The COVID-19 (SARS-CoV-2) pandemic of 2019–2020 has incurred astonishing social and economic costs in the United States (US) and worldwide. Native American reservations, representing a unique geography, have been hit much harder than other parts of the country. This study seeks to understand the reasons for the disproportionate impact of the pandemic on Native American communities by focusing on the Navajo Nation – the largest Native American reservation in the US. I first reviewed the historical pandemics experienced by Native Americans. Guided by the literature review, an institutional analysis focusing on the Navajo Nation suggests a lack of both institutional resilience and healthcare preparation. The analysis further identified four factors that could help explain the Navajo's slow response to the COVID-19 pandemic: prevalence of underlying chronic health conditions, lack of institutional resilience, the relationship between the federal government and tribal governments, and lack of social trust. Relevant policy implications are discussed. For instance, to better prepare Native American communities for shocking events like the COVID-19 pandemic in the future, policymaking should integrate informal institutions to build efficient formal institutions for self-governance. Promoting public health education and establishing collaborations between Native and non-Native communities are also necessary long-run strategies.

2019-2020 年的 COVID-19 (SARS-CoV-2) 大流行在美国 (US) 和全世界造成了惊人的社会和经济成本。代表独特地理的美洲原住民保留地受到的打击比该国其他地区要严重得多。本研究旨在通过关注美国最大的美洲原住民保留地纳瓦霍族，了解大流行病对美洲原住民社区造成不成比例影响的原因。我首先回顾了美洲原住民经历的历史大流行病。在文献综述的指导下，一项针对纳瓦霍族的机构分析表明，该机构缺乏机构弹性和医疗保健准备。该分析进一步确定了四个可能有助于解释纳瓦霍人对 COVID-19 大流行反应缓慢的因素：潜在慢性健康状况的流行、缺乏制度弹性、联邦政府与部落政府之间的关系以及缺乏社会信任。讨论了相关的政策影响。例如，为了更好地为美洲原住民社区应对未来 COVID-19 大流行等令人震惊的事件做好准备，政策制定应整合非正式机构，以建立有效的正式自治机构。促进公共卫生教育和建立土著和非土著社区之间的合作也是必要的长期战略。为了更好地为美洲原住民社区做好准备，应对未来 COVID-19 大流行等令人震惊的事件，决策制定应整合非正式机构，以建立有效的正式自治机构。促进公共卫生教育和建立土著和非土著社区之间的合作也是必要的长期战略。为了更好地为美洲原住民社区做好准备，应对未来 COVID-19 大流行等令人震惊的事件，决策制定应整合非正式机构，以建立有效的正式自治机构。促进公共卫生教育和建立土著和非土著社区之间的合作也是必要的长期战略。