PROJECT SUMMARY Alaska Native and American Indian (ANAI) communities are experiencing a disproportionate share of SARS- CoV-2 infection and its sequelae in the US. As of September 2021, ANAI people had a cumulative incidence of 9,256 COVID-19 cases per 100,000, compared with 5,445 among non-Hispanic Whites. The current rate of COVID-19 associated deaths per 100,000 population is 220 among ANAI people, compared with 137 among non-Hispanic Whites. Widespread vaccination remains the best strategy to control COVID-19 morbidity and mortality, but the US has one of the lowest vaccine acceptance rates in the world with wide regional variability. Little research has attempted to understand or address barriers to COVID-19 vaccination in ANAI people, despite unique geographical, historical, and cultural factors that could influence vaccine uptake in this population. We have formed a consortium of Tribal health leaders from across Alaska to better understand vaccine attitudes and intentions, including hesitancy, and to increase vaccine uptake in Alaskan ANAI communities. In conjunction with community advisors, we will develop and implement a theory-driven intervention that is grounded in ANAI values of relationality and respect. First, we will use vaccination tracking data to assess current rates of vaccine uptake and analyze preexisting quantitative and qualitative data regarding vaccine attitudes, intentions, and behavior among ANAI people in rural and urban areas of Alaska. We will also conduct a survey in southcentral Alaska to inform intervention design. Second, we will work with statewide Tribal health leaders and regional Community Advisory Boards to create educational information, stories, and messages keyed to the beliefs and perceived norms that drive vaccine behavior. This content will be incorporated into an eHealth toolkit for use by community members and specially trained community vaccine advocates, laypeople who volunteer to provide information and motivational/emotional support to their friends, families, and communities. Third, we will launch the intervention in the southcentral region of Alaska and evaluate effectiveness using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE- AIM) framework. Refinements based on program data and participant feedback will be made, then the refined intervention will be deployed in two rural regions of Alaska and evaluated. This project will add to the limited evidence base regarding adult vaccine attitudes, intentions, and behaviors among ANAI people. It holds the potential to increase vaccination in a hard-hit population and build support for future vaccination as SARS-CoV2 continues to evolve. Our findings will have broader applicability to vaccine outreach and engaging ANAI communities in leveraging peer relationships, their social networks, and eHealth to promote health education and behavior change.

PROJECT NARRATIVE Alaska Native and American Indian (ANAI) people in the state of Alaska are twice as likely as the general population to contract SARS-CoV-2, are at elevated risk for hospitalization and death from COVID-19, and vaccination remains low. To increase COVID-19 vaccine uptake among ANAI people in Alaska we will train and support ANAI community members to serve as community vaccine advocates by providing information, motivational strategies, and Web-based tools to help them talk with vaccine-hesitant friends and family about COVID-19 vaccines. Broader applicability includes the development of new approaches to vaccine outreach and engagement in ANAI communities, one that leverages peer relationships, social networks, and eHealth to promote health education and behavior change.