WAGNER, S.D. — Avery Medicine Bear, a 12-year-old on the Yankton Sioux Reservation, got the COVID-19 shot in his right arm.

That's because he's a basketball player.

And he shoots with his left.

"That's why he got it with his right," said Harry Medicine Bear, Avery's father, with a laugh. "He's not even sore."

The vaccination effort in Indian Country has been one of the brighter stories of the fight against COVID-19. On Thursday, June 24, the acting director of the IHS, Elizabeth Fowler, toured the IHS clinic in Wagner — the first IHS site in the nation last year to report a COVID-19 case.

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Now, Fowler noted, the site touts a 71% vaccination rate among both native and non-native persons in the service area, a rollout the envy of many, if not most communities across South Dakota.

"I'm here because I wanted to see firsthand the work that the advocates and employees are doing to support community immunity," said Fowler.

While South Dakota infamously "didn't shut down" during COVID-19, the state's citizens were in the top one-fifth of states for both deaths per-capita and third overall for infection rates across the nation. In tribal communities, the threat of COVID-19 was elevated, as many residents suffer a range of co-morbidities and live, like the Medicine Bears, in multi-generational housing.

"Everybody in the house is vaccinated now," said Medicine Bear.

Health officials say these amplified public health vulnerabilities have spurred vaccine uptake in places like Wagner.

While South Dakota's overall vaccination rate has remained hovering just above 50% after starting with a jolt, it's been the rural state's 9 tribal nations — all of whom chose to rely on IHS, rather than the state government for supplying their vaccination shots — who've led the way in inoculating at-risk populations.

"I like baseball," said Melody Otte, a nurse practitioner with IHS in Wagner, on Thursday. "I feel like we hit it out of the park."

The Biden administration had sought 70% of Americans starting their vaccination series by Independence Day 10 days away. Although that mission remains elusive, it's happened in Wagner.

In addition to opening up vaccination sites to non-Native persons, IHS has engaged in education campaigns, reached out to vaccinate non-Native teachers at the local school, and even parked a mobile vaccination site — a joint-effort with Federal Emergency Management Administration — at the old Shopko in Wagner.

"Our communities are geographically vast," said IHS Great Plains Area COVID-19 Task Force lead Dayle Knutson. "But we are also small families."

Myrtle Bruguier, a tribal elder, told Forum News Service that she'd had a heart stent put in and remained isolated during the pandemic on the reservation — which incorporates land running along the Missouri River and includes the city of Wagner, though it has been checker-boarded up through allotment.

A personal tie brought her into the clinic for a jab.

"That lady right there," said Bruguier, pointing to the uniformed public health nurse standing nearby and smiling. "She called me and asked me if I wanted to take the vaccine."

Bruguier said she asked the nurse, "'Is it safe?' And she said, 'Well, I think so.'"

Bruguier then called her doctor, who told her to take the vaccine because "it was going to do me good."

While the ramifications of COVID-19 — and vaccination rates — vary from each of the tribal nations in South Dakota, the tribes largely took a more aggressive stance in combating the virus than the state, ordering curfews, temporary closures of certain businesses, and even, in some instances, checkpoints on highways bifurcating tribal lands.

Knutson said that these efforts partially were driven by heightened concerns. The mortality rates in American Indians and Alaskan Natives are 3 1/2 times higher than in non-Hispanic whites, according to national data.

Yankton Sioux Tribal Chairman Robert Flying Hawk spoke to the gathering on Thursday briefly, recounting his own battle with COVID-19.

"I caught the virus, and it was scary," said Flying Hawk, who said he stayed home for three weeks with a headache, body aches, unable to sleep. Ultimately, a clarifying thought came to him, which he now uses while campaigning for vaccine uptake.

"At my age, I wanted to continue to live."

Health officials say the next task remains convincing those persons with doubts to get the vaccination and further ward off future damage from the virus or variants. While vaccine skepticism in Native communities mirrors non-Native communities, elders — and the youngest generation currently eligible for the vaccine (those between 12 and 18) — are also showing higher uptake rates.

"You have to protect everyone around you," Avery said, eating a plate of fruit on Thursday next to his father. "And yourself."