Throughout the COVID-19 pandemic, a segment of the state’s population has proven unreceptive to science-backed recommendations on mask-wearing, social distancing and vaccination, according to state and local public health officials. The result has been needless deaths, they say.
“What’s really challenging for all of us in public health is we’re providing people with the information and the tools they need… to prevent sickness, hospitalization and death, but yet we’re still seeing people dying and being hospitalized,” said Renae Moch, director of Bismarck-Burleigh Public Health.
North Dakota policymakers have frequently rejected the advice of public health professionals as well, said Dr.
Joan Connell, the state’s former field medical officer.
Connell, a Bismarck pediatrician, said she resigned her role with the health department in August because leaders in state government were making decisions without giving due consideration to the expertise of public health officials.
“I felt like I’m not somebody who can sit and spin my wheels for long,” Connell said. “I need to feel like I’m making a difference, and I did not feel like I was making a difference.”
The struggles of the pandemic have left some in public health disheartened and questioning how their once-widely respected profession can proceed in the age of misinformation and extreme political polarization.
“The data doesn’t seem to be speaking to the people anymore,” said Grace Njau, an epidemiologist with the state Department of Health.
“It’s not just COVID. It’s a much bigger battle, and unfortunately I don’t know if we’re on the winning side.”
A fight to be heard
Every day, state immunization coordinator Molly Howell receives a report containing details about North Dakotans who recently died of COVID-19. Much of the time, those appearing on the list are unvaccinated residents in their 20s, 30s and 40s, Howell said.
It’s “frustrating and somewhat defeating” that many North Dakotans are still choosing not to get vaccinated against COVID-19 despite the overwhelming evidence public health officials have provided showing the impact the shots have in preventing serious illness, Howell said.
North Dakota ranks in the bottom 10 states in vaccination rate with just over half of the population having been fully vaccinated, according to the U.S. Centers for Disease Control and Prevention.
Howell used to think vaccine holdouts might come around to getting the shots after losing a loved one to COVID-19 or fending off the illness themselves, but she now believes some North Dakotans have fallen too deep down the misinformation rabbit hole to be convinced.
“If (losing a loved one) is not even going to change their mind, then there’s nothing that I or a physician could do to change their mind,” Howell said. “Sometimes, I think we have to admit to what’s out of our hands and focus on what is within our control.”
Prior to the arrival of the vaccine, getting residents to wear masks and take other COVID-19 precautions was similarly difficult, Moch said.
North Dakota disease control chief Kirby Kruger has overseen contact tracing operations, which aim to curb the spread of COVID-19 by identifying close contacts of those infected and asking them to quarantine.
His team frequently encountered sick residents who refused to stay home or disclose their contacts, allowing the virus to circulate rampantly through communities.
Kruger, who started working with the health department in 1989 on the prevention of sexually transmitted infections, said it was unusual back then to come across someone who didn’t want to cooperate with the public health process. But it’s never been easy to get people to change their behavior, he said.
The availability and pervasiveness of unverified and false information online has been the greatest foe in the fight against COVID- 19, health officials told Forum News Service.
People often gravitate toward information that confirms their existing biases, and sometimes what they find might not be credible, they agreed.
“Anyone in the entire world has as much information as I do, but how they choose to interpret it is a whole different conversation,” Njau said.
“I don’t know if there’s anything you can do to beat that.”
Public health experts said they have also struggled to gain traction with elected officeholders.
Connell said she felt local and state leaders disregarded her advocacy of mask mandates in the lead-up to a fall 2020 surge in cases. Despite being the top doctor at the health department, Connell said she wasn’t invited to any meetings with Gov. Doug Burgum in which mask mandates were discussed.
The Republican governor backed a statewide mask mandate in mid November 2020 after North Dakota’s COVID- 19 outbreak had become the nation’s most severe.
Two other top doctors frequently cited by Burgum as advisors were not consulted on pandemic mitigation strategies for most of the fall surge leading up to that decision.
Burgum spokesman Mike Nowatzki said former interim State Health Officer Dirk Wilke, who received guidance from Connell, was present during discussions of mask mandates. Wilke had no medical background.
Current State Health Officer Dr. Nizar Wehbi said he has built a trusting relationship with Burgum and meets with him frequently.
Nowatzki added that the governor’s job is to take a variety of professional opinions into consideration when making decisions that will directly affect citizens.
Connell said she also felt discredited by policymakers when testifying on proposed legislation.
Following her departure from the health department, Connell came out against a bill during the November special legislative session that cemented broad exemptions to COVID-19 vaccine mandates.
That same night, anti-vaccine activist and self-proclaimed “OSHA-credentialed subject matter expert” Tammy Clark submitted numerous false claims to lawmakers, including that vaccine makers Pfizer and Moderna had not performed animal testing while developing the COVID-19 shots.
Several lawmakers appeared engaged during Clark’s testimony and asked questions about her credentials and the information she presented.
Connell said she believes legislators viewed Clark’s counterfactual comments as being “just as valid as my testimony as a pharmacist with a master’s in biomedical research, a master’s in public health and a medical degree.”
“Everybody’s voice deserves to be heard, but when the listeners who are making laws can’t discern credibility and knowledge base, that’s a problem,” Connell added.
Howell noted that some of the legislation passed during the regular and special sessions, including the anti-vaccine mandate bill, wasn’t in line with the recommendations of public health officials, though she acknowledges lawmakers “were under quite a bit of pressure.”
Moch said it’s frustrating when decision-makers in government don’t follow the guidance of public health experts, but she declined to name specific politicians or issues where she has felt ignored.
An existential question
Despair is not too big of a word to describe how many public health workers are feeling as the third year of the pandemic approaches, Connell said.
More than half of the 26,000 public health workers surveyed by the CDC in spring 2021 reported symptoms of at least one mental health condition. Nearly 37% reported symptoms of post-traumatic stress disorder, while more than 8% said they had contemplated suicide.
Public health workers who spent a majority of their time on COVID- 19 response activities were even more likely to experience PTSD and depression.
And the mental health issues facing those working in the field have likely only gotten worse since the survey was taken, Connell said.
The social fractures unmasked by the pandemic have also compelled some public health experts to rethink how they do their jobs and what function they will serve going forward.
“If people are getting information from elsewhere, what is the role of public health?”
Njau asked. “It’s a very strange place to be.”
Njau said she no longer has the will to actively promote disease mitigation measures since she thinks her advocacy is unlikely to make a difference. To preserve herself and maintain passion for her work, Njau said she has taken on a more passive role, providing information only to those who want to listen.
Kruger said he thinks it’s important for public health agencies to disseminate scientifically accurate information, though he acknowledges he can’t control how people receive it.
When deciding what information to push on the public, Kruger said he picks his battles, believing he might have more impact endorsing life-saving vaccines than broadly unpopular masking.
Moch, who endured intense harassment from members of her community while advocating for a local mask mandate, said she can’t shy away from the public eye and must stick up for what she believes is right.
However, on a personal level, Moch has refrained from telling people she meets that she works in public health to avoid soliciting resentment toward her profession.
When staff members are feeling discouraged, Kruger said he reinforces that the work they do is important and has saved lives.
On disappointing days, Howell said she looks at the positive effect of the vaccines on those who have gotten the shot. She also receives occasional “thank you” notes from residents who got their booster doses.
Wehbi notes that public health workers are extremely valuable right now, because without them, misinformation would have an even greater hold on communities across the country.
But the road ahead for public health could be bumpier than the one in the rearview mirror.
Prior to COVID-19, Howell said North Dakota parents were very supportive of giving routine vaccinations to their children with only about 3% securing exemptions to immunization requirements for their kindergarteners. That figure has inched closer to 5% just since the pandemic began, and Howell worries the troubling trend could continue.
More children going to school without getting their shots means the state could see the reemergence of vaccine-preventable illnesses like meningitis, polio and measles, Connell said. In her own clinic, Connell said most parents are still willing to get routine vaccinations for their kids, but more are refusing the influenza vaccine than in previous years.
North Dakota’s public health officials are also concerned that veterans of the field will become burnt out and prospective employees might be turned off of the profession by the last two years.
“I’m worried that public health doesn’t look all that attractive because of comments on social media or people not valuing it,” Howell said, adding that she hopes North Dakota won’t lose employees to other states that hold the field in higher esteem.
“I would expect there will be fewer people going into public health because people who want to do that are nurturers who share the same goal of trying to improve a population’s quality of life and health,” Connell said. “I think this pandemic has demonstrated that the government and the citizenry aren’t really interested in that.”
Wehbi took the opposite view, saying that increased investment in public health infrastructure and workers will benefit the field in the future.
Restoring faith, finding truth
Public health officials see a number of ways the field can rise to meet the challenges ahead.
Kruger said health experts must push information out that people will find relatable. Howell said officials could stand to become more politically savvy and adept in conflict resolution.
Wehbi said being available to the community on a grassroots level will help public health build strong bonds.
Moch said she hopes public health agencies can streamline data collection and sharing because misinformation gains a foothold when experts can’t quickly provide hard answers.
Officials also urged residents to rely on public health agencies as a resource for answering questions and evaluating information.
Howell encourages North Dakotans to scrutinize their sources of information and avoid cherry picking material that confirms biases.
Connell said residents should also be very thoughtful when they go to the polls this year about which candidates will be willing to listen to the majority of their constituents rather than the “loud, screaming minority.”
Contact Jeremy Turley at jturley@ forumcomm.com or on Twitter at @jeremyjturley.
“If people are getting information from elsewhere, what is the role of public health? It’s a very strange place to be.”
GRACE NJAU, EPIDEMIOLOGIST WITH NORTH DAKOTA DEPARTMENT OF HEALTH