In Alaska, gathering enough patients to administer an entire vial of the Covid-19 vaccine to can be a challenge.

“One of our villages has four year-round residents. Another village has one,” said Bernina Venua, the Incident Commander of Bristol Bay Area Health Corporation’s Covid-19 response. The health center is the only medical facility serving all 28 villages in Alaska’s Bristol Bay region, an area covering more than 45,000 square miles with a population of roughly 7,500.

“We have to make sure when we go to the villages there is a multiple of 10 or…close to a multiple of 10 to make sure there is no waste,” explained Venua. BBAHC is using the Moderna vaccine. Each vial contains 10 doses and, once a vial is open, it must be used within 6 hours.

In many of Alaska’s roadless communities, where the outside world is only accessible by plane or ferry, finding extra arms if there are remaining doses is particularly difficult.

The solution? “Chartering a plane,” said Venua. When necessary, the health centers carts residents back and forth between their homes and the nearest vaccination site on small passenger planes. “This is how we can provide that service for those residents and at the same time, minimizing any wasted vaccine.”

In one of the villages BBAHC serves, three residents were traveling when the health center’s medical team went to administer vaccines. They were at high risk and wanted the vaccine. “Instead of wasting seven doses, we flew them in,” said Venua.

The health center is also making special accommodations for patients who are homebound. While some have conditions that limit their mobility, others rely on less insulated modes of transportation, which can make travel difficult during the winter. “Getting an elder to sit on a four-wheeler in minus 10 degrees, or even at 10 degrees, to go to the clinic” is not going to happen, explained Venua. Instead, providers administer the shot in the comfort of the patient’s home.

This kind of approach has made Alaska the most fully vaccinated state in the country. As of Monday, about one-quarter of the population has received a first dose and nearly 16%  have received a second.

The push to vaccinate the community comes as the region prepares for an influx of visitors during the spring and summer fishing season, when the population typically doubles in size. “We really want people to be more protected,” said Venua.

Without thorough vaccination, tourism could undo months of effort on the part of residents to keep Covid outside their borders. “People in our region have taken Covid fairly serious from the beginning,” said Venua.

That seriousness is partly due to the impact of the 1918-19 Spanish Flu, which decimated Alaska’s tribal communities, wiping out entire villages. Many children were orphaned during that time by parents sickened by the virus. Some were without care for months before being found by rescue officials. Eventually, an orphanage was set up in Dillingham, Bristol Bay, which now serves as the site of the regional hospital BBAHC operates.

“The people that we have here are children raised by people who were in the orphanages,” explained Venua. Many patients grew up hearing stories about the devastation their communities, and families, experienced during the previous pandemic. “That fear, I think, helped people move towards protection.”

Another reason residents are taking pandemic precautions more seriously could be because, in Alaska, the stakes are higher to get to care in time.

“Anyone who has severe Covid…we have to medevac them out of the region,” said Venua. Critical patients must be flown to the nearest ICU, which is located in Anchorage. During the height of the pandemic,  weather also introduces an uncertain variable:

“If you get really, really sick and there is a blizzard, we are going to do our best to fly, but we are weather dependent.”

The most critical patients must be flown to the nearest available ICU bed. During the peak of the pandemic in November and December, hospitals in Anchorage—the closest major city—reached capacity. That meant providers like Venua had to scour the state for open beds and, should they find one, hope the weather cooperated. 

These limitations have shaped both provider and patient expectations around Covid care. “BBAHC has been pretty honest about our capacity to deal with a surge, which we can’t,” said Venua. “People know that.”

Direct Relief has provided Bristol Bay Area Health Corporation with a $200,000 grant to support their vaccination efforts, including funds to help reach patients in the region’s most remote communities.