In June, Manumalo Ala’ilima got a call from a family member that their brother was hospitalized for Covid-19. Ala’ilima lives in Portland, Oregon, while the rest of their family — some of whom also contracted the virus — live in Southern California.
For a while, Ala’ilima was convinced their brother would soon recover. But during their daily calls, his breathing, already labored, grew fainter until he couldn’t call or text anymore. A week and a half later, their family spent three hours saying their goodbyes over video. Ala’ilima watched, from their phone, as the hospital staff pulled the plug on their brother’s life support.
“In my mind, I was thinking to myself — no, not my family,” said Ala’ilima, who is of Samoan and Tongan descent from American Samoa and Samoa. “The hardest thing was debating at that time whether or not to attend his funeral because Southern California was a hot spot. Like how would we reimagine what a cultural funeral would be like so that we could celebrate and honor my brother in a very safe and accessible way?”
As the co-chair and co-founder of the United Territories of Pacific Islanders Alliance Portland, or Utopia PDX — a nonprofit group run by and for queer and transgender Pacific Islanders — Ala’ilima was already aware of how much Covid-19 had impacted Native Hawaiian and Pacific Islander (NHPI) communities. And how much they had been ignored.
When Oregon began publishing its weekly Covid-19 data report on the onset of the pandemic, Ala’ilima noticed that Native Hawaiian and Pacific Islanders had the highest infection rate out of all ethnic groups in the state — around 13.1 per 10,000 cases in the middle of April. And yet the group wasn’t even included in Oregon’s priority testing list when testing availability was limited in the state. Even the Center for Disease Control and Prevention (CDC) still won’t acknowledge NHPI’s high Covid-19 death and hospitalization rates, only showing statistics for Black, Latino, and Asian populations. The CDC, like other government agencies, tend to aggregate Pacific Islander under the Asian demographic, which harmfully hides the high infection and death rates within the community.
Because of this lack of data and prioritization by government agencies, Utopia PDX then decided to pivot its mission from queer and transgender Pacific Islander advocacy work to providing Covid-19 resources for Oregon’s NHPI community. In fact, across the country, it has been up to Native Hawaiian and Pacific Islander groups to help their own communities, including gathering data about Covid-19 testing, cases, and deaths.
“When this pandemic hit, we thought, ‘Do we let these government agencies derail our community?’ or ‘Are we going to help our community get the resources that they need in a culturally respectful and competent way?’” Ala’ilima said. “And a lot of us pivoted from our original missions, so that we could do this work together to serve our communities.”
In August, Ninez Ponce, director of the UCLA Center for Health Policy Research, and a group of scholars launched the Native Hawaiian Pacific Islander Covid-19 Data Policy Lab to collect, scrape, track, and interpret local Covid-19 data in NHPI communities, in collaboration with the coalition of Pacific Islander groups under the National Pacific Islander Covid-19 Response Team. As of December 2, the NHPI community has faced 30,832 positive cases and 366 deaths, according to the lab — but these numbers could be higher due to aggregated Asian American and Pacific Islander data in some states.
Ponce said when Covid-19 infection rates are calculated per 100,000 populations, the cases among Native Hawaiian and Pacific Islanders are the highest compared to any other racial or ethnic groups in 14 of the 21 states and Washington DC that report disaggregated NHPI data. Meanwhile, NHPI Covid-19 death rates are also the highest in 11 of the 16 states and DC that are reporting the demographic’s mortality data.
“NHPIs are currently seeing infection rates up to five times that of white people in Los Angeles County alone, and this impact is being felt across the country,” Ponce told Vox. “The impact on the NHPIs is devastating, and without accurate data, lives are lost each day.”
Why Pacific Islanders are at greater risk for Covid-19
Pacific Islanders, like other ethnic groups, are not a monolith. This growing group — 0.5 percent of the entire US population — includes Native Hawaiians, Chamorus, Samoans, Marshallese, Tongans, Fijians, and more. But for a long time, in general surveys and many government agency data, the diverse Native Hawaiian and Pacific Islander group have been lumped under the Asian American category, despite many advocates saying the group is more likely appropriate under the Native American category. In fact, 8 out of 10 Pacific Islanders in the country are Indigenous to the US-colonized territories, according to a report by a White House Initiative on Asian Americans and Pacific Islanders.
These US-colonized islands are scattered across the Pacific Ocean’s three regions — Melanesia, Polynesia, and Micronesia. Before European and American voyagers began colonizing the islands, Indigenous Pacific Islanders, like Native Americans, had been co-existing with the land and water for centuries. But as result of colonialism, Pacific Islanders have long carried a disproportionate health burden, researchers have found. Food diets (in which foreigners provided them with mostly oily processed or canned food), major illnesses, economic practices, and even military contamination have all been linked to the colonial disruption of Pacific Islanders’ native lifestyle. And when many Pacific Islanders moved to the mainland US, they still encountered rampant racism and faced disparities.
Health experts like Ponce and Raynald Samoa, MD, the lead expert of the Pacific Islander Covid-19 Response Team, said that because Pacific Islanders already suffer disproportionately on many fronts — from chronic illnesses like diabetes and heart disease to socioeconomic barriers that block access to health insurance — they are more vulnerable to the severe impacts of Covid-19.
Even in Hawaii, the only state that disaggregates both Native Hawaiian and Pacific Islander data, Pacific Islanders — excluding Native Hawaiians — show a huge disproportionate Covid-19 impact: Pacific Islander groups like Chuukese, Marshallese, and Samoan residents are more than twice as likely to suffer severe Covid-19 outcomes than other racial and ethnic groups in the state.
Before Ala’ilima’s brother passed away from Covid-19, he had high blood pressure and diabetes. He was also a former US Marine and had just retired from working at the Transportation Security Administration. While their family was playing it safe the whole time, Ala’ilima’s brother was the one doing the errands — so they believe that he contracted the disease while shopping for groceries.
The grieving process was the hardest part. “The pandemic is asking us how do we grieve in a totally different way that is considered appropriate,” they said. “It’s so hard. Even our family who were there couldn’t be with him in his last moments.”
Pacific Islander families tend to live in large, multi-generational, and close-knit homes. So if one family member gets infected, self-isolation is difficult and the ripple effects could be harrowing. “Many of our homes are multi-family,” Ala’ilima adds, “so it’s not just a nuclear family in a Westernized sense of just like maybe two parents and a child. We’re talking about multiple families for a household to be easily 10 or more.”
The Pacific Islander community — specifically Micronesians who are migrants under the Compact of Free Association (COFA) — are more likely than others to be uninsured, even excluded from Medicaid, and are more likely to be frontline essential workers, increasing their risk of exposure to the virus. COFA migrants, who come from the Federated States of Micronesia, Marshall Islands, and Palau, have a unique relationship with the US in which they can travel, live and work in the US for free without a visa or time constraints — in exchange for permitting the US access to their Indigenous Pacific lands for military purposes. But for COFA migrants, access to health care is a constant battle.
“US Pacific Island territories have some of the highest rates of recruitment into the US Armed Forces, reflecting the commitment of our men and women who are willing to die in defense of the freedoms we Americans so richly enjoy,” Samoa, who also got Covid-19 earlier this year, said in recent testimony to Congress representatives. And yet, Pacific Islanders who are “at higher risk of infection ... report experiencing discrimination in health care settings and a mistrust in seeking health care services.”
Joseph Seia, executive director of the Pacific Islander Community Association in Washington state (PICA-WA), said that in the beginning of the pandemic, the community initially wanted to highlight the Marshallese experience and the historical injustice that they went through after the US military nuclear testing in their home islands. The long-term effects of exposure to nuclear radiation, such as cancer, birth defects, thyroid complications, and asthma, still linger in Marshallese communities and are easily a determinant of a pre-existing condition for Covid-19. But the same issues of environmental injustice and socioeconomic barriers could be seen as an overarching problem across communities.
“If you look at the actual breakdown, the nuance of it all, our community is suffering, not just the Marshallese, but every [Pacific Islander] group,” Seia said. “It’s just sad because everybody knows someone in the community who died.”
Grassroots Pacific Islander organizations are working around the clock
Since Covid-19 hit communities in March, NHPI advocates have been building regional Pacific Islander Covid-19 task forces, working under the national coalition, Pacific Islander Covid-19 Response Team, to not only provide resources, but to also address the underlying issues exacerbated by the pandemic such as health care disparities, housing and food insecurity, high poverty and unemployment rates, immigration barriers, and environmental racism.
In Oregon, Utopia PDX has been working with lawmakers like Oregon Rep. Suzanne Bonamici and Hawaii Rep. Tulsi Gabbard to prioritize COFA migrants in health care insurance and services. In Washington, PICA-WA has hosted town halls to weigh the needs of NHPI communities and have submitted reports to the governor’s office. Both groups have also been helping with economic needs, such as housing and food. In Hawaii, various organizations launched the NHPI Collective Covid-19 Awareness Prevention Campaign to curb the effects of the virus.
“We’re not gonna leave our people hanging,” Ala’ilima said. “I don’t like being in a situation where a disparity like this is impacting our community this way. But in a lot of ways, it brought us all closer together, that we know we have each other’s backs, and we’re able to advocate for ourselves.”
After NHPI leaders asked Ponce to help with gathering data from local and state health departments, other members of local and national Covid-19 response teams requested even more data for their counties and states. Ponce also helped train more NHPI volunteers to help with her work that it became a weekly meeting of sharing and checking data scrapes from different sources. Now, they have the NHPI Covid-19 data dashboard, which reports weekly Covid-19 statistics and synthesis of findings that NHPI advocacy groups could use in their individual reports. The data also influenced the National Academy of Sciences, Engineering, and Medicine to include NHPI as a priority population in its vaccine allocation framework since it previously did not.
They’ve also been challenging government agencies, like the CDC, to expand their reporting and disaggregate NHPI communities — roughly nine months later, data is still lacking and some policies still tend to disregard the community. “The policies that will distribute recovery and equity dollars to disproportionately affected communities should not neglect the NHPI population,” Ponce said. “They should not be an afterthought.”
Grassroots organizations, including Utopia PDX and PICA-WA, aren’t giving up, either. Lately, they’ve been spreading public safety messages during the holiday season when most Pacific Islanders are drawn to gather with extended relatives.
“It’s using whatever influence we have to try to further our cause and our advocacy so we can get meaningful visibility and our voices magnified,” said Ala’ilima, adding that the memory of their brother is what’s driving the energy and heart of their advocacy work.
“I have a small family of my own — my partner and I and our 4-year-old, I have people to live for, and I have a community to live for,” they add. “I’m gonna do my best to make sure that I can keep them safe and that we can survive together in the near future someday safely.”