A State Health Commissioner’s perspective on the COVID-19 crisis

The United States does not have a nationalized health care system, and the fragmentation of our public health enterprise presents a variety of challenges in the face of a pandemic. Siloed information systems. Disparate data collection methods. Varying state approaches to public health and pandemic response. Now that we find ourselves in an extended state of emergency, ICF is eager to help reinvent America’s public health enterprise. That’s why we’re engaging experts from across the public health landscape to share their perspectives and inform the path forward.

How do states, counties, and the federal government coordinate their pandemic response efforts? Where do the various responsibilities sit, and how are regional differences addressed in a given state? The COVID-19 pandemic is serving as the ultimate stress test on our public health enterprise, and by understanding how our system functions under the hood, we hope to uncover creative solutions designed to protect and serve all citizens more effectively.

In this podcast, hosted by David Speiser, Ph.D., executive vice president at ICF, we zero in on the state’s perspective to capture insights from the front lines of the pandemic. The conversation with Virginia State Health Commissioner Dr. Norman Oliver covers topics such as:

• The fragmented nature of public health across the U.S. and how states vary in their approaches.
• The role of the Virginia Department of Health in regulating hospital capacity, along with lessons being absorbed from the COVID-19 emergency about how to maintain surge capacity of facilities and medical professionals.
• How to align the public with the need to embrace critical public health interventions such as vaccine acceptance, masking, and physical distancing requirements.
• Recommendations for how to effectively prioritize new or modernized public health information systems after the pandemic, while also ensuring that they are truly national and universal.

Full transcript below: 

Dave: Hello, welcome to another in our series of podcast episodes on the extended public health enterprise in the U.S. I'm Dave Speiser, executive vice president of Corporate Strategy at ICF. And joining me today, I'm excited to say, is Dr. Norman Oliver, Virginia's state health commissioner. Dr. Oliver, welcome.

Dr. Oliver: Thank you. I'm glad to be here. Looking forward to our conversation.

Dave: I really appreciate your taking the time. I know these are exceptionally busy times for folks in your role. As a brief means of introduction before we get started on the main topic, I was wondering if you could give us a summary of your personal journey that led you to the leadership role you're in today.

Dr. Oliver: Oh, boy, that's a long story. So, I trained as a family physician. And family docs tend to have an orientation towards not just the patient sitting in front of you, but how that patient's related to family, and how that family is related to community. And I had a general interest in community health. Over the years of my career as an academic family physician, I get more and more involved with public health.

I was at the University of Virginia until 2017. I was there for about 21 years, and got involved in a lot of work with our local health department, and then had an opportunity to become a deputy commissioner at the Virginia Department of Health as the deputy commissioner for Population Health, and then in 2018, was appointed by the governor to become state commissioner.

Dave: Well, that's actually a pretty kind of robust journey. It's not a lot of twists and turns at all. It's a pretty much a rise into a position of passion for you, it sounds like.

Dr. Oliver: Yes, it was. And I'm very excited about it. Although, I don't think I was planning on falling into the middle of the worst pandemic since 1918.

Dave: Well, we can only address the challenges that are put in front of us, I suppose.

Dr. Oliver: Yeah.

What makes the Virginia Department of Health different

Dave: So, it might help if we start out with talking about what the overall scope of the Virginia Department of Health is-- what the department's responsible for, just to kind of set the stage for the rest of the conversation.

Dr. Oliver: Yeah. Virginia Department of Health is responsible for a lot of things. We have 42 lines of service that are defined for us in the code, the Virginia law, and in the budget. Everything from assuring that there's no coliform bacteria in the oysters and the oyster beds in Virginia, to making sure there's no lead in the water, to ensuring that the food you get in restaurants is not only nutritious but safe to eat from a health point of view, to looking at chronic disease--and how heart disease, or diabetes, or obesity, or smoking is tracking in the Commonwealth--and doing what we can to help people prevent those diseases, to dealing with outbreaks of infectious diseases.

Dave: Yeah, I think I'd heard that last one recently.

Dr. Oliver: Yes. So, we have a very wide range of responsibilities. And right now, of course, we're mostly focused on COVID-19. But these other activities are still ongoing. It's really quite a challenge to have a robust response to the pandemic while ensuring that other aspects of public health are taken care of.

Dave: Obviously, the state fits into a larger context, as you and I talked about previously. Can you talk a little bit about the delineation of roles at the state level, how you interact with the federal public health agencies, and your role in providing leadership to the counties?

Dr. Oliver: Yes. The Virginia Department of Health is one of about a third to half of the health departments around the country that are referred to as centralized health departments. What is meant by that is the 35 health districts in the Commonwealth of Virginia are actually part of the state health department. You take a state like, say, Massachusetts, that's not the case. The state health department is an entity and the local health departments are completely separate.

What that means for us is that we can, as a state, set strategic priorities as a health department and that those strategic priorities are the strategic priorities in all 35 of our districts. The other thing that happens is my authorities stipulated in the code, like, restaurant inspection, I can delegate to local health departments. And then they have that same authority. So, our local health district can deploy their environmental health specialist. They do the restaurant inspections. And if they find a restaurant with a rat infestation and they're given instructions on how to deal with it, and they don't deal with it, then they have the authority to suspend that restaurant's license under the State Code because I've delegated that authority to them.

On things like with COVID-19, where there's a tremendous need for resources, we do case investigation and contact tracing. This is something we do all the time, right? We do that for sexually transmitted diseases, for example. So, there's normally a team of case investigators and contact tracers that are in our local health department. But with COVID-19, hundreds--and perhaps thousands--of cases in our local health district, they needed far more resources than that.

At the state level, we organized to increase our workforce. We increased our workforce by more than a third over the last couple of months in order to supply our local health districts with hundreds and hundreds of case investigators and contact tracers. So that's a relationship we have. And the central office plays a big role in helping provide the sort of data and data analytics that the local health departments need in carrying out their work in partnership with local jurisdictions and their other partners in their local areas.

Dave: And you all are the ones who provide me with my daily dose of data goodness when I look at the number of COVID cases in Northern Virginia.

Dr. Oliver: Exactly. Exactly. Exactly. That data was done here, and then we provide the dashboards, and all those sorts of things that you either get at our site. And I'm sure in Northern Virginia, the local health department takes that data, and they might slice and dice it differently for consumption by you and others.

You mentioned the federal government and, you know, we as a state health department want to be sure that we're aligning our guidance with the guidance that's coming from the CDC. We have agreements with the CDC to share data with them about what's happening here in Virginia. And then we collaborate with the CDC, and others within HHS, and other federal agencies on the response around COVID-19 and on other public health and emergency issues as well.

Dave: So, in your role as the Virginia State Health Commissioner, to the extent that there are discussions around the social determinants of health in Virginia communities, I'm assuming you play a central role. But do you coordinate with other Virginia state departments on issues around social determinants?

Dr. Oliver: That's a really interesting question. Yes. One of the things that I did when I became the deputy commissioner of Population Health is I'd reach out to other state agencies and have more discussions about the relationship between the work that they do and health. I think that it was really heartening to have this discussion because I found that, in talking to folks in housing and community development or in social services--our Medicaid agency--and Behavioral Health Agency and so on, they were all dealing with many of the same issues. Which is, as you just described, social determinants of health and realizing that they had a role to play in that.

One of the things that we were able to do over the last couple of years after I became a commissioner is launch, in conjunction with the Virginia Hospital and Health Care Association-- the association of all the hospitals in the Commonwealth--and partner with probably 30 to 40 organizations. Hospital systems, some banks, community-based organizations, philanthropies, and faith-based organizations, and a number of state agencies. So, the Department of Health, Department of Behavioral Health, DMAS--which is the Medicaid agency--social services, and housing community and development got together and formed something called Partnering for a Healthy Virginia.

The focus of that coalition is to look at the social and economic sort of factors that drive the health and well-being of Virginians, looking at things like affordable housing, food and security, transportation, educational achievement, all these sorts of things. And being a resource for local initiatives to deal with those sorts of issues. That group has been doing a lot of work with a number of areas around the state.

Currently, we have a big project going on looking at diabetes and cardiovascular disease, with five large healthcare systems--and focusing not simply on the issue of dealing with the medical problems that these people are having, but looking at the health-related social needs that these individuals have. And how those health-related social needs are connected to the sort of structural problems in those communities, right?

So, food insecurity of the individual diabetic patient is facing what lead to they're having difficulty in controlling their diabetes. But that food insecurity may be related to the lack of jobs in that particular area. And so, the hospital has to be working with other community organizations to try to figure out ways to improve that situation if they want to get a handle on what's happening with all the diabetics in that region.

How regional differences play out in Virginia

Dave: Do you see regional differences either around the social determinants or at any of the core kind of public health responsibilities? Virginia is a quite diverse state, even though we're not a huge state. You know, Northern Virginia versus the Tidewater versus the Southwest, I mean, those are some very different environments. Do you all see a lot of regional differences and have to act differently?

Dr. Oliver: Yes, there are huge regional differences. You can use a wide paintbrush and talk about urban versus rural, for example, in which case you'll see Virginia split into two states--essentially, the northern and southern side of the states. You know, a county like Fairfax is probably in the top five counties in terms of wealth in the country. And it's reflected in about a 20-year difference in life expectancy in Fairfax versus, you know, pick a county in far southwest of Virginia. If you live there, you can expect to live 20 years fewer than if you lived in Fairfax.

Now, that being said--to be fair to Fairfax--it's a big county, and there are pockets of poverty and health disparities within Fairfax. So, I think it's important to not use such a big paintbrush to characterize geographies. And so, we make a point of drilling down even further.

If you go to our website and look for Health Opportunity Index, we look at about 31 different factors that are essentially social determinants of health, and we put them into this index we call the Health Opportunity Index. And we can drill down right down to the census block level, which usually comprises about 400 people. So, we can look at census blocks, census tracks, localities, cities, counties, that sort of thing. And when you do that, you begin to realize that within urban areas--like I was saying--there are huge differences. In Fairfax, you have areas where you'll see that same spread in life expectancy from one side of Route 1 to the other. Right?

Dave: Right.

Dr. Oliver: If I showed you a map of the Health Opportunity Index in Richmond, you wouldn't even need to know anything about Richmond to tell me where the African American community was, for example. Because it will pop out as this area with very low health opportunity.

Dave: Got you.

Dr. Oliver: So, yeah, there's big differences in geographies. And what that means, I think in terms of public health interventions, is our view is that you’ve got to take care of the most vulnerable first and direct your attention there. And really try to do your best to improve the health and well-being of that community, not because, you want to ignore others, but they're the ones who are most in need. Truth is, if we eliminated racial and ethnic health disparities in Virginia, we'd be probably in the top 10 most healthy states in the country.

Dave: Yeah, if we lifted everybody up to that level, that would mean success for all of us.

Dr. Oliver: Exactly. For all of us. It really would.

Dave: We've certainly seen during the current pandemic. The fact that as communities, we are each only as healthy as our neighbors.

Dr. Oliver: Isn't that the truth? You know, it's been such a good example of that. I think you and I probably have said things like that before, but it's really brought home by this infectious disease, right? You can be young and healthy, and get this disease. For you, it's a really bad cold maybe, or not, you know, there's a small percentage who will wind up being even sicker. But meanwhile, you can spread it to somebody else for whom it's a deadly disease and, they die from it or are severely harmed by it. It's really important that we recognize that we're all in this together.

Positive attitudes towards public health during the pandemic

Dave: Well, in a lot of ways, public health has been an ignored mission area in the U.S. Partly because as you know I've asserted in other venues, we were kind of relying our overall wealth--as opposed to taking a very, specific approach to making sure that we actually generate and maintain public health for all of our citizens, residents, and neighbors.

But part of that gets to the attitude of Americans toward public health. Is there any insights you'd be willing to share into public attitudes towards public health? Do you actually track public attitudes towards public health? Have you seen any changes or any salient issues in how people have treated public health workers during this crisis?

Dr. Oliver: Well, I'll deal with the last part of that set of questions first. And this is just anecdote. We don't do any formal studies on it. But the sense that I'm getting--and I hear this from my co-workers in public health here in Virginia and across the country, for that matter--is that the general public is very supportive, I think, of what public health is doing to protect them or help protect them from COVID-19. This pandemic and our response to it, has increased not only the knowledge about public health but the understanding of how important public health workers and public health workforce is.

Now, it's also true, as you well know, just from reading the news, and so on. This response has been politicized a lot at the federal level. As a result of that, there has been some negativity. But that's the politicization of it. That's not what people are reacting to. You know, most people are, "Thank you for what you're doing. We really appreciate what you're doing."

And even on something politicized, like the mask or face coverings, the overwhelming majority of people are actually doing what they need to do to protect themselves, their loved ones, and their communities. When I go out to the grocery store or out and about in my hometown, most people are wearing masks.

So, I think it's been a good response. It's true, like you said, that public health is not very well-resourced and it's understaffed. The emphasis in healthcare in the United States is very much focused on specialty care. So, it's not just even public health that has been neglected. As a family doc, I would say primary care and public health both suffer from that same neglect. My hope is that one of the lessons that will be drawn from what's happened around COVID-19 is the necessity of investing in public health and primary care. Now as we continue our fight against COVID-19 and going forward in preparation for the next pandemic.

Concerns of surge capacity

Dave: So, you mentioned the primacy of primary care, which I guess is a tautology. But obviously, one of the roles that I believe that the Department of Health plays in Virginia is on being the regulator of hospital or acute care hospital capacity at least. Is that right?

Dr. Oliver: Yes. In Virginia, there's what's called a Certificate of Need that we regulate.

Dave: So, one of the interesting issues that arose in the early kind of more frantic--at least in our part of the country--times of the pandemic was the notion of surge capacity. We were worried that our capacity to care for acutely ill patients would be overrun, whether it was in the ICU or merely people who needed nursing care, and constant monitoring, and provision of oxygen, etc. Does emergency surge capacity, either today or maybe in the future, become a driver of the regulation of hospital capacity?

Dr. Oliver: Yeah. It was this time around, and I could see that happening in the future as well. As you said, early on in the pandemic, we were concerned that this could spiral out of control, and that we'd be in a situation where we did not have enough hospital capacity to deal with the number of patients who would need acute care or ICU, intensive care. We were looking at what was going on in Italy, for example, and saying, "We got to prepare for that."

So we started looking at the possibility of doing alternate care facilities, particularly in the Urban Crescent from Northern Virginia down through Richmond out to the Tidewater area. We identified places in Hampton Roads in Richmond, and in Northern Virginia, where we would stand up these acute care facilities. The National Guard was going to be involved in helping to build these facilities and...

Dave: If I recall, they could be the Dulles Expo Center.

Dr. Oliver: Yes.

Dave: ...in Northern Virginia.

Dr. Oliver: Exactly. And the Coliseum down in Hampton. And we identified the Richmond Convention Center and one other place in Richmond. And so, we're going to build these out as essentially field hospitals. Right?

As we were going through those plans and working with the Army Corps of Engineers on this, the pandemic was continuing to go. And we began to realize that the hospital systems were able to figure out ways to expand their capacity through reassigning the hospital beds. We altered our process on Certificate of Need so that we can get more rapidly approve these beds. They didn't have to go through the normal process.

We were able to increase bed capacity by, I would say, something on the order of 8,000 beds across the Commonwealth. And we realized that, given what we were actually seeing on the ground with the cases-- and Virginians responded really well to the stay-at-home order--we were being successful in decreasing the incidence of the disease. So-called flattening the curve. Between those two things, we realized, “I think we can handle the surge if there is one.” And that proved to be the case. So, we never actually pulled the trigger on those alternate care facilities.

Dave: Right. Well, certainly the reduction in discretionary procedures had a big role in kind of freeing up beds in existing facilities as well. I know from my role at one of our local institutions that our census went way down before it started climbing again because of COVID. So, we had that extra capacity.

Would you ever consider from a planning perspective, you know, God forbid, an even more serious infectious disease event? Either taking advantage of the planning you've already done or doing pre-planning for kind of other local facilitation of emergency capacity? Lying in wait if you will, kind of not necessarily dedicated but repurposing hotels or these kind of more convention center kind of field hospital sites?

Dr. Oliver: Yeah. I think it's important to first utilize the infrastructure we have. So, doing what we did--shifting around and utilizing existing bed capacity--would be the first step. And then before doing a field hospital, I think the better thing is to augment what the big healthcare systems already have.

To give you an example. If you're a big healthcare center, we won't name any, up in Northern Virginia, and you fill up your ICU beds, but you have people who actually could be a step down from that, and it would free up ICU beds. So having a step-down sort of unit that's out in a parking lot or nearby building-- maybe even a close-by hotel--that would be a big benefit for that healthcare system. Because then, it would free up the ICU space. The step-down care is not quite as acute, and you could get the sort of resources you need to run that. And it's a lot cheaper than trying to set up an actual field hospital with ICU beds and that sort of thing.

Healthcare disparities on a national level

Dave: Right. Right. Well, one of the things that we've seen in the current pandemic--and I'm going to assume until you tell me differently, that it's kind of reflective of what life was like before--is a huge disparity across the country in how people have approached emergency. But that seemed to reflect a real heterogeneity in just how things get done from a broad perspective. I'm assuming, as Virginia's health leader, you are in contact, communication, and partnership with folks around the country. Can you give us your perspective on what that, you know, U.S. heterogeneity fragmentation kind of looks like and where you see Virginia in the midst of all that?

Dr. Oliver: Right. Well, I'm glad you used the word ‘fragmentation’ because I wouldn't even call it just heterogeneity. It's really a fragmentation. We do not have a national healthcare system and we do not have a national system of public healthcare. And it's problematic from a whole number of ways, right? So, a really integrated national system of public healthcare could coordinate and implement public health initiatives around something like COVID-19 in a way that would save far many more lives than what we've been able to do here in the United States. To be concrete, you look at a place like Taiwan, which hasn't had a case of coronavirus...

Dave: Tremendously well.

Dr. Oliver: ...for months now, right? They have a really well-organized national system. They go out and decide you're going to do contact tracing, they blanket the place where they do everything. And that was true in a number of places. New Zealand is another example. South Korea and the way they carried out their testing.

So, we couldn't do that. We were not set up to do that. And it really hurt us. We knew that the virus was coming, you know, in January. We knew it was going to get here. With a really well-organized national system, it would have been possible to ramp up production for testing supplies and that sort of thing. So we've been playing catch up for eight months.

Dave: If you were to imagine yourself in a different reality where you could be in the same room as your peers in the other 49 states, what are the biggest differences we would observe in the different state approaches, given that we don't have a national approach? You mentioned one of them because you said that Virginia is one of the ones with kind of centralized responsibilities. But are there other important dimensions of differences between how states kind of approached the entire mission?

Dr. Oliver: One of the things that you'll see with the public healthcare system here is, I already mentioned, that some of our public health interventions have been politicized. So, depending on the political environment in which public health workforce is operating in, you will find public health agencies having different sort of constraints, right?

So, here in Virginia, the governor and the secretary of health are very supportive of taking really assertive action around non-pharmaceutical interventions to protect people from COVID-19. So, the governor issued a stay-at-home order in order for the people to stay at home. And he kept that on longer than a lot of other governors did. He issued a mandate for wearing masks. When we saw a surge in cases in the Eastern region of the state, he stepped in and imposed more strict guidelines and increased the restrictions in that region. Whereas, in other states, that wouldn't necessarily have been the case and wasn't the case.

Dave: From the outside in, just in terms of public reporting and whatever trade descriptions I've been able to consume, a lot was made about the independent authority under the California Constitution of County Public Health Directors. Quite famously, Sara Cody, leading her colleagues around the Bay Area to institute the first shutdowns. Is there a difference in the level of kind of independent authority that public health officials have in different states?

Dr. Oliver: Yeah, very much so. And that relates to what we were talking about at the top of this conversation, right? California does not have a centralized state health department. So, the county health departments are the ones where all that authority lies. And so, you probably have pretty big differences between what one county will do versus another, both driven by that political environment but also just resources, right? There'll be some counties that just don't have the kind of resources, and staff, and everything. And then you'll have counties that have a very well-financed county health department. And so they can do a lot more. That makes big differences even within the state.

We don't have that issue as much here. I say “as much” because there is some component of that. Our local health departments have cooperative agreements with their local jurisdictions. And part of those agreements is an agreement for the local jurisdiction to share in helping out with the expense of running that local health department. And so counties that are more well off can provide more resources, more support than others. So, there's some differences that way. But I don't think it's as pronounced as it would be if we were not centralized.

The value of data modernization

Dave: Gotcha. One of the topics that we've touched on briefly, but that comes up all the time, and I know--you know--my colleagues here work on a daily basis is the issue of the information systems that support your mission. If I think about the fragmentation and the fact that we don't have a national public health delivery system, I know that there do exist national data systems. But that are primarily voluntary in terms of state participation. In your own mind, right, if you were a king for a day, and you could launch no costs constraints included--a complete revamping of our public health information infrastructure--how would you prioritize that, right? What aspects of the public health information...?

Dr. Oliver: That's a huge one, right?

Dave: Yeah, I mean, which would be the first thing to get your attention?

Dr. Oliver: I would say data modernization. By which I mean, what data is getting collected? How is it structured and how is it shared? I'd want to see it shared--which means getting agreement on what data you want to have in the first place and getting agreement on how it's structured. Because the way it's structured would then determine how you'd be able to access it. And then there's related things to that, right?

So, in COVID-19, for example, we get problems with this all the time. In Virginia, we're dealing with maybe 700 or so different labs that are doing testing on COVID-19. We're constantly trying... Every time one of these new labs comes on board, we have to work out a whole new data-use agreement. We have to get them to agree to format their data in such a way that it can then be sent to us electronically, so we don't have to hire a whole team of people just to do manual data entry. And we keep repeating that, right? Because just this past week, there were, like, 16 new labs that came on board. So, having some system already set up would be a huge help. You know, how do you get that for information from the last? How do you integrate all the data on outbreaks that occur? The mortality and morbidity data, it's not just...

Dave: Do you see they derive much data from electronic health records, say at healthcare providers or does it all have to come over separate portals to you?

Dr. Oliver: It comes over separate portals. I mean, I would love to have some agreements with healthcare providers and healthcare systems. That would be a big help in public health. And also integrating to the extent that healthcare systems and community-based providers are getting interested in things like social determinants of health and public health matters. I think if we could integrate those... Integration might be the wrong word.

If we could find a way to have the systems be interoperable, and talk to one another, and have standards so we're talking about the same data, it would be a benefit not only to public health, but also to healthcare providers of all types. But then you're getting into some bigger issues around data repositories and data governance, and, you know, that sort of thing.

Dave: I mean, those are going to be issues, in any case, if we really try and architect a national approach.

Dr. Oliver: Exactly.

Dave: There's no way of getting past that. Obviously, the current pandemic situation puts a very, very sharp point on this discussion. If we think about the ‘before’ times or the ‘after’ time-- hopefully there will be an ‘after’ time--where we are worried much more about building a steady drumbeat of improving public health and reducing the disparities, and outcomes, and opportunity. Some of those may be less critical, minute by minute changes in the data. Or maybe that's less important than understanding that kind of status of a local community and kind of the big levers one has to pull. I mean, that's, in some ways, a different set of data. Maybe it gets more to the prevalence, as opposed to kind of levels of acuity and kind of specific clinical data. Is that part of this realm also or is that almost like a separate conversation?

Dr. Oliver: No, I think it's part of it. I mean, if you get the data on individual people, you can always aggregate it up to the community level or whatever sort of population level that you want. And so, you can talk about both. I'd love to do a couple of things with that type of data if you had it at a national level or even at a statewide level. I could see doing data visualization with that--that would become a powerful tool for designing interventions. Whether you're doing it from a public health point of view or you're a big healthcare system trying to think about, ‘how am I going to deal with all my diabetic patients that I'm responsible for?’ Particularly, if you're in one of these value-based markets, where you're going to be financially liable for...

Dave: Right. You're taking risk on the health of the population.

Dr. Oliver: Right? So you want to be able to visualize what's going on and everything. But the other thing that I think could be really powerful about a data system like that is, from an analytical point of view, I would love to see predictive analytics developed, right?

So, right now, epidemiologically what we do is run essentially correlational kinds of statistics, right? I can show you that the lack of affordable housing is associated with an increase in, name the disease, substance use disorder, depression, diabetes, cardiovascular disease, whatever.

I'd love then to be able to go to my state senator, delegate from my neighbor and say, "You know, if you could work with your colleagues to come up with some money to increase affordable housing in your constituency by 30%, you could expect to decrease infant mortality by X amount. How would you like to save the lives of, you know, 100 of your constituents," right?

Dave: Right. Not to make light of it, but it harkens back to a famous line from the original "Ghostbusters." You'd be saving the lives of millions of registered voters.

Dr. Oliver: Right. Right. Exactly.

Dave: Yeah.

Dr. Oliver: Exactly. And that would be really powerful, right?

Dave: It would be. One could argue that we don't need sophisticated analytics to know what we need to do, right, but it's a matter of political will. I'm not arguing with you as a leader that that would be incredibly powerful, and that maybe that would help you make the case.

Dr. Oliver: Yeah, that's the way in which I'm talking about it being really powerful. The truth is, we all know it's the right thing. I shouldn't say we all know. Maybe you and I know it's the right thing to do. But just because it's the right thing to do is, unfortunately, not often enough to convince people to do it.

The elements to an educational campaign on vaccines

Dave: Speaking of the right thing to do, in the minutes that we have left, I want to look forward a little bit. As a former molecular biologist myself, I track the progress going on with all of the vaccine candidates as closely as I can as my duties permit. I'm personally cautiously optimistic that out of this incredibly broad field of candidates, something will emerge with good Phase 3 efficacy and safety data. But as I think we've spoken about before, vaccines don't protect anyone, only vaccinations do. And so, vaccines aren't useful unless people will take them.

What would you like to see happen between now and whenever we do have an effective and safe vaccine that's available to ensure that the broadest population possible is going to sign up and take the vaccination? What do we need to do as a society to make that happen?

Dr. Oliver: First thing you need to do is really ensure that whichever candidates make it out onto the streets have been vetted by your scientific colleagues there.

Dave: Well, hallelujah for that.

Dr. Oliver: I really think, you know, they need to finish the Phase 3 trials, you know, and prove their safety and efficacy. And you and I both know that having gone through a trial of 30,000 might prove your safety and efficacy but really rare things are still going to come up. So I think the other thing we have to do is we have to do a massive, massive educational campaign to explain to people in such a way that it's easily understood by the lay public, that they're safe, effective, but not falsely claim that if we give this to, you know, 8 million people in Virginia, is there going to some rare thing that may happen that is an adverse effect? Probably.

Dave: Almost certainly, yeah. Yeah.

Dr. Oliver: Almost certainly. Right? So, not trying to shy away from that, but explain that from the public's point of view, this is going to be safe and effective, and help stop the spread of COVID-19. I think that education campaign is going to be paramount and we need to start doing it now to the extent that we can because we need a general education around vaccine-preventable diseases.

I think it's going to be particularly challenging with this one, again, getting back to the fact that the response to COVID-19, it's gotten politicized. And to the extent that that's happened, there's some in the public who will view with some skepticism a vaccine that comes down the pike. And I think those of us who are convinced that it's actually been vetted in the right way through appropriate clinical trials and so on, we're going to have to make that point really strong in order to overcome that.

Unfortunately, that's even more the case in the communities that have been hardest hit by COVID-19. So, you look at Black and Brown communities across this country. In Northern Virginia, 60% of the cases have been in Latinx community. And they have a lot of distrust of the government. And, you know, I would venture to say it's not unjustified. And so, to the extent that this has been politicized, they have even less trust around it. Meanwhile, they're the ones who need it the most. And so...

Dave: Is that a role that the Virginia Department of Health would take on or is that happening to be a nationally sponsored effort?

Dr. Oliver: Both. We plan on taking it on. We are now mapping out plans for such a communication campaign. Once we get a safe and effective vaccine, we're going to do our best to convince the African American communities, and Latinx community, and everyone else that they should get vaccinated. Because I agree completely with you, a good vaccine isn't going to protect the population. It's vaccination of millions that will protect them.

Dave: Right. Right. Well, Dr. Oliver, I can't thank you enough for taking the time to be with us today. Before we go, is there any particular message that you'd want to end with, thinking about this kind of broader topic of the public health enterprise that you wish people would understand?

Dr. Oliver: I think that people can really rally around public health, having seen the importance of it in fighting COVID-19. And I hope going forward, they would do what they can to ensure that we get the resources we need to build a robust public health system.

Dave: Well, I think that's a great way to wrap it up. Dr. Norman Oliver, Virginia State Health Commissioner, thanks again for being our guest on the podcast today. And I'm a daily visitor to your COVID-19 data website. So, I'll think of you every time in the morning when I go and look for today's numbers. And I look forward to success on convincing all of our fellow citizens to get vaccinated once we have a safe and effective vaccine that's available.

Dr. Oliver: Thank you, and thanks for having me. I appreciate the opportunity.

Dave: Okay, that was terrific. Have a great day.