Rural Vaccine Distribution is Solvable

a harder time assessing medical care. They are fewer hospitals, fewer doctors and nurses, and it's challenging to deliver medical supplies into rugged wilderness. So when it comes to fighting COVID nineteen, how has Alaska been so successful reaching remote communities. We do have two hundred twenty nine independent sovereign tribes in the state of Alaska who have their own distribution. We are partnered with them at every level to get

it out. They've got testing supplies, when they have the knowledge and resources, when they have vaccine, they'll get it out. Look get it done. They just need the resources to do it. Collaboration and coordination among agencies. The Department of Defense Veteran Affairs and the Indian Health Service has been a big part of Alaska's success. As cities and states across the US continue to hone their distribution plans, there are lessons to be learned starting with this one. Use

every resource available. We have had dog slids and helicopters and boat up vaccines and ferries and planes and people showing up on snowmachine to get vaccinated. Doctor Anne Zinc is the chief Medical Officer of the State of Alaska, and she believes the challenges of COVID nineteen vaccine distribution are surmountable. Distribution of vaccine across rural Alaska is solvable.

My co host an Apple Bomb, spoke with doctor Zinc about some of the unique challenges Alaska faces and what we can all learn from their successes across the state. That little star at the end of your shipment that says you know does not shift to Alaska and Whai makes a difference up here. So we've always had to have an existing infrastructure and plan for vaccine distribution across the state. We've really built on it for the COVID

nineteen vaccine. It's probably worth mentioning that Alaska is one of the five smallest states in the US based on population, and a lot of your residents are concentrated in the city of Anchorage. But Alaska is also a state with a lot of wilderness, and throughout the state their pockets of small communities tucked into rural areas. Am I correct in imagining? I don't know dog sleds, people on skis.

Is this too stereotyped? How are you getting vaccines out of Anchorage and into the farthest flung communities in your state? Things we're asking, I don't think I've ever heard our state described as small. We are not very populous, but we are larger than Texas, Montana, and California combined, so it is a very large geographical space. All those you mentioned not many people, and you are not far flung.

We have had dog slids and helicopters and boat up vaccines and ferries and planes and people showing up on snowmachine to get vaccinated before the plane takes off to the next village. So it's been a pretty interesting and beautiful distribution across a wild and wonder estate. And how do you normally get medical service to your most rural, most far flung residents? Sometimes it is boat a lot

of airfare. Many of our communities can only be reached by air, so there's no roads that go to and from them, so we use not only medical air transport, but also commercial air transport. We have many small planes and small airlines that helps to transport between many of our communities. Everything from a swab to bringing in a woman who is about to deliver, to getting out vaccine. These are all kind of complex logistical challenges that are

always a part of last with healthcare. Right That's really interesting. I'm wondering if in big cities like New York and LA where they're having more trouble with the distributing the vaccine, it's not because they're lazier. They're not used to having to reach out to people in the same way that you guys do. Yeah. No, I mean, I think every state is working so hard on this right now. It's a really big logistical challenge. Honestly, it's a bit harder

in our urban areas than our rural areas. I mean, I think that there's four major reasons we've been able to get vaccine out quickly. First of all, I think when you have smaller communities, communities can really rally around the cry very quickly, and we've just seen tremendous work

by Alaskans. We do also, our pandemic is kind of slowing down here, so that gives more space for our public health team as well as the hospital personnel and public health nursing and nurses across the state, more space and time to be able to respond to the vaccine and not having to respond to the pandemic in the same sort of way. There's also federal distribution for tribes

as well as the VA and DoD. We do have the highest percentage of veterans than any other state per capita, and we do have two hundred and twenty nine independent sovereign tribes in the state of Alaska who have their own distribution. We are partnered with them at every level

to get it out. They had a choice to go with IHS or to go with the state, and we did partner with them to help get that out, and I think that partnership is really paying off, both to get in their vaccine, get out their vaccine, and to

be able to coordinate transportation. And then we also are being treated kind of like a territory, so we're getting month to month allocation, and so that allows us to order in, say an entire month's set for a place like Adiac that requires a plane and then a helicopter to get there and be able to ship that rather than having to wait for each week's to come in

before we can get enough. I mean, many of our communities, it might be a vial or a half of a vial that might meet the first Phase one A or even the beginning of phase one v criteria. By being able to kind of pool resources together like that with multiple partners, it's really helped us to get vaccine out faster. I mean, tell me a little bit more about the Native communities in Alaska. I understand it's a very diverse population.

They're Alaska Natives, American Indian communities, Native Hawaiians, Pacific Islanders. And also I understand that they've been disproportionately affected by COVID. One report I saw showed that thirty seven percent of those who died from the virus in Alaska were Native. Is there any special strategy that you need to reach them? How do you think about those communities? Thanks for asking that,

because it is a hugely important topic. Sixteen percent of our population as Alaska Native people, yet currently they actually make up thirty nine percent of our death so we just reran the numbers. They were thirty seven and we just random We've seen that with every pandemic from the

nineteen eighteen pandemic on. We've had communities completely devastated by the nineteen eighteen pandemic where language and culture were lost in entire orphanages were built, and that history looms large in many of our communities and has played a very large role in our response from day one to this pandemic, remembering that historical trauma and trying to not repeat it. Fifty percent of our testing sites are run by the

native system, again only sixteen percent of the population. We have communities where it can take two weeks to get a squab out. We've unfortunately had people die where we've been unable to get them out or oxygen in because

the weather has been so bad. In some regions, up to sixty percent of the communities have no running water and sewer and that makes a really challenging environment to be able to fight respiratory infections, and we see high rates of respiratory infections in those communities, so it plays a really big role in the making sure that we're getting equitable distribution and we have a chance for equitable outcomes for all Alaskans. And that takes different resources in

different parts of the country. It takes different resources in Alaska. What we found in our communities is when you can empower them, they can protect themselves. They've got testing supplies, when they have the knowledge and resources, when they have vaccine, they'll get it out. They'll get it done. They just need the resources to do it. So by empowering you mean give them resources directly. I understand that in some cases the supply of vaccine did go straight to Native communities.

Was that logistically important, psychologically important, Yeah, all of the above. So HS did have its own distribution and all two hundred and twenty nine tribes opted to have the state help distribute the vaccine around the state. And that was just because we've always had this close working relationship and very grateful for that HS allocation and working very hard with them to distribute as quickly as possible, particularly to the most vulnerable populations, to make sure that they have

this opportunity to be protected. They can decide on how they want to use the vaccine and how they want to prioritize it in their community. So, for example, Indigenous language speakers have been prioritized by many of our tribal communities to make sure that that language continues on. So being able to prioritize what's important in that community and

being able to get vaccine out quickly. Do you think that any of these strategies, the things that we're talking about would work well in other rural, remote, or rugged parts of the United States, Whether it's direct distribution to particular regions, whether it's prioritizing even unique methods of transport. I mean, can you extrapolate from your experience and imagine how it could be used elsewhere. Yeah, it's interesting to look at the map and to see, you know, kind

of who's been able to vaccinate more quickly. It's been some of our more rural states when you look at it, South Dakota and North Dakota, West Virginia, Alaska. For sure. I think that we've been able to really build on our community partnerships and community strengths, and I think that that is very helpful. And being able to get out vaccine very very quickly. It's a whole other burden and a huge challenge in really large urban areas. And like I said, even here, our urban areas or sometimes are

more challenging issues. You need more technology for scheduling, you need just to manage a lot more people. Communication becomes much harder, while logistics is something that is easier to overcome than some of those other barriers. So I think that relying on partners really being able to ask communities what makes sense for them. I think being able to ask for help that's been a big thing for us. We've just said, Okay, we've got this vaccine, how can

you get it out? And we've had you know, for example, and one of our communities we're struggling to get vaccine out and a bunch of people who had suffered opioid addiction said we'll help, and we'll call and they help schedule appointments and drive elders and volunteer at a site

and be able to move it forward. So it's one of the things I really love about working in Alaska as these community resources and efforts, But I think it's something that we can do more of as a kind tree, is being able to ask each other for help and being able to rely on a diverse set of partners to be able to do everything from vaccine distribution to other healthcare needs so that we collectively can be more healthy and well together and look outside of traditional partners.

It doesn't just have to be the nurse or the doctor, or the state or the federal government to do this. It really takes all of us. Let me ask you a little bit about yourself. When the pandemic hit Less Spring, you'd only been the chief medical officer for about six months. What was it like to have to deal with such a huge emergency so quickly? How did you how did

you begin to think about it when faced with this problem. Yeah, so I'm a practicing emergency medicine physician as my background, and I still see patients, so I think that I bring that approach to whatever I do. I had an experience early in residency that reminded me how important it is to treat the patient first and remember that the rest is noise, and so that's been kind of my guiding professional philosophy throughout my entire career in medicine. I

really believe an open, honest community. We have just dozens of these echoes where we have calls with the public and healthcare workers and vaccine providers all across the state. So having a lot of two way conversations really really important, and just relying on our team. As emergency medicine doctor, I'm not the cardiologist, I'm not the orthopedic surgeon. I'm

not the primary care doctor who knows their history. But I'm that person in a time of crisis who helps to connect the pieces together for one goal, and that's the health of my patient. And I just see this role and as a chief medical officer as an extension of that. I'm not the epidemiologist. I'm not the infectious disease doctor. I'm not the logistical expert. I'm just the er doc in the center. We're really trying to figure out what makes sense for the health and well being

of Alaskans. So in a lot of parts of the country, I know that public health officials have faced a lot of pushback and even personal threats. In some places, there have been a lot of resignations. People say there's too much political pressure from the job. Have you found any of that in Alaska? And how have you coped with the politicization of this crisis and the depth of anger that people have felt about some of the restrictions that have been placed on them. Yeah, I think this pandemic

has been hard on everyone. It's been hard on Alaskans, It's been hard on public health officials. It's been incredibly hard on my team, both because of political but just because of work. It's been NonStop for you know, almost a year now, of responding and really taking on the responsibility of every death, of every hospitalization, of every vaccine being distributed, and making sure that it's done as fast

and fair as we possibly can. I think again, in the emergency department, I'm used to people being scared and frustrated and angry, and sometimes when they are hurt or lost or upset, that's when they lash out. And I have found it useful to just really stay focused on my own internal principles and what I can do for the patient at that moment. And I think that that

clarity has been helpful despite a lot of frustration. I also, early on the pandemic, when I was looking around to other countries and other states, felt like when a state could work collectively together or country could work collectively together despite large differences of opinions, they did better, there were less cases, there were less deaths, that COVID really takes advantage of the cracks between us, and it was more important to me that I work collectively than any specific policy,

any one decision, And so I don't always agree with the governor. He doesn't always agree with me. I don't always agree with my team, and we hash it out together as adults and go around and around and share our sides, and at the end of the day, try to always make decisions collectively together because we feel like that is more important to controlling COVID than any single policy decision. And you do all of this while still working occasionally as an ear doc. Is that is that

what I heard? Yeah, I still work in the emergency department. I love it. It's helpful, it's really grounding. It's great to solve little problem. Second, so a laceration and it looks better, which is sometimes way easier than trying to get vaccine out across our state. So it's rewarding in that way. I really just love talking to people and

hearing their stories. It's this incredible gift in medicine to be able to walk into someone's room who you've never met and within seconds they tell you, you know, something that's really scaring them, or something that's super concerning to them, or they're in pain, and you're able to help them.

So I find that my work as a chief medical officer helps me with the feeling of frustration and that the systems are never going to change in the ear, but working that ar helps to ground me in the work that we're doing and the people that it's serving. Just the complexity of how medicine presents and how it's not all a cookbook, and how it's not all just

follow this and this is what happens. I love that in the emergency room, and I found that I just kept serving and making sure that what we're doing really has meaning and that it's really working at the ground level. So to me, they're kind of a union yang of each other, and I couldn't do one without the other. Sounds very much like how COVID had to be approached. I mean, we didn't understand it at first, had unveiled

itself slowly. At each stage there have been new demands hospitalizations, now vaccinations, and at each stage there's a lot of mysteries that is that is that part of why you've You've been so passionate about it. They have felt incredibly intertwined. There's clearly huge differences between the two jobs as well, but I find that the skills from one really have helped with the other. We have limitations, you know, I

am not an infectious disease doctor. I've learned so much infectious disease this past year, but I have an amazing team that I've been able to rely on and say, help me understand this. I'm not sure about this and have spent a lot of my time just trying to learn more about vaccinology or immunology, things that were not a part of my emergency medicine world prior to this. I don't think Alaska was originally part of your life either. You were born in Colorado. I think where you grew

up in Colorado? What what what drew you to Alaska and how did you become so integrated into the community of the state. You're right, Alaska is not a part of my plan. I you mentioned grew up in Colorado. During college, I would spend my summers either in Wyoming or then most of my summers actually in Alaska, working in the mountains of Alaska. And completely fell in love

with this place. And I actually met my husband up here, and he followed me down to residency and med school in California, then in Utah and after that, you know, he said, I did this seven years of med school and residency for you. Can you do three years of Alaska for me? I miss those mountains and I miss being up there. I interviewed up here and took a job in Palmer, Alaska and this kind of smallish er. It was about as urban as he could live and about as rural as I could work, and I just

fell in love with it. I fell in love with the medicine. I fell in love with the people. I fell in love with the community trying to figure out solutions together. And I am the sort of person who keeps asking like, well, why not and how about this? And can't we make this better? And one meeting after another led to multiple meetings and ultimately led to me having this job. And predecessor took the job as the deputy director at the CDC over infectious disease, and he's

been a great mentor through this as well. So Doctor Zinc, we like to end all of our episodes by offering suggestions to listeners, giving them ways they can be help they can help, and solving problems as well. What can people do to better support the delivery of vaccines and the rural communities in their states? Lean in, get involved. My husband always told me to show up for the client, show up for your community. Ask how you can help. Every state and every county and every community is a

little bit different. But there are lots of volunteer organizations. You can check with Red Cross, you can check with your local public health department. Most public health departments do have a way for people to volunteer if you're a licensed healthcare professional or if you're someone who wants to volunteer to bring food or to drive people onto those areas. I am amazed at the incredible ingenuity and problem solving

that can happen at the local level. And it might be driving seniors to the local place to get vaccinated. It may be helping them with the website, It may be trying to figure out distribution and working with your community. But there's just real power and community. So looking around your community and looking at who's left out, who doesn't know that it's their turn to be vaccinated. How can you reach out to them, and how can you make sure that they are connected, Even those little small things

that may not get a big notice. If you pick up two or three of your friends and neighbors and help them get vaccinated, help them work through the system, I think that that makes a big difference. This is a huge lift. I think so many times I just see people waiting for someone else to do the vaccine distribution, or waiting for someone else to figure out the problem. We just need the ingenuity of every American helping to

solve this problem together. Everybody stepping into this space. Doctor Ann zinc It's the chief Medical Officer of Alaska and also an er doctor. Next week, I'm Solvable. I'm going to sit down with my co host and Apple Bomb for a conversation about repairing American democracy and as a Pulitzer Prize winning historian, her most recent book is about the eyes of authoritarianism around the world. President Joe Biden has taken his seat in the Oval Office and our

country is deeply polarized. Ann and I will talk about what steps might be useful to take to diminish conflict and restore confidence in our political future. Please join us Solvable is produced by Jocelyn Frank, research and booking by Lisa Dunn. Our managing producer is Catherine Girardell and Pushkin's executive producer is Mia Loebell. I'm Jacob Weisberg.