Bristol Bay Area Health Corporation (BBAHC) operates a critical access hospital in Dillingham, Alaska, a hub community. The corporation also staffs 21 village clinics in the 28 communities it services. The area spans approximately 35,000 square miles with a population of about 6,800 people. The majority (64%) of permanent residents in Bristol Bay are Alaska Native and American Indian, a federally identified medical underserved population (MUP). In addition to the hospital, state-of-the-art emergency room, primary care clinics, behavioral health, and dental services, BBAHC provides a range of preventive and health-promotion-oriented services to all residents including its State-supported Infant Learning Program serving children aged 0-3, Supplemental Nutrition Program for Women, Infants and Children (WIC), and Tobacco Cessation. Federally-supported programs include Injury Prevention, Special Diabetes Program for Indians, Indian Environmental General Assistance Program (IGAP), and Health Resources and Services Administration (HRSA) supporting tribes in their efforts to administer environmental programs.
BBAHC seeks support from the Centers for Disease Control and Prevention to strengthen public health infrastructure in Bristol Bay in Southwest Alaska to support more robust planning, delivery, evaluation to advance the health and wellness of Indian Country. The focus of the program will be increasing immunization rates throughout the region and will be named Bristol Bay Immunization Initiative.
Alaska Native and American Indian residents who are not vaccinated against preventable diseases face increased morbidity and mortality – diseases that a sophisticated and culturally-informed public health system can systematically reduce through improved capacity, strong surveillance and reporting, workforce competence, and collaborative partnerships that build system capacity. Bristol Bay’s rural and remote location in Southwest Alaska presents itself as a year-round obstacle to efficient delivery to the 28 villages BBAHC serves.
The challenge to increase and sustain a high level of vaccination coverage for children and adults in rural Alaska is ever-present and multi-factorial. Further, most vaccination rates for children and adults lag behind state and national targets including those published in the Healthy People 2020 objectives. The trends in the region’s overall immunization data also appears evident in recent Influenza immunization rates. Active clinical patients in Bristol Bay aged 6 months-17 years saw a 5.1% decline from 34.9% to 29.8% in 2017 from base year 2010. The Healthy People 2020 Target is 70%. Patients 18 and over saw an increase of 5.5% for the same period from 30.6% to 36.1%. This rate falls under the Healthy People 2020 target of 70%.
Residents of the region have not exhibited a sustained demand for immunizations including seasonal Influenza vaccination which further exacerbates systems-level constraints to higher vaccination rates. In this proposal BBAHC lays out a plan to evaluate and begin building up, with CDC’s support, requisite public health infrastructure, programs and services, as well as community awareness tools about the value of vaccines in preventing disease. The focus for Phase 1 is to increase Influenza vaccination coverage to 40% for children and 40% for adults 18 and older. BBAHC hopes to acquire both Phase 1 funding and will apply for Phase 2 funding to further advance tribal public health capacity and quality in support of healthier communities.