Culture, warfare and assimilation all play significant parts in the history of Native Americans and infectious disease, spanning from the 1600s to present day. Scarce medical records among Native Americans prior to Europeans’ arrival make it difficult to know the severity of communicable illnesses before contact.

“Settlement patterns were dispersed enough that traveling between one location and another, you just didn’t have a whole lot of sick people who were infectious and feeling ill, traveling back and forth, because people weren’t bunched up together,” said Dr. Kelli Mosteller, Citizen Potawatomi Nation Cultural Heritage Center director.
However, those settlement patterns changed with new technology and economic ideologies.

Citizen Potawatomi Nation and other tribes across the United States continue to manage the plights of infectious disease into the present day.

Great Lakes and first contact

The Potawatomi fought the Iroquois for control of land in the Great Lakes region, eventually settling in Wisconsin with other refugees in the early 1600s. They met French explorer Jean Nicolet in 1634, their first European contact. The Potawatomi likely lived amongst the people of the Ho-Chunk Nation at that time as they descended from the area. Nicolet’s records note meeting 4 to 5,000 Ho-Chunks; however, other historians’ records indicate their population reached upward of 25,000.

Throughout the next 20 years as more coureur des bois — French-Canadian fur traders — arrived around Green Bay, Potawatomi and other Indigenous groups established trading posts and larger communities, often up to 10,000 people. They created deeper relationships with Europeans, some of whom recorded a Ho-Chunk population in the area of only 500 people by the 1650s; smallpox caused the drastic decrease.

“The numbers recorded at Green Bay help to illustrate the relative mortality rate of smallpox in the 17th century,” said Cultural Heritage Center Curator Blake Norton.

Biological warfare and psychology

European forces also used smallpox as a biological weapon against Native Americans in the Great Lakes region — both during Pontiac’s War and the American Revolutionary War.

In early spring 1763, British forces used Fort Pitt in Pennsylvania as a makeshift hospital for troops and tradespeople during a large smallpox outbreak. Only a few months later, Commander in Chief Jeffrey Amherst and Colonel Henry Bouquet presented tribes with infected hospital linens as false gifts of peace during the siege of Fort Pitt at the beginning of Pontiac’s War.

“During this time, local Native populations affected by smallpox numbered in the tens of thousands,” Norton said. “Some estimates reach as high as 100,000 people who were either infected or infected and died from the outbreak during Pontiac’s War and the decade after.”

Historians allege that British forces used smallpox as a biological weapon again during the Revolutionary War in the 1770s to weaken American forces. Within 10 years, it spread between traders and tribes along the upper Mississippi River, resulting in a potential 95 percent infection rate among Native Americans who visited posts in the area. During an interview with the Hownikan, Norton described the psychological effects from a Native warrior’s perspective.

“To think, European Americans not only have power in large numbers and wield incredible weapons, but now, they’re able to tap into their spiritual abilities and their gods to create deadly infectious diseases. That’s a morale killer for the strongest warriors,” he said.

Dr. Mosteller added, “At the time we’re talking about, not only (did) the Native communities think that this might be a spiritual power, but the Europeans thought that God was making the Natives sick and not them because he wanted them to take over. They were using the spiritual justification of ‘providence’, and it just emboldened them that much more.”

Sustained trauma

In 1838, the Potawatomi Trail of Death killed more than 40 people during the two-month forced removal from Indiana to Kansas. The mortality rate climbed due to the lack of rest, water and proper nutrition, which all negatively influenced the refugees’ immune systems. Children with cholera and typhoid comprised a significant portion of the deaths.

After arriving in Kansas, more and more people relocated to the area, such as missionaries, tradespeople and military. Another cholera outbreak killed dozens of Potawatomi during the first winter in their new home. Shortly thereafter, diseases began coming in waves and seasons.

“As more people moved in, settlement patterns changed. You started to have contact with people and there was a lot of interaction. You’re moving between one village and the other regularly. Now, there were people settled in between those locations,” Dr. Mosteller said.

In the late 19th and early 20th centuries, Native American boarding schools aimed to assimilate young generations of tribal members. Students left their families and moved across the country to live in dorms and bunkers, forced to do manual labor without adequate hygiene facilities — an ideal situation for infections to spread. The high mortality rate led to mass graves at schools across the country, some of which are still being uncovered today. The Indian Child Welfare Act of 1978 granted parents the legal right to refuse their child’s attendance at an off-reservation boarding school.

“When we’re talking about what the psychological aspect of how many parents had their children taken away, and they never came back. And, they never learned why; that’s a real legacy of the trauma of residential schools or boarding schools,” Dr. Mosteller said.

Culture and COVID-19

Community-oriented, Indigenous cultures revolve around time together eating, participating in ceremonies and caring for one another. COVID-19 and other diseases with prolonged incubation periods force participation in those group practices to dwindle.

“A particularly painful challenge of this is that in a lot of Native communities, our ways of healing ourselves, whether in sweat lodges or other healing ceremonies, require the community to come together and to be able to do ceremony for this (sick) person,” Dr. Mosteller said. “Togetherness and the ability to practice traditional ceremonies or traditional healing practices that were outlawed for so long has been a real source of comfort and strength for modern Native peoples.”

According to a U.S. Census Bureau report from 2012, more than 10 percent of Native American households are multigenerational, compared to less than 4 percent for non-Hispanic whites. In 2020, the Centers for Disease Control and Prevention labeled those 65 and older a “high-risk” segment of the population for COVID-19 and advised quarantining to slow transmission rates.

“In a lot of ways, it’s so counter to the deeply ingrained teachings of ‘You keep your elders with you. You keep them close. You check on them. You make sure they have what they need. You prepare.’ But right now that can be the biggest risk, and to leave them isolated is also a risk,” Dr. Mosteller said.

Some reservations allow for ample conditions for the spread of viruses and bacterial infections, including government funded living quarters built close together and restricted access to necessities such as running water. In May 2020, the Navajo Nation, primarily in Arizona, had the nation’s highest COVID-19 infection rate per-capita in the U.S. Doctors without Borders sent nine specialists to the reservation. It was the first time the organization dispatched units within the United States.

Modern struggles with infectious disease as seen at the Navajo Nation and other tribes across the United States ensure the legacy continues for generations across Indian Country. However, CPN’s robust efforts to mitigate the coronavirus’ spread focus on the safety of Tribal members, staff and health care workers. Find more information at