In the waiting room of the Meskwaki Tribal Health Center in Tama County, Iowa, Genesis Ramirez gripped a digital timer, her legs swinging in a chair.
The 17-year-old just got her second dose of the Pfizer COVID-19 vaccine, but she didn’t do it just to keep herself safe.
"My family is very high risk, and I don't want to bring anything back to them where I can't help them," she said.
Ramirez isn’t a member of the Sac and Fox Tribe of the Mississippi, also known as the Meskwaki Nation. But she is one of the 2,600 people who live or work on the tribe’s 8,100 acre settlement west of Cedar Rapids.
She’s also one of the many members of her community who’s fully vaccinated against COVID-19.
"I’ve been waiting and I've been wanting to get a vaccine just so I can know...I did something to help," Ramirez said.
According to state data, less than half of adult Iowans have been fully vaccinated. That’s far short of what experts say is needed for herd immunity.
But that number is much higher for the Meskwaki Nation, where officials estimate more than 70 percent of those eligible who live and work on the settlement are fully vaccinated.
"I'm actually a little surprised to be honest," said Rudy Papakee, the health director of the Meskwaki Tribal Health Center.
"I didn't expect our numbers to be this high this quick, I thought, eventually we'd start, you know, we'd hit a plateau, or we're trying to build upon those numbers. But we actually had a pretty, in my opinion, a pretty substantial number from the very beginning."
As Iowa’s only federally-recognized tribe, Meskwaki Nation leaders faced a unique choice last fall. They could get the vaccine through the state of Iowa or the federal government’s Indian Health Service.
Papakee said the tribe chose the feds.
"I just thought the connection with Indian Health Service was going to get much stronger," he said. "They made some promises right from the beginning that once we get it, we'll get it to your hands as quickly as we can."
Like some other tribes who have also chosen to go through the federal government, Papakee said that’s just what happened.
Doses started coming slowly in December. They vaccinated elders and health care workers first, and quickly moved on.
But vaccine hesitancy was prevalent at the start. Even tribal leaders like Delonda Pushetonequa, the treasurer for the Tribal Council, initially turned down the vaccine in December.
"I was one of the people who said no, you know, like, I don't trust the government to be able to give us a vaccine," she said.
But Pushetonequa said the Meskwaki Nation is a close-knit community with many multi-generational homes. She said this is what ultimately persuaded her to change her mind.
"I don't want to be that person who gets my dad sick, or any of my uncles, you know, who might not fare as well, if they were to get COVID," she said.
Pushetonequa said she believes this has pushed others to get vaccinated as well.
But officials said it’s taken more than that.
Sara Augspurger, the clinic nurse manager at the tribe’s Health Center, said the center’s staff works hard to spread accurate vaccine information and address concerns.
Augspurger said she’s careful not to push anyone who’s not ready.
"I also tell people, if you're not comfortable, then it's not time. You know, once you get comfortable with it, that's when you should get vaccinated," she said.
"And I've had four or five people be like,’ nobody's ever said that to me. You know, I feel like everybody's forcing me, but that makes sense,’ and have actually turned around and gotten vaccinated."
Papakee said he posts updates regularly in Meskwaki Facebook groups to address ongoing hesitations. He said he answers questions directly and tailors the experience of getting vaccinated to the community.
"We created a post on social media that said, ‘If you've had the vaccine, what were your reactions?’ It's no longer, ‘I read this on the news,’ or ‘I saw it on the internet.’ It's your friend, your neighbor, your cousin, your relative," he said.
But Papakee said demand for the vaccine has started to decline. Meskwaki leadership launched a program three weeks ago for the settlement’s 500 tribal operations employees. It offers them a $100 Visa gift card for each COVID-19 shot they get.
That’s pushed their group’s vaccination rate to nearly 80 percent. It’s a program Papakee said he hopes to extend to all tribal members soon, so he can reach his goal of getting 85 percent vaccinated.
This story was produced by Side Effects Public Media, a news collaborative covering public health.