Disease Has Never Been Just Disease for Native Americans

Native communities’ vulnerability to epidemics is not a historical accident, but a direct result of oppressive policies and ongoing colonialism.

An illustration of Native Americans with red dots surrounding them.
Culture Club / Getty / The Atlantic

About the author: Jeffrey Ostler is the Beekman Professor of Northwest and Pacific History at the University of Oregon. He is the author of Surviving Genocide: Native Nations and the United States from the American Revolution to Bleeding Kansas.

As the death toll from COVID-19 mounts, people of color are clearly at greater risk than others. Among the most vulnerable are Native Americans. To understand how dire the COVID-19 situation is becoming for these communities, consider the situation unfolding for the Navajo Nation, a people with homelands in Arizona, New Mexico, and Utah. As of April 23, 1,360 infections and 52 deaths had been reported among the Navajo Reservation’s 170,000 people, a mortality rate of 30 per 100,000. Only six states have a higher per capita toll.

The spread of COVID-19 is reminiscent of previous disease outbreaks that have ravaged Native American communities. Many of those outbreaks resulted in catastrophic loss of life, far greater than even the worst-case scenarios for COVID-19. Even the 1918–19 flu pandemic, in which an estimated 650,000 Americans died (0.6 percent of the 1920 population of 106 million), pales in comparison to the losses Native Americans have suffered from disease.

Until recently, histories of disease and Native Americans have emphasized “virgin-soil epidemics.” According to this theory, popularized in Jared Diamond’s Guns, Germs, and Steel, when Europeans arrived in the Western Hemisphere, they brought diseases (particularly measles and smallpox) that indigenous people had never experienced. Because they had no immunity to these diseases, so the theory goes, the resulting epidemics took the lives of 70 percent or more of the Native population throughout the Americas.

New research, however, provides a much more complicated picture of disease in American Indian history. This research shows that virgin-soil epidemics were not as common as previously believed and shifts the focus to how diseases repeatedly attacked Native communities in the decades and centuries after Europeans first arrived. Post-contact diseases were crippling not so much because indigenous people lacked immunity, but because the conditions created by European and U.S. colonialism made Native communities vulnerable. The virgin-soil-epidemic hypothesis was valuable in countering earlier theories that attributed Native American population decline to racial inferiority, but its singular emphasis on biological difference implied that population collapses were nothing more than historical accidents. By stressing the importance of social conditions created by human decisions and actions, the new scholarship provides a far more disturbing picture. It also helps us understand the problems facing Native communities today as they battle the novel coronavirus.

Virgin-soil epidemics undoubtedly occurred. In 1633, for example, a smallpox epidemic struck Native communities in New England, reducing the Mohegan and Pequot populations from a combined total of 16,000 to just 3,000. The epidemic spread to the Haudenosaunee in New York, but no farther west than that. Smallpox did not hit communities in the Ohio Valley and Great Lakes until 1756–57, a century or more after initial contact with Europeans. When it did, it was because Native fighters, recruited to fight for the French against the British during the Seven Years’ War, had contracted the virus in the east and infected their communities when they returned home. Lack of immunity mattered, but it was the disruption resulting from war that promoted smallpox’s spread.

Smallpox did not arrive in the Southeast until 1696, a century and a half after the Hernando de Soto expedition. It was once thought that de Soto’s men carried smallpox, but this view reflected the flawed assumption that Europeans were always infected with smallpox and always contagious. De Soto’s expedition did cause disease to erupt in Native communities, but the reason was that the expedition’s violent warfare led to outbreaks of pathogens such as dysentery, which was already present in the Americas. When smallpox finally hit the Southeast, it spread rapidly from Virginia to East Texas across networks created by an English trade in Native captives for enslavement in their coastal and West Indies colonies. Raiding, capturing, and transporting human bodies created pathways for the smallpox virus. To make matters worse, those bodies were already weakened by war and its companions—malnutrition, exposure, and lack of palliative care.

By the end of the 18th century, most Native communities in what would eventually become the United States had been exposed to smallpox. Nevertheless, as smallpox recurred in the 19th century, its impact correlated not with a lack of prior exposure, but with the presence of adverse social conditions. These same conditions would also make Native communities susceptible to a host of other diseases, including cholera, typhus, malaria, dysentery, tuberculosis, scrofula, and alcoholism. Native vulnerability had—and has—nothing to do with racial inferiority or, since those initial incidents, lack of immunity; rather, it has everything to do with concrete policies pursued by the United States government, its states, and its citizens.

Consider the impact of the Indian Removal Act. Formally adopted in 1830, this policy called for the relocation of Native peoples east of the Mississippi River to “Indian Territory” (what would eventually become Oklahoma and Kansas). Most everyone has heard of the Cherokee Trail of Tears, but it is seldom considered a U.S.-caused health crisis. The expulsion of the Cherokee from their homeland in Georgia, North Carolina, and Tennessee had three phases. In the first, the U.S. Army forcibly evicted Cherokees from their homes and held them for several months in concentration camps with inadequate shelter, insufficient food, and no source of clean water. The camps became death traps. Of the 16,000 people held in them, about 2,000 died from dysentery, whooping cough, measles, and “fevers” (probably malaria). In the second phase, the journey west, an additional 1,500 perished, as people, already sick and further weakened by malnutrition, trauma, and exposure, succumbed to multiple pathogens. In the months after reaching Oklahoma—the third phase—an additional 500 died from similar causes. The death toll was 4,000, or 25 percent of the original 16,000 forced from their homes.

Although the Cherokee Trail of Tears is the most well known, there were dozens of other such forced removals. Creeks, Seminoles, Chickasaws, Choctaws, Senecas, Wyandots, Potawatomis, Sauks and Mesquakies, Ojibwes, Ottawas, Miamis, Kickapoos, Poncas, Modocs, Kalapuyas, and Takelmas represent only a partial list of nations that suffered trails of tears. Not all experienced the same mortality as the Cherokee, but many did, and for some, the toll was even higher. The allied Sauks and Mesquakies were forced to move four times from their villages in western Illinois—once to central Iowa, once to western Iowa, once to Kansas, and finally to Oklahoma. In 1832, the time of the first expulsion, the Sauks and Mesquakies numbered 6,000. By 1869, when they were finally sent to Oklahoma, their population was only 900, a staggering loss of 85 percent. Year after year, unrelenting diseases, including an outbreak of smallpox in 1851, took many lives. Low fertility and infant mortality, the result of malnutrition, sickness, and trauma, hindered population replacement. The Sauk and Mesquakie catastrophe was not an accident. It was a direct and foreseeable consequence of decisions made by the United States and its citizens to dispossess Native people of desirable lands and shove them someplace else.

Navajos (Dinés, as they refer to themselves in their language) were also evicted from their homelands. In the winter of 1863–64, the U.S. Army pursued scorched-earth tactics—destroying their peach trees and cornfields—to drive them to a barren reservation at Bosque Redondo, on the Pecos River in New Mexico. On the 250-mile forced march, known as the Long Walk, several hundred of the 8,000 to 9,000 Dinés died en route. Over the next four years, Dinés lost as many as 2,500 of their people to disease and starvation. In their darkest hour, though, Diné leaders successfully prevailed on government officials to release them from their prison and return home. But even though their population has grown over time, the legacies of the Long Walk remain. The Diné historian Jennifer Denetdale observes that “severe poverty, addiction, suicide and crime on reservations all have their roots in the Long Walk.”

As cases of COVID-19 began to appear on the Navajo Reservation in late March, tribal President Jonathan Nez spoke to his people on Facebook. Summoning memories of the Long Walk, he “called on citizens to help one another,” reminding them “that’s when the best came out of many of our ancestors, helping each other out, carrying the load for the elders, carrying the children for our mothers.” “Now it’s our turn,” he said, “to think of our future, our children, our grandchildren.” Ongoing colonialism makes fighting COVID-19 a challenge. Although the Navajo are a sovereign nation with resources of their own, Dinés have a high incidence of conditions—diabetes, hypertension, and lung disease—that increase their susceptibility to becoming severely ill from the coronavirus. Lack of access to clean water makes hand-washing difficult. Many people cannot afford food, hand sanitizer, and other necessities. And there is an acute shortage of hospital beds and medical personnel.

Many public officials, health experts, and journalists are drawing attention to the disproportionate impact of COVID-19 on communities of color. Even so, large segments of America are indifferent, if not outright hostile, to recognizing these disparities and the inequities underlying them. Native Americans are visible to the general public far more often as sports mascots than as actual communities. The Trump administration initially resisted providing any relief to tribal nations in the $2 trillion stimulus package passed in early April, and although the legislation ultimately appropriated $10 billion to tribal governments, the Treasury Department, tasked with distributing these funds, has failed to disburse them. According to New Mexico Senator Tom Udall, Treasury Department officials “don’t know how to interact in the appropriate way with tribes and they’re just not getting the job done.”

Countering the invisibility of Native peoples, of course, means greater awareness of how COVID-19 is affecting them and enhanced efforts to provide resources to help them combat the current outbreak. It also means creating a deeper understanding of the history of American Indians and disease. Although the virgin-soil-epidemic hypothesis may have been well intentioned, its focus on the brief, if horrific, moment of initial contact consigns disease safely to the distant past and provides colonizers with an alibi. Indigenous communities are fighting more than a virus. They are contending with the ongoing legacy of centuries of violence and dispossession.