus-based events, which incorporated vaccine messaging. They hosted several activities to engage students and shared vaccine-related information in a setting and place that felt safe and inviting for the students. This approach provided an avenue for open and honest dialogue and discussion about fears and hesitations around immunizations. They also partnered with the Muscogee (Creek) Nation Department of Health to help promote the department’s mobile vaccine lab and decrease barriers to accessing vaccination.  

Increasing knowledge related to all recommended adult immunizations was key to the Fort Peck Community College (FPCC) project. The team realized that adult immunization recommendations go well beyond just COVID-19 and influenza. Unfortunately, adults often are not aware of what those vaccine recommendations include. FPCC in Poplar, Montana, provided immunization educational sessions open to staff, students, and community members. These presentations focused on the importance of adult vaccinations, including an update on all currently recommended adult immunizations, the purpose of those vaccines, where to get them, how they work, and potential side effects. Participants valued having a safe place to be able to ask specific vaccine-related questions, and the presentations were seen as valuable to improving perceived vaccine safety within the community.

The Nebraska Indian Community College was instrumental in engaging its community through immunization educational events. They conducted in-person, vaccine educational “lunch and learn” programs, which were held monthly and open to students, staff, and community members. In total, 76 community members from the Omaha and Santee reservation areas attended these trainings, which helped to increase the adult uptake of the COVID-19 vaccine to 96% of the population.

Nebraska Indian Community College’s clinic helped achieve a 96% vaccination rate among the Omaha and Santee tribes.

One of the major successes of the team from the College of Menominee Nation in Keshena, Wisconsin, was the use of video messages created specifically for their students and community. As a part of their EXCITE project, they created eight videos featuring 18 to 24-year-olds from the college sharing their personal stories about why they opted to receive the COVID-19 vaccine. The videos garnered around 5,300 views through a variety of social media platforms. The team noted that during the time of their project, the vaccine rate among 18 to 24-year-olds nearly doubled from 31.2% to 77.6%.

The Blackfeet Community College (BFCC) in Browning, Montana, project focused on vaccine outreach, particularly regarding RSV, COVID-19, and influenza vaccinations. They hosted events on their campus in partnership with the Blackfeet Tribal Health Department that were open to students, staff, and the surrounding community members. One significant event that the BFCC participated in was the health day held on campus. Over two hundred participants at the fair were provided with information on various aspects of holistic health, including immunizations. The fair featured booths dedicated to adult immunization, including posterboards and handouts created by nursing program students. An immunization magnet game was also utilized at the booth as a way to engage participants and share vaccine knowledge. After learning about the importance of vaccines by eliminating certain germs in the game, attendees were directed to the posterboard most relevant to their age group and the recommended vaccines. Participants expressed positive feedback and appreciated receiving vaccine information tailored to their specific situations. Many individuals noted that they had no idea that their health status put them at high risk for pneumonia and that they should talk to their provider about getting a pneumococcal vaccine. 

Aaniiih Nakoda College in Harlem, Montana, participated in EXCITE efforts to increase vaccine confidence in the Fort Belknap community. Their initiative focused on providing vaccine education and connecting residents with vaccination opportunities, in partnership with the Fort Belknap Public Health Department. The college hosted a major vaccination event in November 2024 in collaboration with the Blaine County Health Department, which offered COVID-19 and influenza vaccines. Nursing students from the college administered the vaccines. Their event was open to anyone who wanted to attend, regardless of insurance status, Indian Health Services membership, or tribal enrollment.

To support ongoing outreach, Aaniiih Nakoda College nursing students created brochures and flyers that incorporated artwork and stressed the importance of vaccinations. These handouts were distributed on campus and through partner agencies like the public health and WIC (women, infants, and children) offices. They reported a reach of 160 people for their print media. The materials included QR codes linking to IHS and CDC resources, as well as event details for local vaccination clinics.

Aaniiih Nakoda College’s handout underscored the dangers of pneumococcal disease, encouraging community members to vaccinate.

The Red Lake Nation College (RLNC) in Red Lake, Minnesota, also incorporated culturally relevant vaccine messaging into events and activities being hosted on campus. They recognized the significance of blending both Western medicine approaches, such as vaccines, with tribal health approaches, such as sweats and smudging, as essential for holistic health. RLNC also created patches that read “Vaccinated Native,” which were able to be sewn into traditional ribbon skirts as a subtle message to others about the importance of immunization.

Cankdeska Cikana Community College in Fort Totten, North Dakota, and Little Priest College in Winnebago, Nebraska, leveraged the use of social media through various platforms. These two institutions participated in some of the earliest EXCITE efforts. They utilized various social media platforms available through the campus, which allowed their messages to reach not only the students and staff of the institution but also the alumni, family, and friends who were located across the nation, resulting in a broad and impactful reach. They boosted their social media posts by purchasing advertisements to ensure the messages reached the intended audience. These teams were able to share promptly valuable and impactful information related to safety and the importance of immunizations from trusted sources.

Challenges and Recommendations

Institutions that participated in the EXCITE work experienced a number of challenges throughout their projects. Some included difficulty with identifying partner providers who could provide vaccines at their events. There were frequent institutional staff turnover issues and concerns related to grant management at many of the institutions. One TCU hosted a large in-person educational session in May of 2023 for their community members. This session shared the importance of adult immunizations. But due to staffing turnover, they were unable to complete their project or share the impact of their work. Other barriers identified by the TCUs included vaccine hesitancy within the institution, short grant timelines which did not allow for hiring of additional personnel, financial restrictions related to what the funds could be used for, and the political climate surrounding immunizations. Some teams also indicated that the constant changing of vaccine recommendations and immunization fatigue made their efforts more challenging. By far the largest barrier to participation in EXCITE efforts was a lack of people resources to do the work and the many competing institutional priorities.

Regardless of these challenges, every participating institution had positive things to say about their experience working with the EXCITE program. These institutions all had a strong commitment to the health of their students and the greater tribal community. They all had a willingness to do what they could to share science-based knowledge with those they serve, hoping to play a role in positively impacting the health of their community.

All 13 of the TCUs that participated in EXCITE projects throughout the past four years completed their efforts by March 2025. Collectively, they reported reaching nearly 454,000 individuals through their outreach and working with 55 different partners. These collaborations laid the foundation for lasting relationships that will continue to enhance the health and well-being of students and the surrounding communities.

Although institutions faced staffing shortages, limited resources, and competing priorities, they remained committed to delivering timely, culturally relevant, and science-based immunization education. Each TCU developed tailored strategies that reflected their community’s values, resulting in messaging that was trusted and well-received. By empowering local leaders and leveraging culturally grounded communication methods, EXCITE enabled TCUs to play a pivotal role in promoting public health. Their grassroots efforts demonstrate how community-based approaches can yield national impact by informing, engaging, and protecting medically underserved populations with respect and effectiveness.

Ruth Hursman, RN, MSN, is an EXCITE project coach that assists and supports immunization efforts at tribal colleges; Melanie Pugsley is a coordinator at the Extension Foundation; and Tia Gregory, MS, is an extension instructor in the School of Human Sciences at Mississippi State University.

References

National Center for Health Statistics (U.S.). (2022). Provisional Life Expectancy Estimates for
            2021 (NCHS Vital Statistics Rapid Release Reports No. 23). Washington, DC: National
            Vital Statistics System. DOI: 10.15620/cdc:118999

Hurwitz, I., Yingling, A.V., Amirkabirian, T., Castillo, Khan, J.J., Do A., et al. (2023).
            Disproportionate Impact of COVID-19 Severity and Mortality on Hospitalized
            American Indian/Alaska Native Patients. PNAS Nexus, 2(8), 259.
            doi:10.1093/pnasnexus/pgad259

Acknowledgements

EXCITE is made possible through an interagency agreement between the United States Department of Agriculture – National Institute of Food and Agriculture and the Centers for Disease Control and Prevention, with a cooperative agreement with the Extension Foundation in partnership with the Extension Committee on Policy Health Program Action Team. The Extension Foundation is a nonprofit organization that provides grant administration and fiscal oversight in support of the Cooperative Extension System. The Extension Foundation effectively ensured operational and technical support for grant administration, established system-wide communication and data collection, provided coaching support, created dashboards, and fostered partnership development.