Left: Kayla In The Woods, 27, with her children in Eagle Butte, the largest city on the Cheyenne River Reservation. Right: Upon the arrival of Europeans in the Americas, Native Americans suffered unimaginable levels of death from flu, smallpox, and measles. Pictured here is the cemetery at St. Joseph Catholic Church in Cherry Creek, Cheyenne River Reservation, established by missionaries in 1894. (Sarah Stacke)

Joseph White Eyes walks along the Moreau River. White Eyes chose to get the Covid-19 vaccine to protect himself and the people around him, but he understands people's hesitancy. The Lakota were “used as test dummies in hospitals and infected with smallpox blankets to wipe us out,” he says.(Sarah Stacke)

“Mass sterilization to most people is just an event,” Remi Bald Eagle told me recently, holding back tears. “But to us, that’s family that never made it here.” The sterilization campaign that the Indian Health Service carried out in the 1960s and ’70s afflicted somewhere between 25 and 40 percent of Native American women of childbearing age nationwide. Sterilizations were performed through coercion and without informed consent, a grievous violation of the physical integrity and personal agency of the women affected. On the Cheyenne River Reservation, the sovereign Lakota nation in South Dakota where Bald Eagle lives, the campaign left deep scars in the community. “There’s always that loss,” said Bald Eagle.

“The vaccine is an event we have to figure out how it’s going to affect our families for generations to come,” says Remi Bald Eagle, the Intergovernmental Affairs Coordinator for the Cheyenne River Lakota Nation in South Dakota.(Sarah Stacke)

Now, the IHS, the same US government agency that sterilized women, is comanaging the vaccination effort to combat the Covid-19 pandemic along with CRST Tribal Health. Tribal leaders and health care workers are making every effort to overcome resistance to vaccination, but for many Cheyenne River tribal members, this legacy of abuse is making the choice to get vaccinated or not acutely difficult.

Last year, I covered the tribe’s bold battle against Covid-19 for The Nation. When the vaccine arrived and many of the newly inoculated shared their status on social media, I wondered how the people I spent time with at the height of infections on the reservation were feeling about this possibility of relief. Opinions varied, of course, even within the same households, but everyone I interviewed relied on personal reflection and prayer, history, and experiences both lived and passed on, while making a decision about the vaccine.

Cheyenne River Chairman Harold Frazier says the hardest thing about the pandemic for his people has been not being able to see family. “The basis of our culture is family and it’s really taken a toll on a lot of people,” he says.(Sarah Stacke)

Like many places, there was an initial surge of vaccinations in Cheyenne River once they became available late last year. After months of separation in a community that deeply values family, people were desperate to see relatives again. Tribal Chairman Harold Frazier said the “hardest thing” about the pandemic for his people “is not being able to see family,” adding, “The basis of our culture is family and it’s really taken a toll on a lot of people.”

Left: A mural by M. Running Wolf depicts the Sun Dance, the most important ceremony practiced by the Lakota. The US government outlawed the Sun Dance in 1904, and it wasn’t until 1978 that the American Indian Religious Freedom Act was passed, protecting the rights of Native Americans to exercise their traditional religions. Right: Joyce Edwards, 64, hesitated before getting the Covid-19 vaccine. It’s estimated that in the 1960s and ’70s, when Edwards was a young woman, the Indian Health Service sterilized 25–40 percent of Native American women of childbearing age. “I got too many grandkids and great-grandkids running around me, that’s why I got it,” says Edward.(Sarah Stacke)

Left: Patricia Little Wounded lost her son, Waylon Young Bird, to Covid-19 on November 4, 2020. Incarcerated when the pandemic took root, Young Bird had severe kidney disease and other underlying conditions. He reportedly wrote 17 letters to US District Judge Roberto Lange requesting to serve the remainder of his sentence in home confinement. Young Bird was denied compassionate release and died one week after contracting the virus. He was 52. Patricia, who goes by Patty, chose to be vaccinated. Right: The photographs of Frank Cundill, a homesteader and politician, are housed at the Timber Lake and Area Historical Society in Timber Lake, a small community on the Cheyenne River Reservation. Originally from Iowa, in 1911 Cundill joined the migration of people settling the newly opened Cheyenne River Reservation.(Sarah Stacke)

Today, the Cheyenne River reservation, like the rest of the country, is experiencing a plateau in vaccination rates. The dynamics for this marked decline in new vaccinations are different from community to community, but on the reservation, people I spoke to said the main reason remains distrust of the US government in general and of IHS medical authorities in particular. This distrust began with the first colonizers in the 15th century and continued through the founding of the US and has thrived to this day.

As of June 30, a total of 6,091 vaccinations had been given on the reservation. Of these, 3,136 were first shots and 2,955 were second shots, in an estimated population of 10,000–12,000. With the more transmissible Delta variant rapidly gaining ground in the United States, that means that well over half the reservation’s population remains at high risk of contracting the virus. Yet every decision the tribe makes is shaped by that history of cruelty and betrayal, and that includes medical care.

“The threat against our people has never changed,” Bald Eagle, intergovernmental affairs coordinator for the tribe, told me. “We survived massacres, wars with the US, and laws the US made against us. We survived prejudice, racism, genocide, sterilization, boarding schools, I don’t even want to get into adoptions, the churches.” The Covid-19 pandemic “is just another thing to survive,” he said. “And we did it through the resilience of the people here, not because of the CDC or the state of South Dakota for sure, they were fighting against us.”

Danny Grassrope, left, has chosen not to get the Covid-19 vaccine. His partner, Joseph White Eyes, is fully vaccinated. Grassrope is hesitant to get the vaccine because he doesn’t trust the government, “especially IHS,” and he’s concerned about the long-term health effects of the vaccine. Still, he feels “relieved” and it makes his “spirit happy” that his Lakota relatives “are more uplifted and they’re more positive” since the arrival of the vaccine. (Sarah Stacke)

Joseph White Eyes walks along the Moreau River. White Eyes chose to get the Covid-19 vaccine to protect himself and the people around him, but he understands people's hesitancy. The Lakota were “used as test dummies in hospitals and infected with smallpox blankets to wipe us out,” he says.(Sarah Stacke)

At the pandemic’s onset, the tribe’s response was swift and sweeping. This wasn’t their first rodeo with a deadly virus, after all. They followed recommendations by medical professionals and scientists, and developed their own strict response plan, driven by the entrenched knowledge that the tribe must protect itself at all costs. In early 2020, the tribe set up checkpoints on all roads with access to the reservation in a vigilant effort to protect its people. South Dakota Governor Kristi Noem, who eschewed pandemic precautions, ordered the checkpoints removed, a demand she and then-President Donald Trump, whom Noem turned to for support, did not have the legal right to enforce. After the vaccine arrived and infection rates fell, the tribe made the decision to remove the checkpoints themselves. Thanks to their quick efforts, infection rates remained under control, though 1,815 people have contracted the virus and 37 people have died, a mortality rate slightly higher than the national average.

Infection control nurse and tribal member Molly Longbrake has been on the frontlines of the pandemic since it arrived on the reservation. The most challenging part of the vaccine rollout, according to Longbrake, has been combatting vaccine hesitancy. “Our main goal is to protect everybody,” she says. “It’s such a scary disease.”(Sarah Stacke)

Marcella LeBeau with her granddaughter, Dawnee LeBeau. Marcella, 101, is the oldest matriarch on the Cheyenne River Reservation, and Marcella and Dawnee are both fully vaccinated. “I do the best I can for myself and for my people,” says Marcella, who was a nurse for over 30 years. When Marcella was born in 1919, she wasn’t considered a citizen of the United States.(Sarah Stacke)

For tribal members who choose to get vaccinated, access to the vaccine and as much information that’s known about it are not the hurdles. Chances are high in this tight-knit community that the person administering the vaccine was a schoolmate or at a minimum a familiar face. CRST Tribal Health infection control nurse and tribal member Molly Longbrake, who lost her mother to Covid-19, regularly travels 90 minutes or more, round trip, to administer the vaccine to people living in the reservation’s smallest communities. She and her team, which consists of three providers, eight nurses, and 17 support staff, also go door to door and make phone calls to offer information. “Education, education, education,” is how Longbrake said they are addressing those who say no, need more time, or ask for more information. “I’m not ready to let our guard down by any means, especially with the new strains that are popping up,” she told me.

Before the vaccine was available in Cheyenne River, most fears centered around keeping the virus away from tribal members. Now, “the anxiety is the vaccine itself,” said Joseph White Eyes, noting the possibility of physical side-effects as well as the history of broken trust and abuse by the US government. We were “used as test dummies in hospitals and infected with smallpox blankets to wipe us out,” said White Eyes.

A lot of people believe the vaccine was too rushed and the long-term effects could be harmful, said Longbrake—they ask her what it’s going to do to them “a year down the road? Ten years down the road? Will it cause infertility?”

Tami Hale walks along the Moreau River. Hale has chosen not to get vaccinated, but she respects people who do. “If someone wants to take the vaccine, they should,” says Hale. And if they don’t, she says, they should “find other ways to protect themselves. Follow the CDC guidelines. Love yourself enough to take care of yourself because ain’t no one going to do it for you.”(Sarah Stacke)

The US government’s brutal crackdown to the protests against the Dakota Access Pipeline on the Standing Rock Reservation, which borders Cheyenne River, reaffirmed in the minds of many young people that the government was not there to protect them. As 44-year-old Tami Hale told me, the US government “put fear in us, just taking lives like it was nothing. And now they’re taking the biggest life of all and that’s Mother Earth. Natural resources. If you drain the blood out of your body, you’ll die. That’s what they’re doing, they’re killing her.”

“Now they want me to take the vaccine. I said no. I don’t trust the government, I don’t trust the shot,” said Hale.

TaSina Sapa Win Smith chose not to get the Covid-19 vaccine. “When it comes to a virus that comes straight from Unci Maka [Mother Earth], I feel Unci Maka provides the medicines that we need to fight those types of viruses.” Smith also attributes her decision to say “no” to the vaccine to her complete mistrust of the US government. “There is no trust,” she says, “the US government, even today, they are lying to us” about political and environmental issues. Right: Evening settles over Eagle Butte, the largest city on the Cheyenne River Reservation.(Sarah Stacke)

Earl Grindstone has chosen not to get the Covid-19 vaccine, while his wife, Mona, has received both doses.(Sarah Stacke)

“The vaccine is an event we have to figure out how it’s going to affect our families for generations to come,” said Bald Eagle. “When we make a decision to get the vaccine, we’re not just balancing whether or not that vaccine is good for me, but whether or not there’s other things involved in this vaccine.”

“Every decision we make, whether it’s putting our children in school, getting a vaccine, the food we eat…is overcast by the shadow of tyranny” Bald Eagle told me. “The wheels of Manifest Destiny are still full of blood, and it’s ours.”

Mahto In The Woods, 19, rides his horse on his family’s land along the Moreau River, the same land on which Crazy Horse and Sitting Bull used to camp. In The Woods does not trust the US government or the Covid-19 vaccine and has chosen not to get vaccinated.(Sarah Stacke)