Speaker 1: Pushkin, this is solvable. I'm Jacob Weisberg. Every state is
Speaker 1: working so hard on this right now. It's a really
Speaker 1: big logistical challenge. Honestly, it's a bit harder in our
Speaker 1: urban areas than our rural areas. As of January twenty
Speaker 1: twenty one, Alaska is number one. It's the US state
Speaker 1: that has vaccinated the largest percentage of its population against
Speaker 1: COVID nineteen. That might seem surprising. Rural areas typically have
Speaker 1: a harder time assessing medical care. They are fewer hospitals,
Speaker 1: fewer doctors and nurses, and it's challenging to deliver medical
Speaker 1: supplies into rugged wilderness. So when it comes to fighting
Speaker 1: COVID nineteen, how has Alaska been so successful reaching remote communities.
Speaker 1: We do have two hundred twenty nine independent sovereign tribes
Speaker 1: in the state of Alaska who have their own distribution.
Speaker 1: We are partnered with them at every level to get
Speaker 1: it out. They've got testing supplies, when they have the
Speaker 1: knowledge and resources, when they have vaccine, they'll get it out.
Speaker 1: Look get it done. They just need the resources to
Speaker 1: do it. Collaboration and coordination among agencies. The Department of
Speaker 1: Defense Veteran Affairs and the Indian Health Service has been
Speaker 1: a big part of Alaska's success. As cities and states
Speaker 1: across the US continue to hone their distribution plans, there
Speaker 1: are lessons to be learned starting with this one. Use
Speaker 1: every resource available. We have had dog slids and helicopters
Speaker 1: and boat up vaccines and ferries and planes and people
Speaker 1: showing up on snowmachine to get vaccinated. Doctor Anne Zinc
Speaker 1: is the chief Medical Officer of the State of Alaska,
Speaker 1: and she believes the challenges of COVID nineteen vaccine distribution
Speaker 1: are surmountable. Distribution of vaccine across rural Alaska is solvable.
Speaker 1: My co host an Apple Bomb, spoke with doctor Zinc
Speaker 1: about some of the unique challenges Alaska faces and what
Speaker 1: we can all learn from their successes across the state.
Speaker 1: That little star at the end of your shipment that
Speaker 1: says you know does not shift to Alaska and Whai
Speaker 1: makes a difference up here. So we've always had to
Speaker 1: have an existing infrastructure and plan for vaccine distribution across
Speaker 1: the state. We've really built on it for the COVID
Speaker 1: nineteen vaccine. It's probably worth mentioning that Alaska is one
Speaker 1: of the five smallest states in the US based on population,
Speaker 1: and a lot of your residents are concentrated in the
Speaker 1: city of Anchorage. But Alaska is also a state with
Speaker 1: a lot of wilderness, and throughout the state their pockets
Speaker 1: of small communities tucked into rural areas. Am I correct
Speaker 1: in imagining? I don't know dog sleds, people on skis.
Speaker 1: Is this too stereotyped? How are you getting vaccines out
Speaker 1: of Anchorage and into the farthest flung communities in your state?
Speaker 1: Things we're asking, I don't think I've ever heard our
Speaker 1: state described as small. We are not very populous, but
Speaker 1: we are larger than Texas, Montana, and California combined, so
Speaker 1: it is a very large geographical space. All those you
Speaker 1: mentioned not many people, and you are not far flung.
Speaker 1: We have had dog slids and helicopters and boat up
Speaker 1: vaccines and ferries and planes and people showing up on
Speaker 1: snowmachine to get vaccinated before the plane takes off to
Speaker 1: the next village. So it's been a pretty interesting and
Speaker 1: beautiful distribution across a wild and wonder estate. And how
Speaker 1: do you normally get medical service to your most rural,
Speaker 1: most far flung residents? Sometimes it is boat a lot
Speaker 1: of airfare. Many of our communities can only be reached
Speaker 1: by air, so there's no roads that go to and
Speaker 1: from them, so we use not only medical air transport,
Speaker 1: but also commercial air transport. We have many small planes
Speaker 1: and small airlines that helps to transport between many of
Speaker 1: our communities. Everything from a swab to bringing in a
Speaker 1: woman who is about to deliver, to getting out vaccine.
Speaker 1: These are all kind of complex logistical challenges that are
Speaker 1: always a part of last with healthcare. Right That's really interesting.
Speaker 1: I'm wondering if in big cities like New York and
Speaker 1: LA where they're having more trouble with the distributing the vaccine,
Speaker 1: it's not because they're lazier. They're not used to having
Speaker 1: to reach out to people in the same way that
Speaker 1: you guys do. Yeah. No, I mean, I think every
Speaker 1: state is working so hard on this right now. It's
Speaker 1: a really big logistical challenge. Honestly, it's a bit harder
Speaker 1: in our urban areas than our rural areas. I mean,
Speaker 1: I think that there's four major reasons we've been able
Speaker 1: to get vaccine out quickly. First of all, I think
Speaker 1: when you have smaller communities, communities can really rally around
Speaker 1: the cry very quickly, and we've just seen tremendous work
Speaker 1: by Alaskans. We do also, our pandemic is kind of
Speaker 1: slowing down here, so that gives more space for our
Speaker 1: public health team as well as the hospital personnel and
Speaker 1: public health nursing and nurses across the state, more space
Speaker 1: and time to be able to respond to the vaccine
Speaker 1: and not having to respond to the pandemic in the
Speaker 1: same sort of way. There's also federal distribution for tribes
Speaker 1: as well as the VA and DoD. We do have
Speaker 1: the highest percentage of veterans than any other state per capita,
Speaker 1: and we do have two hundred and twenty nine independent
Speaker 1: sovereign tribes in the state of Alaska who have their
Speaker 1: own distribution. We are partnered with them at every level
Speaker 1: to get it out. They had a choice to go
Speaker 1: with IHS or to go with the state, and we
Speaker 1: did partner with them to help get that out, and
Speaker 1: I think that partnership is really paying off, both to
Speaker 1: get in their vaccine, get out their vaccine, and to
Speaker 1: be able to coordinate transportation. And then we also are
Speaker 1: being treated kind of like a territory, so we're getting
Speaker 1: month to month allocation, and so that allows us to
Speaker 1: order in, say an entire month's set for a place
Speaker 1: like Adiac that requires a plane and then a helicopter
Speaker 1: to get there and be able to ship that rather
Speaker 1: than having to wait for each week's to come in
Speaker 1: before we can get enough. I mean, many of our communities,
Speaker 1: it might be a vial or a half of a
Speaker 1: vial that might meet the first Phase one A or
Speaker 1: even the beginning of phase one v criteria. By being
Speaker 1: able to kind of pool resources together like that with
Speaker 1: multiple partners, it's really helped us to get vaccine out faster.
Speaker 1: I mean, tell me a little bit more about the
Speaker 1: Native communities in Alaska. I understand it's a very diverse population.
Speaker 1: They're Alaska Natives, American Indian communities, Native Hawaiians, Pacific Islanders.
Speaker 1: And also I understand that they've been disproportionately affected by COVID.
Speaker 1: One report I saw showed that thirty seven percent of
Speaker 1: those who died from the virus in Alaska were Native.
Speaker 1: Is there any special strategy that you need to reach them?
Speaker 1: How do you think about those communities? Thanks for asking that,
Speaker 1: because it is a hugely important topic. Sixteen percent of
Speaker 1: our population as Alaska Native people, yet currently they actually
Speaker 1: make up thirty nine percent of our death so we
Speaker 1: just reran the numbers. They were thirty seven and we
Speaker 1: just random We've seen that with every pandemic from the
Speaker 1: nineteen eighteen pandemic on. We've had communities completely devastated by
Speaker 1: the nineteen eighteen pandemic where language and culture were lost
Speaker 1: in entire orphanages were built, and that history looms large
Speaker 1: in many of our communities and has played a very
Speaker 1: large role in our response from day one to this pandemic,
Speaker 1: remembering that historical trauma and trying to not repeat it.
Speaker 1: Fifty percent of our testing sites are run by the
Speaker 1: native system, again only sixteen percent of the population. We
Speaker 1: have communities where it can take two weeks to get
Speaker 1: a squab out. We've unfortunately had people die where we've
Speaker 1: been unable to get them out or oxygen in because
Speaker 1: the weather has been so bad. In some regions, up
Speaker 1: to sixty percent of the communities have no running water
Speaker 1: and sewer and that makes a really challenging environment to
Speaker 1: be able to fight respiratory infections, and we see high
Speaker 1: rates of respiratory infections in those communities, so it plays
Speaker 1: a really big role in the making sure that we're
Speaker 1: getting equitable distribution and we have a chance for equitable
Speaker 1: outcomes for all Alaskans. And that takes different resources in
Speaker 1: different parts of the country. It takes different resources in Alaska.
Speaker 1: What we found in our communities is when you can
Speaker 1: empower them, they can protect themselves. They've got testing supplies,
Speaker 1: when they have the knowledge and resources, when they have vaccine,
Speaker 1: they'll get it out. They'll get it done. They just
Speaker 1: need the resources to do it. So by empowering you
Speaker 1: mean give them resources directly. I understand that in some
Speaker 1: cases the supply of vaccine did go straight to Native communities.
Speaker 1: Was that logistically important, psychologically important, Yeah, all of the above.
Speaker 1: So HS did have its own distribution and all two
Speaker 1: hundred and twenty nine tribes opted to have the state
Speaker 1: help distribute the vaccine around the state. And that was
Speaker 1: just because we've always had this close working relationship and
Speaker 1: very grateful for that HS allocation and working very hard
Speaker 1: with them to distribute as quickly as possible, particularly to
Speaker 1: the most vulnerable populations, to make sure that they have
Speaker 1: this opportunity to be protected. They can decide on how
Speaker 1: they want to use the vaccine and how they want
Speaker 1: to prioritize it in their community. So, for example, Indigenous
Speaker 1: language speakers have been prioritized by many of our tribal
Speaker 1: communities to make sure that that language continues on. So
Speaker 1: being able to prioritize what's important in that community and
Speaker 1: being able to get vaccine out quickly. Do you think
Speaker 1: that any of these strategies, the things that we're talking
Speaker 1: about would work well in other rural, remote, or rugged
Speaker 1: parts of the United States, Whether it's direct distribution to
Speaker 1: particular regions, whether it's prioritizing even unique methods of transport.
Speaker 1: I mean, can you extrapolate from your experience and imagine
Speaker 1: how it could be used elsewhere. Yeah, it's interesting to
Speaker 1: look at the map and to see, you know, kind
Speaker 1: of who's been able to vaccinate more quickly. It's been
Speaker 1: some of our more rural states when you look at it,
Speaker 1: South Dakota and North Dakota, West Virginia, Alaska. For sure.
Speaker 1: I think that we've been able to really build on
Speaker 1: our community partnerships and community strengths, and I think that
Speaker 1: that is very helpful. And being able to get out
Speaker 1: vaccine very very quickly. It's a whole other burden and
Speaker 1: a huge challenge in really large urban areas. And like
Speaker 1: I said, even here, our urban areas or sometimes are
Speaker 1: more challenging issues. You need more technology for scheduling, you
Speaker 1: need just to manage a lot more people. Communication becomes
Speaker 1: much harder, while logistics is something that is easier to
Speaker 1: overcome than some of those other barriers. So I think
Speaker 1: that relying on partners really being able to ask communities
Speaker 1: what makes sense for them. I think being able to
Speaker 1: ask for help that's been a big thing for us.
Speaker 1: We've just said, Okay, we've got this vaccine, how can
Speaker 1: you get it out? And we've had you know, for example,
Speaker 1: and one of our communities we're struggling to get vaccine
Speaker 1: out and a bunch of people who had suffered opioid
Speaker 1: addiction said we'll help, and we'll call and they help
Speaker 1: schedule appointments and drive elders and volunteer at a site
Speaker 1: and be able to move it forward. So it's one
Speaker 1: of the things I really love about working in Alaska
Speaker 1: as these community resources and efforts, But I think it's
Speaker 1: something that we can do more of as a kind tree,
Speaker 1: is being able to ask each other for help and
Speaker 1: being able to rely on a diverse set of partners
Speaker 1: to be able to do everything from vaccine distribution to
Speaker 1: other healthcare needs so that we collectively can be more
Speaker 1: healthy and well together and look outside of traditional partners.
Speaker 1: It doesn't just have to be the nurse or the doctor,
Speaker 1: or the state or the federal government to do this.
Speaker 1: It really takes all of us. Let me ask you
Speaker 1: a little bit about yourself. When the pandemic hit Less Spring,
Speaker 1: you'd only been the chief medical officer for about six months.
Speaker 1: What was it like to have to deal with such
Speaker 1: a huge emergency so quickly? How did you how did
Speaker 1: you begin to think about it when faced with this problem. Yeah,
Speaker 1: so I'm a practicing emergency medicine physician as my background,
Speaker 1: and I still see patients, so I think that I
Speaker 1: bring that approach to whatever I do. I had an
Speaker 1: experience early in residency that reminded me how important it
Speaker 1: is to treat the patient first and remember that the
Speaker 1: rest is noise, and so that's been kind of my
Speaker 1: guiding professional philosophy throughout my entire career in medicine. I
Speaker 1: really believe an open, honest community. We have just dozens
Speaker 1: of these echoes where we have calls with the public
Speaker 1: and healthcare workers and vaccine providers all across the state.
Speaker 1: So having a lot of two way conversations really really important,
Speaker 1: and just relying on our team. As emergency medicine doctor,
Speaker 1: I'm not the cardiologist, I'm not the orthopedic surgeon. I'm
Speaker 1: not the primary care doctor who knows their history. But
Speaker 1: I'm that person in a time of crisis who helps
Speaker 1: to connect the pieces together for one goal, and that's
Speaker 1: the health of my patient. And I just see this
Speaker 1: role and as a chief medical officer as an extension
Speaker 1: of that. I'm not the epidemiologist. I'm not the infectious
Speaker 1: disease doctor. I'm not the logistical expert. I'm just the
Speaker 1: er doc in the center. We're really trying to figure
Speaker 1: out what makes sense for the health and well being
Speaker 1: of Alaskans. So in a lot of parts of the country,
Speaker 1: I know that public health officials have faced a lot
Speaker 1: of pushback and even personal threats. In some places, there
Speaker 1: have been a lot of resignations. People say there's too
Speaker 1: much political pressure from the job. Have you found any
Speaker 1: of that in Alaska? And how have you coped with
Speaker 1: the politicization of this crisis and the depth of anger
Speaker 1: that people have felt about some of the restrictions that
Speaker 1: have been placed on them. Yeah, I think this pandemic
Speaker 1: has been hard on everyone. It's been hard on Alaskans,
Speaker 1: It's been hard on public health officials. It's been incredibly
Speaker 1: hard on my team, both because of political but just
Speaker 1: because of work. It's been NonStop for you know, almost
Speaker 1: a year now, of responding and really taking on the
Speaker 1: responsibility of every death, of every hospitalization, of every vaccine
Speaker 1: being distributed, and making sure that it's done as fast
Speaker 1: and fair as we possibly can. I think again, in
Speaker 1: the emergency department, I'm used to people being scared and
Speaker 1: frustrated and angry, and sometimes when they are hurt or
Speaker 1: lost or upset, that's when they lash out. And I
Speaker 1: have found it useful to just really stay focused on
Speaker 1: my own internal principles and what I can do for
Speaker 1: the patient at that moment. And I think that that
Speaker 1: clarity has been helpful despite a lot of frustration. I also,
Speaker 1: early on the pandemic, when I was looking around to
Speaker 1: other countries and other states, felt like when a state
Speaker 1: could work collectively together or country could work collectively together
Speaker 1: despite large differences of opinions, they did better, there were
Speaker 1: less cases, there were less deaths, that COVID really takes
Speaker 1: advantage of the cracks between us, and it was more
Speaker 1: important to me that I work collectively than any specific policy,
Speaker 1: any one decision, And so I don't always agree with
Speaker 1: the governor. He doesn't always agree with me. I don't
Speaker 1: always agree with my team, and we hash it out
Speaker 1: together as adults and go around and around and share
Speaker 1: our sides, and at the end of the day, try
Speaker 1: to always make decisions collectively together because we feel like
Speaker 1: that is more important to controlling COVID than any single
Speaker 1: policy decision. And you do all of this while still
Speaker 1: working occasionally as an ear doc. Is that is that
Speaker 1: what I heard? Yeah, I still work in the emergency department.
Speaker 1: I love it. It's helpful, it's really grounding. It's great
Speaker 1: to solve little problem. Second, so a laceration and it
Speaker 1: looks better, which is sometimes way easier than trying to
Speaker 1: get vaccine out across our state. So it's rewarding in
Speaker 1: that way. I really just love talking to people and
Speaker 1: hearing their stories. It's this incredible gift in medicine to
Speaker 1: be able to walk into someone's room who you've never
Speaker 1: met and within seconds they tell you, you know, something
Speaker 1: that's really scaring them, or something that's super concerning to them,
Speaker 1: or they're in pain, and you're able to help them.
Speaker 1: So I find that my work as a chief medical
Speaker 1: officer helps me with the feeling of frustration and that
Speaker 1: the systems are never going to change in the ear,
Speaker 1: but working that ar helps to ground me in the
Speaker 1: work that we're doing and the people that it's serving.
Speaker 1: Just the complexity of how medicine presents and how it's
Speaker 1: not all a cookbook, and how it's not all just
Speaker 1: follow this and this is what happens. I love that
Speaker 1: in the emergency room, and I found that I just
Speaker 1: kept serving and making sure that what we're doing really
Speaker 1: has meaning and that it's really working at the ground level.
Speaker 1: So to me, they're kind of a union yang of
Speaker 1: each other, and I couldn't do one without the other.
Speaker 1: Sounds very much like how COVID had to be approached.
Speaker 1: I mean, we didn't understand it at first, had unveiled
Speaker 1: itself slowly. At each stage there have been new demands hospitalizations,
Speaker 1: now vaccinations, and at each stage there's a lot of
Speaker 1: mysteries that is that is that part of why you've
Speaker 1: You've been so passionate about it. They have felt incredibly intertwined.
Speaker 1: There's clearly huge differences between the two jobs as well,
Speaker 1: but I find that the skills from one really have
Speaker 1: helped with the other. We have limitations, you know, I
Speaker 1: am not an infectious disease doctor. I've learned so much
Speaker 1: infectious disease this past year, but I have an amazing
Speaker 1: team that I've been able to rely on and say,
Speaker 1: help me understand this. I'm not sure about this and
Speaker 1: have spent a lot of my time just trying to
Speaker 1: learn more about vaccinology or immunology, things that were not
Speaker 1: a part of my emergency medicine world prior to this.
Speaker 1: I don't think Alaska was originally part of your life either.
Speaker 1: You were born in Colorado. I think where you grew
Speaker 1: up in Colorado? What what what drew you to Alaska
Speaker 1: and how did you become so integrated into the community
Speaker 1: of the state. You're right, Alaska is not a part
Speaker 1: of my plan. I you mentioned grew up in Colorado.
Speaker 1: During college, I would spend my summers either in Wyoming
Speaker 1: or then most of my summers actually in Alaska, working
Speaker 1: in the mountains of Alaska. And completely fell in love
Speaker 1: with this place. And I actually met my husband up here,
Speaker 1: and he followed me down to residency and med school
Speaker 1: in California, then in Utah and after that, you know,
Speaker 1: he said, I did this seven years of med school
Speaker 1: and residency for you. Can you do three years of
Speaker 1: Alaska for me? I miss those mountains and I miss
Speaker 1: being up there. I interviewed up here and took a
Speaker 1: job in Palmer, Alaska and this kind of smallish er.
Speaker 1: It was about as urban as he could live and
Speaker 1: about as rural as I could work, and I just
Speaker 1: fell in love with it. I fell in love with
Speaker 1: the medicine. I fell in love with the people. I
Speaker 1: fell in love with the community trying to figure out
Speaker 1: solutions together. And I am the sort of person who
Speaker 1: keeps asking like, well, why not and how about this?
Speaker 1: And can't we make this better? And one meeting after
Speaker 1: another led to multiple meetings and ultimately led to me
Speaker 1: having this job. And predecessor took the job as the
Speaker 1: deputy director at the CDC over infectious disease, and he's
Speaker 1: been a great mentor through this as well. So Doctor Zinc,
Speaker 1: we like to end all of our episodes by offering
Speaker 1: suggestions to listeners, giving them ways they can be help
Speaker 1: they can help, and solving problems as well. What can
Speaker 1: people do to better support the delivery of vaccines and
Speaker 1: the rural communities in their states? Lean in, get involved.
Speaker 1: My husband always told me to show up for the client,
Speaker 1: show up for your community. Ask how you can help.
Speaker 1: Every state and every county and every community is a
Speaker 1: little bit different. But there are lots of volunteer organizations.
Speaker 1: You can check with Red Cross, you can check with
Speaker 1: your local public health department. Most public health departments do
Speaker 1: have a way for people to volunteer if you're a
Speaker 1: licensed healthcare professional or if you're someone who wants to
Speaker 1: volunteer to bring food or to drive people onto those areas.
Speaker 1: I am amazed at the incredible ingenuity and problem solving
Speaker 1: that can happen at the local level. And it might
Speaker 1: be driving seniors to the local place to get vaccinated.
Speaker 1: It may be helping them with the website, It may
Speaker 1: be trying to figure out distribution and working with your community.
Speaker 1: But there's just real power and community. So looking around
Speaker 1: your community and looking at who's left out, who doesn't
Speaker 1: know that it's their turn to be vaccinated. How can
Speaker 1: you reach out to them, and how can you make
Speaker 1: sure that they are connected, Even those little small things
Speaker 1: that may not get a big notice. If you pick
Speaker 1: up two or three of your friends and neighbors and
Speaker 1: help them get vaccinated, help them work through the system,
Speaker 1: I think that that makes a big difference. This is
Speaker 1: a huge lift. I think so many times I just
Speaker 1: see people waiting for someone else to do the vaccine distribution,
Speaker 1: or waiting for someone else to figure out the problem.
Speaker 1: We just need the ingenuity of every American helping to
Speaker 1: solve this problem together. Everybody stepping into this space. Doctor
Speaker 1: Ann zinc It's the chief Medical Officer of Alaska and
Speaker 1: also an er doctor. Next week, I'm Solvable. I'm going
Speaker 1: to sit down with my co host and Apple Bomb
Speaker 1: for a conversation about repairing American democracy and as a
Speaker 1: Pulitzer Prize winning historian, her most recent book is about
Speaker 1: the eyes of authoritarianism around the world. President Joe Biden
Speaker 1: has taken his seat in the Oval Office and our
Speaker 1: country is deeply polarized. Ann and I will talk about
Speaker 1: what steps might be useful to take to diminish conflict
Speaker 1: and restore confidence in our political future. Please join us
Speaker 1: Solvable is produced by Jocelyn Frank, research and booking by
Speaker 1: Lisa Dunn. Our managing producer is Catherine Girardell and Pushkin's
Speaker 1: executive producer is Mia Loebell. I'm Jacob Weisberg.