Oral History Interview with Dr. Steven Stack

Mandy Higgins 0:00 It is June 23rd, at 11:10 in Frankfort, and we're interviewing Dr. Steven Stack. I'm Mandy Higgins with the Kentucky Historical Society, if you can just state your name.

Dr. Stack 0:11 My name is Steven Stack and I'm the Commissioner for Public Health.

Mandy Higgins 0:13 Thank you. How did you join the administration?

Dr. Stack 0:17 So, I'd had a wonderful career as an emergency physician, and also as an administrator for emergency departments. And additionally, in organized medicine, and I became the president of the American Medical Association in 2015. I had hoped I'd have a chance in my career to have a period of government service and to see what it was like to serve on the other side of the desk, rather than just petitioning people in government. And when Governor Beshear got elected in November of 2019, that became a potential opportunity to--to serve. And so, I submitted an application just like other people, on the transition website, and was pleasantly surprised to get a call for an interview, and after a couple interviews, I was offered this post. Ironically, that was on January 7th, when I was offered the position. And I began on February 10th. When I was offered the job, it was not clear what was happening in China, it was just beginning. By the time I showed up on February 10th, it was very clear there was a global pandemic unfolding, and just a month later, we had our first patient, so that began my journey, but that's how I got into government.

Mandy Higgins 1:25 Yeah. What did you expect you would be doing when you accepted the job on January 7th?

Dr. Stack 1:30 So, the Department for Public Health is a fascinating department, even without COVID. So, we have seven divisions that [do] does everything from a high complexity reference laboratory. [clears throat] So, we do all the public health testing for all 53,000 newborns in the state have all their screening testing done there for inborn errors of metabolism. We're the only lab in the state that tests for white powders, biohazardous materials, like anthrax and bio-threatened materials, and a number of other things we do. We also though, do women's health, where we do cervical and breast cancer prevention programs, colon cancer screening programs, lung cancer now has recently been--been given some funding for us to do screening for lung cancer. We run programs that inspect pools, through our local health department partners, pools, restaurants, food manufacturing, a number of--septic systems, a whole number of other things. And of course, we do disease surveillance, which is what COVID really brought to the forefront. We do emergency response, when there's tornadoes and floods and ice storms. And of course, COVID became a natural disaster in its own right. So we do a whole wide array of things that are really, really quite fascinating, including early childhood interventions, where we go and help support mothers who are having their first or second children, to try to help with parenting skills, and provide support for them. So, I had hoped and thought that I would be getting immersed in programs like that. And in fact, those programs continue to operate throughout the pandemic. But for me, my journey will forever be identified, is being related to the pandemic because, that essentially drowned out for me, just about everything else for about a year and a half or two years after it started getting going in March.

Mandy Higgins 3:26 So you mentioned that when you accepted the job in January, it wasn't very clear what was happening. But by the time you started in February, it was. So, how did you learn about the virus and the sort of what was happening in that interim?

Dr. Stack 3:39 Right. So, in January, all I had access to was ever--bo--is what was in the popular media, and it really was not that much, it was we think something's happening, and there could be this mysterious illness in China. By the time I became the health commissioner, the news coverage was increasing, because there was--it was now impacting or starting to impact Europe, where there was more information available. And then, once I became the Health Commissioner, I became one person as a member of a community nationwide, who are state health officials. So, as Commissioner for Public Health in Kentucky, I am the designated state health official, and that has meaning nationally. So, I and others from forty nine other states and the territories, engaged through an organization called the Association for State and Territorial Health Officials or ASTHO.

And I started attending meetings, virtual meetings, telephone meetings, with this group. They later then changed to Zoom meetings, and started learning from them. And then, the last airplane trip I took, was before the pandemic, in late February was to Washington D.C., where we were there with state health officials and we were brought into the White House grounds and given a briefing by senior administration officials about what they understood and what was going on at that time. And then, I didn't go on an airplane or go anywhere until May of this year.

Mandy Higgins 5:03 Oh, wow!

Dr. Stack 5:03 --At least out of the state, you know, through domestic air travel. So, that was quite the journey, but we have a very rich dialogue and collaboration across the state health officials around the country. And we work closely with our federal partners at the federal agencies. And then of course, here in the state itself, we have one hundred and twenty counties served by sixty one local health departments, and we had lots and lots of interactions and discussions with the public health directors for the counties, and I would just wanna make sure people know how grateful I am to all those local health leaders, because they really are the principal health strategist for their communities. And they are deeply, deeply committed to the health and wellness of the people they serve, and it's been a privilege to serve with them.

Mandy Higgins 5:49 Can you take me back to that March, sixth day and the feelings of having to announce this first case of--communicating this to the public?

Dr. Stack 6:01 You know, [clears throat] feelings might be a little bit more challenging. At that point, when we identified our first patient in Kentucky, it was only the first one we found, it probably was not the first one out there. And it was a landmark moment, because, it was the first one we had confirmed and could announce. But, we really had no idea how long this would go on for or what the outlook would be. So, my recollection of that is more of just uncertainty, remember, I'd not really done a press conference with the governor before, and so we all showed up there in suits and ties and very formal. And if you look back at those video clips, and you look at the evolution over time, it's just like a favorite television show, you would watch, where the cast and the characters don't have the chemistry in the first few episodes. But, if you watch three, four--ep or seasons later, they're like, you know, well worn friends, and everyone knows each other.

Mandy Higgins 7:00 Yeah.

Dr. Stack 7:01 So, you can watch that transformation, over the course of the time I've had the privilege to work with the governor and the Cabinet Secretary. So, I just remember a lot of uncertainty, novelty, trying to learn my job. Remember, I didn't know my team or the agency, I didn't know how all these public health systems worked, at least not from inside the government. So, it was a very, very steep learning curve. But again, there were so many wonderful people who were involved in the Department for Public Health, that--that we could draw on that resource of knowledge and experience and hopefully get through this pretty well.

Mandy Higgins 7:38 Did you get any training, or was it just, hey, go talk into this microphone?

Dr. Stack 7:43 Well--there's an irony here, and I've told this story repeatedly. So, on my first day in the office, [clears throat] which is February 10th, I shared with my senior team, you know, that it was a privilege to be there, and I'd be happy to do whatever the job required, but if I could have one preference, I'd prefer not to seek out media opportunities. [laughter] And--they didn't know me, you know, and there's an irony, right, so don't [laughing] be careful, I got retribution, I guess or payback because that's what I got in spades, was media opportunities. But I'd been trained through the American Medical Association in my--my career before, so it wasn't because I was unfamiliar with it, it was just that I really wanted to focus on public health, very specifically, helping to support the team, helping to address problems that had been long neglected, and help to unleash their full potential to do good things for people in Kentucky. It was not about for me, getting in front of TV cameras, or talking to public outlets. I wanted other people to have that chance and to showcase their good work and their ability. So--but, I'd had plenty of training before and, and hopefully in some small measure, that came across but, when I started to get relaxed into the role and just get down to doing the work.

Mandy Higgins 8:54 Yeah. I am a Kentuckian, and it did come across. [laughter] So, it is there. Can you tell me about the development of the branding of Team Kentucky and having that as a sort of rallying cry within those early moments of the media and the press conferences?

Dr. Stack 9:14 Yeah, so one of the--the great joys and privileges of what I get to do is, I get to be an advisor to the governor and his team. One of the other things is, I am but one advisor. So, I can take no credit for and actually don't know, the origin story for Team Kentucky, specifically, but I certainly can speak to what it meant to myself and what I observed along the journey. So we said early, early on and the governor of course, one of his catchphrases became very clearly, "we'll get through this, we'll get through this together." But, those words have meaning and they're powerful, particularly when people hear them repeatedly and in a calm, reassuring manner. Because, for a lot of people, for a whole lot of people, this was a very terrifying moment because, we had no idea what was coming. We had no idea how badly people could get hurt, or how many would get hurt, and it felt very disempowering, like there was very little people could do to act.

And I think one of the obligations of people in positions of authority or leadership, is that you have to paint for people a picture of a future that is better, and a path that we can get there, a credible path. What can I do to be part of making that happen? And I think the Governor did a really wonderful job. When he very early on, said, "we'll get through this, we'll get through this together." And I hope, in my own way, people heard me say, repeatedly, my approach was to remind people to be kind and caring to other people, and look out for each other, and be patient with each other and tolerant, you know, as we go through all these difficult times, because a lot of people were hurting. And so, I think in our different ways, we conveyed that similar message. And I think there were two different ways of many, many ways to convey that Team Kentucky concept. And really, it is together, we're stronger, and together, we can achieve more, and I think we showed that.

Mandy Higgins 11:09 Yeah. Can you describe some of your emotions in briefing the state and trying to--to portray that message?

Dr. Stack 11:18 Yeah, and it [sighs] it really was quite the journey, because it--it became very regular. I mean, there were months where we were on television, doing those briefings, so much so that you're well aware, probably yourself or your friends and family had bourbon or beer with Beshear at five, right? So--so it became the thing for people to do when they couldn't do all their other activities. And along the way, one of the things that was quite the experience for me, because I never expected to lose my anonymity by--when I took this job. How many health commissioners can you name before Steve Stack, right? So there's-- [laughter]

Mandy Higgins 11:58 Zero.

Dr. Stack 11:58 Yeah, [laughter] it's--not a--it's not a job that--that generally has very high public visibility. That's what I sort of thought I was signing up for, and it became exactly the opposite of that. And so, I have a whole Tupperware container full of handwritten notes from people all over the state, the governor gets a lot more mail than I do. But, I also got--people sent me, you know, things like rosaries and notecards, people noticed that I would bring a blue notebook sometimes to the press conferences, as a way to jot my notes down, and one person noticed that I was almost out of my notebook. And so, he had a very nicely leather-bound notebook that he had written his name in the front, he erased his name out. And he said he had--hadn't started using this one yet, but saw that I was almost out and thought I would need it more. So I had all these little unexpected acts of kindness. And so--but the other thing was, people saw when [clears throat] I got tired or exhausted, and you could see the frustration, hopefully--that hopefully those things bottled up and maintained in a professional way. But, I think we need more people who are willing to--to allow some of the difficulties and some of the strains to show, in order for others to know that that's normal, that that's okay. It's okay, that things are hard, and it's okay to admit that they're hard. And I think we did that, while hopefully also being able to convey calm confidence, and that we weren't powerless to--to influence the world as we saw it.

Mandy Higgins 12:46 Yeah. I vividly remember the day that you cried behind the podium.

Dr. Stack 13:34 Yeah.

Mandy Higgins 13:34 Do you mind talking a little bit about that?

Dr. Stack 13:36 No--no, I, well, it's never--it's not been my strong suit about not having emotional moments, unfortunately. You can tell though, and this is what gets scary, is because it's scary in a vulnerable way. People could start to understand you in ways that you wouldn't have expected for strangers around the state. So, I tend to get emotional, in moments of people really rising to the challenge and being at their best. Moments where people had the unexpected calamities that--that strike them. I mean, there's just fundamental human sadnesses that sort of happen, and I think you saw that at times. I also wanted people to understand because, we all perceive the world differently. This was never about trying to save every single person, because that's--that's an impossible goal. There were really, really big uncertainties and really scary things that could have happened, and some that did, and there's over 16,000 Kentuckians who have died due to COVID, as we sit and talk here now. That's substantial, and there are thousands of additional people who have passed from COVID, who when you look at our historical death rates for the state, are additional deaths above and beyond what our normal baseline mortality rate is. So, COVID has really hit a lot of families hard in the state and those are just the people who have died, think about all the people who got sick, who missed weeks or months from work and the people who had the long illness that are still--we're still learning about.

So, when I would get up there and communicate, you wanted to try to convey, at least I wanted to try to convey to people, that we were aware that there were difficult trade offs, people's businesses were hurting, it's very hard to run a business, when you have to all be six feet apart inside of it, I appreciate that. That--the flip side, though, was that in the early days, there was a very, very real incredible risk, that as much to one, as much as one to two percent of an entire population, could die if the disease just ran unchecked through it. If you use those numbers, I told you, we have over 16,000 deaths, you're talking 45,000 to 90,000 potential deaths. And those were credible numbers, based on what we knew at the time, and as our evolution of our knowledge and learning improved, is we got--finally access to masks as we finally had access to testing, as we eventually had access to vaccines, and other treatments. And then there was more immunity in the population and the virus finally became a little less dangerous. But that circumstance changed, but in the early days, none of that was true. And so we had to find a way to try to convey to the public why it was serious, and why these other sacrifices were necessary from so many people. And--and I only--and I would give us incomplete success on that, because it's really never possible to fully get through. But from what I get, I still get people come up to me, you know, strangers in public, and say thank you, it appears that we managed to get through to quite a few people. You don't have to know the answers all the time, but you should at least be able to be honest with folks and be straight, and not scare the heck out of them at the same time--so that they don't feel like they are completely powerless to try to chart a course that leads them to safety.

Mandy Higgins 17:02 You mentioned you didn't expect to lose your anonymity, what's it like to be a minor celebrity in Kentucky? [laughter]

Dr. Stack 17:10 It's like, I don't know, I should be careful who I use as comparators, but it's like being Bill Nye the Science Guy [laughter] in Kentucky, right? So, it is really--is really a privilege, but it's also really different. So, now I can go out to restaurants, and I'm very grateful for that. I said earlier on, I mean, the hospitality industry really took it hard, because of the social distancing that was required for the earlier part of the pandemic. I love traveling, I love going out to restaurants there are restaurants where we are regulars and people know us there. So, that was particularly painful to--to have to take steps that we knew were very, very difficult for--for an industry that we had long supported and enjoyed. Now, I go into restaurants and I get hands-down, people who come up and say thank you and have unexpectedly, you know, paid for a part of the dinner, and usually they do that and they leave. And then the waitress says, "hey, that couple that was sitting back there, picked up this part of the thing and just said to tell you they said thank you." And so, those kinds of random acts of generosity mean a lot.

And those were the kinds of things as you can tell now, as I get--where I would get emotional at those press conferences, is where it was really, really hard. But, people could understand it was hard, and understand that sometimes we just get dealt a hand we don't wanna play but, our choice is to play the hand or to walk away and walking away was just not an option. So, as I go around now, I will tell you, overwhelmingly people come up and say thank you, I get caught off guard at the grocery store, at Target, if I go to restaurants, like I've said. Now, if I leave the state of Kentucky, I'm gloriouslty [laughter], no one knows who the heck I am, and they don't care. But, I've traveled a lot now through Kentucky, I've been to half the counties, and fifty-one of the sixty-one health departments, and so, that's all over the state, and I have yet to find a place, where if I walk into a public place, someone doesn't recognize me. And more often than not, it's my voice, [laughter] that gives it away. So, this happened yesterday, I was at an event, and I don't think the individual recognized me and then they said something and I responded. And then he said, "where do I know you from?" My voice--apparently because of all the TV and radio, people really recognize that.

Mandy Higgins 19:30 Umhmm. How did that change affect your family?

Dr. Stack 19:37 Yeah, so one of the things, I generally don't bring my family up all that much because, this is a journey that I'm grateful that they support me for, but it's also a journey that is uniquely something I do. --They've always been supportive, my wife knew who she married and I'm very grateful to her because she's known that for a career. I mean, when I was the president, the American Medical Association, I traveled about 180 days a year for a couple years, outside of the state and then came back and worked in the emergency department when I wasn't doing that. So, there were quite a lot--a long stretch where I was away doing work. My daughter is--who's turned into a wonderful young adult, has been wonderful about this. And so, we have quality time in other ways, but a lot of times I wasn't present, because I was traveling. Well, when I got this job, at least I was home in my own bed every night. So, I didn't go anywhere outside the state for two years or more. But, I was seldom home because, I came to the office before the sun came up and left after the sun went down usually. So, they were very, very long days, and it required them to get used to that. But then again, it was a time when everyone in society was going through so much change and difficulty. So, I think that probably helped in a weird way with us. Because everyone was having their life upended in so what--whatever we were experiencing was hardly exceptional, compared to what other people had to go through.

Mandy Higgins 21:09 How did--what were the reactions to masking and mask wearing? Did they catch you off guard--how did that start?

Dr. Stack 21:20 So, I've said this at press conferences, you know, I love reading history. So, I studied Latin and Greek, you know, in high school and in college, and I read history books for fun. And so, parts of it weren't a shock at all. I mean, history may not repeat, but it certainly does rhyme, and this all happened in the 1918 influenza pandemic. People argued over whether they should wear masks or not, you can see pictures of people in cotton masks. People argued about shutting down businesses and argued about what effort--what interventions were appropriate or not. There was very little about the human behavior of this, that was a surprise. So, that's why messaging is so important early on, as you need to try to get people to see that we--we will either all hang together, or we're all hanging separately. And it'll be worse if we hang separately. So, it's better if we bind together and share a common purpose. I think that that became unfortunately more difficult more quickly than it needed to, because there was obviously other politicization that went on, and that's an unfortunate consequen--that's an unfortunate reality. But if you read Shakespeare, if you read Homer, I mean, this is stuff that humanity has been doing for a very, very long time. So I don't think that was a surprise. It's just--the fact that it's not a surprise, doesn't make it disappointing--each novel time that happens.

But we did, I think, fairly well in Kentucky. And I will tell you, I had the opportunity over that long journey to interact with college and university presidents, with all the health department leaders, with CEOs and chief medical officers and other leaders at all the hospitals across the state. At times with judge executives and mayors, emergency response professionals from across the state and a whole--I have a wonderful deputy commissioner, who has--did a lot of the work with the K through 12 community, but I would periodically appear to talk with the school superintendents. We talked with just about every stripe of society. And I just want people to know we--I can't really recall a time when anyone ever made it a democrat or republican issue. Very, very rarely did the rural or urban issue came [come] up. And usually when it did, it was understandable, it was just the difficulty of scarcity, and everybody wasn't getting enough, but then, people tend to view it from their own lens. And so, is it somehow I'm being disadvantaged because I'm in this setting versus that. But, my memories overwhelmingly and--just solidly are of people coming together, trying to deal with difficult problems and people pulled together. And so, I think we showed in Kentucky, that even in--our states' is politically divided as anyone out there, that even in that--setting and situation, you can get people to come together, if you can help frame it in a way that helps people to have a safe way and a safe space to work together and overcome things that are otherwise pretty minor.

Mandy Higgins 24:32 You mentioned that people would send you gifts and things. Did that start after the push for folks to make cotton masks or did that start immediately?

Dr. Stack 24:42 I don't remember exactly when it started, but--it certainly started at least a few weeks after those press conferences really got going. So, I don't remember when they--when the governor flipped over to the daily briefings. I know we did daily and then at some point, it clearly just became daily and stayed daily for a while. But, it was once that really hit a cadence, that then people started writing and communicating, and sometimes they'd send a letter to the governor's office who'd pass it on to me, sometimes they'd send it to me at the public health office. But, and again, the gifts were usually things that were handmade or that were thoughtful, you know, from them. I got rosaries, people sent me--this was on TV, on--one day I showed up, I hadn't worn a tie to work, and someone mailed me a wooden bow tie. And they--that they had made in their shop, and I wore that to the press conference. And I gave a shout out, it's the closest I'll ever come to being like Oprah, [laughter] where and they had people calling and ordering, they were donating a portion of their proceeds to support health care workers, and first responders. And so, I wore that at the press conference. And I think someone said in the shop, they had a sign that said something along the lines as--seen--"worn by Dr. Stack on TV." So, those things were nice, because I think, people could feel that there was a connection. And the governor, you know, as he had caught, well, it was a cup. He always had a cup of water up there, because these conferences would go on for like an hour, so he'd have some water with him, and then, people started sending him cups. So, the cup started to change on a regular basis, and someone machined one of those cups for me, you know, too. So, most of these things are nicely adorning my office, where people when they come in can see them. But they were--it was more of the thought that--that really counted, and the sentiments that they wrote in their notes.

Mandy Higgins 26:39 Yeah, can you talk a little bit about--you--and it can be big picture, but what those sentiments were that folks were sharing with you?

Dr. Stack 26:44 Yeah, so overwhelmingly, and you know, ninety-eight percent plus, were gratitude, appreciation. When you asked about losing my anonymity, when people would say, "you looked tired at that last press conference, I hope you're taking time to get yourself some rest and stuff," you know, and they were right. And--so, that's a little freaky, when people start to get to know you, in a way, and they're actually right, or--and I was like, "did I look that bad?" [laughter] And I didn't realize I looked that bad that day. So it's a real--it's a real weird, weird journey, when that happens. There were the occasional, and there really weren't many, but there was the occasional note where someone raised a concern or expressed a frustration. Now earlier on, I was so busy with the work I didn't, I just didn't have anything left to be able to write back to all these people. But, as things went on, and we got some stability in some of our approach to some of the bigger problems, then I would try to start to write back. And so, there are--should be quite a few people around the state who have a notecard where I wrote back and at least thanked them for reaching out to me, and I don't have anyone doing that for me. So, when they were handwritten by me, they were handwritten by me. So--it was nice to be able to do that, and then I occasionally got some recurring writers. One person who's associated with a high school where my daughter goes, I got, pretty much every other week, I got a notecard from--from that individual. And there's another one who wrote me, and I recognized the name, so I wrote back, it was nice, it's nice to hear from you again. And so now that person writes me on a regular, periodic basis. So, you know, for some of those individuals, hopefully that has been--had meaning for them. It's certainly--is helpful to people doing jobs like I was doing and am doing, because it helps you know, you've connected and that people see some value and in some way, it helped them to get through a hard time.

Yeah. Can--you brought a gift today, can you describe--

I did.

Mandy Higgins 28:33 --it for us?

Dr. Stack 28:34 So one of the things you had mentioned, before I came here, was that the--the quilt makers and so, the quilt makers sent and I believe the governor has one that's similar to this, but um, yeah, so I brought this notecard. So, the quilt makers made a quilt, which you showed me here earlier, and was available for display, and it kind of captured the COVID journey. And then, they had some leftover quilt squares, and they made teddy bears out of it. And so, they sent me this teddy bear and on--the teddy bears' hanging a mask that I could take off and wear, that has the governor's hallmark phrase, "we'll get through this. We'll get through this together." And then the--the teddy bears' wearing its own mask and a bow tie. One little side story about that, do you associate me with a bow tie?

Mandy Higgins 29:19 I don't, actually.

Dr. Stack 29:20 Okay, well, that's good. [laughter] So--I didn't wear lots of bow ties, but I was wearing, obviously, we were in suits the first couple weeks at all these press conferences. And my wife's friends commented that I had a number of nice ties. And so, I figured well, if people are noticing my ties, I'll wear a bow tie and see where that goes. So, I wore a bow tie and then that kind of became a hallmark and it's because obviously not a lot of people wore a bow tie. So--so apparently, my American Sign Language sign in the state is Dr. Bow tie, where you cross your fingers in front. So, Virginia [Moore], I think coined, that [laughter] So, I'm Dr. Bow tie. So, if you ever watch a press conference where--where Virginia's signing for me, look up and you'll see when she introduces me, she'll cross your fingers in front of her, her throat like a bow tie, and I'm Dr. Bow tie. So, anyway, back to the--the teddy bear I have here. So, the Kentucky quilt makers group sent me this teddy bear that they call Doc, and she wrote me a nice little note in here and a story about Doc being a healthcare hero. And so, most of these gifts I have in my office here in Frankfort on display. This is one that I've taken home with me and it sits on my bookshelf at home. So, these little things go a long way, and they mean a lot to people who are doing things like I'm doing, so I'm very grateful. So to Regina, and the rest of the group, who--who sent this to me.

Mandy Higgins 30:40 Yeah. You bring--you brought up Virginia. Can you talk a little bit about the importance of having an interpreter and the inclusion that that brought to your all's press conferences?

Dr. Stack 30:49 Yeah. So again, the governor, I think Governor Beshear--this is very noteworthy and praiseworthy for him to do this. It was important for him to make sure that people had access to information and they could know what was going on as best we were able to tell them, and feel the comfort in that knowledge in some way. And so, it was second nature, I can't remember a time where we were there that there wasn't a sign interpreter. In fact, I've never been through this kind of journey before, so I would have assumed that that was more normal than not, and apparently it is not. And so, that was a commitment he has made and maintained throughout the entire journey, so much so that people associated, you know, the the governor and Virginia, and then me. And then of course, there were some others, Kenneth was in there--

Mandy Higgins 31:33 Yeah.

Dr. Stack 31:33 --Which--poor Kenneth got got the rap because he was always the one if there was a technical problem that didn't go out quite right, they'd call him out. But, so it was a--it was quite the journey. But no, Virginia and the rest of her colleagues are always there, and I'm grateful for that. And they're an invaluable part of the team, to make sure that we're reaching and communicating with people who might otherwise have difficulty.

Mandy Higgins 31:57 Yeah. You mentioned highlighting some of these gifts in the briefings, why--well why was that important?

Dr. Stack 32:05 There's a connection to the people that we were trying to serve. And I think what happens over time, is when, well and this is my approach to communication. I--I generally don't like rigid, stilted, set speeches. I Generally what--like to engage with the people I'm talking with. It's harder to engage with people through a camera lens, at a distance, but those things helped to show connection, and they were meaningful to me. So, getting that bow tie was a nice treat. There were--there were two women, I don't remember their names, there were two women who sent me a different bow tie, a real bow tie. And it was a medical one that had like, you know, hypodermic needles on it, and a stethoscope or things like that. I wore that to a press conference one day. But, I think people just wanted to let folks like me know that they were listening, that they were appreciative, that they cared, that they saw that it was a difficult journey, and that meant a lot. And so, when I could show back, that their gifts actually got through because, I think a lot of times, people who would send those notes or, or thoughts of kindness, they might never know if they reach the intended audience and just feel it disappears into a black box.

I think people have frustration, they feel their government's not responsive to them. And nobody listens, and then we create, of course, all of us, the worst possible narrative, that they're all incompetent, they don't care, they don't-- nobody's really listening to us, they're in it for themselves. And, and in some small way, hopefully seeing some of those things, and those--those moments that were not just about the science, but also about the human aspect, help people in a way to--to get a sense that there are a lot of who people care. And a lot of those people are working in their state government, and I get to go out and be this very prominent person telling these stories like I am now. But really, it's all the hundreds, and in fact, there's probably three thousnad or more public health workers throughout the Commonwealth, supporting four and a half million people. It's a small workforce, but it's a--it's a mighty and emp--and powerful workforce. All those people are the--are the real heroes who should be celebrated. So, if in some small way, me getting out and telling these stories, helps people to appreciate no, there's really a lot of good people in your state and local government really working hard trying to make sure we keep you safe and allow you to do what you wanna do to have a full--and healthy and happy life. I think that those connections to the people, when I could show some of those things, hopefully helped to make that more real.

Mandy Higgins 34:39 Yeah. How did your colleagues respond to sort of--?

Dr. Stack 34:40 Which colleagues?

Mandy Higgins 34:42 --Your--public health colleagues respond?

Dr. Stack 34:47 Well, you know, that'd be a good thing to ask some of them. [laughter] I don't, I mean, they'd never seen, I don't think--I mean, none of us had seen something like this. None of us alive, no human being alive has been--because the last time that something this--big like this happened, was 1918. So no, or very few humans, I shouldn't say no human alive, but very few humans alive had been through anything like this. So, I don't know for sure, but I think it did help them. Because, they could see a governor, who had a science advisor at his side, who listened to his science advisor, who empowered his public health advisor to have a meaningful and impactful role, and they could, they could see that we were guided by science, guided by the best evidence we had. And that--when the evidence changed, we got up and said, "hey, things have changed, and here's why. And here's what we have to do in response to the new things we've learned or the new things we understand." And so, I think that helped, really empower them in a way, because they could feel that when they met with me, and we were talking, that if we came up with an agreement or a proposal or something that we felt should be done in the greater good for the state, that there was a pretty good chance that that advice would be able to reach the governor. That the governor would take it, in the context of the broader advice he has to work with, and make the best decision that he could. And so, I think it hopefully helped to have them feel empowered and supported. Then, the governor certainly supported public health. Not every other state was a supporter for public health, as Governor Beshear was here in Kentucky. And I think that made a big difference, and--and we're grateful for it.

Mandy Higgins 36:29 Yeah. In that same vein, can you tell me about the first days of the vaccine being available?

Dr. Stack 36:35 Yeah and I'll--and so first of all, we gotta put this in context. The COVID-19 vaccine, is really a modern medical miracle. I mean, to have a new vaccine developed and available for use in less than twelve months, is heroic. And I can't remember now, it was the mumps vaccine would--before that, was the most rapidly developed vaccine, and it took four or more years, and it could have been substantially longer, but I know it took at least four years. So, that was lightning fast. Now, we were fortunate because, the technology that was used for the mRNA vaccines, apparently was just on the cusp of being ready to be used for other purposes, and this provided the urgency to--to go through that last part of the journey. The stories--and I didn't get to go see these personally, but the story is, at the beginning, of people showing up at vaccine sites and crying, to get vaccinated, just are really heartwarming and heart-wrenching at times, because people were living in fear. I mean, if you were someone who was a senior citizen, you had every legitimate and credible reason to be fearful that this disease could wipe you out.

And so, people probably stayed in--in very intense isolation, trying to avoid exposure. And the vaccine offered the hope that they, in addition to the measures they could take for themselves, that this might give them that protection, and in fact, it has. --The data has been very compelling, about how incredibly protective the vaccines are for mortality and severe illness, and that's held up over time. For me, is [as] the state health official, working with our public health team, in the midst of a lot of difficult things, boy, that was a difficult thing. Because, the vaccine was available in very small quantities at the beginning. It had to be stored in special freezers that could go to--to minus sixty or minus eighty degrees Celsius, which is really cold. Very few places in the state had those freezers, and then the qu--they, for whatever reason, it must have been someone at the factory only had a certain number of bottles a certain size, or the machines were built a certain way because, they got shipped in quantities of 1170 for the one vaccine. You know, like, well if you only are gonna get nine trays of 1170, and they can only be stored in the refrige--or freezers of a really special type. that are not really widely available, it was really hard to distribute those. And so people were frustrated, "well, why can't we get seventy doses here or one hundred doses here." It's because it doesn't divide that way, and so, it was really intense and frustrating in the early months, because people, at the early stages were crying out to have access to the vaccine, and it just wasn't enough to go around. And we couldn't get it everywhere because, there was both so little and it required such extreme storage and handling. And of course, now we've gone the full journey, now we're at the other side--

Mandy Higgins 39:35 Yeah.

Dr. Stack 39:35 We're--if the first twenty percent, were eager, early adopters, who were enraged because they couldn't get the vaccine fast enough, now there's the last twenty or twenty-five percent, who are saying, "you stay away from me. I don't want that." So, but again, that's predictable in human history, too, we've seen this in other--other circumstances. So, it's been quite the journey, but in the beginning, it was very intense for our team because, it was a lot of complex logistics. And we had one vaccine, and the next week, we had the next vaccine, and then a few months later, we had a third vaccine. ---We had to become sort of like complex logistics experts for how to allocate and get distributed, a very scarce resource. And so that--in hindsight, an incredible success to have pulled off what was pulled off nationwide and here in Kentucky. But yeah, it was--it was pretty tiring and difficult.

Mandy Higgins 40:23 Yeah, did you attend any of the mass vaccination sites or any, were you ever in one?

Dr. Stack 40:30 Yeah, so I went to the one at UK, Kroger Field, and I saw a couple others, from a distance. My approach, though, generally was, for quite a while, my life was confined to going between my house and my office or the press room, it was just not a good idea to be out in public. One, so that I didn't get infected and exposed people, but also, it's very important to, to model the behavior you're asking others to do. And so, I didn't want to go out and, and one, ever appear to not be following the guidance we were recommending for others. I also didn't wannna take the chance that someone who might be particularly upset, because everyone is a journalist now with their smartphones, would snake-- take pictures from an awkward angle and it made to look like I was doing something I shouldn't. So, quite frankly, the easiest way to avoid that, was just not to go out in public.

Mandy Higgins 41:25 Yeah.

Dr. Stack 41:25 So, I would have liked to have gone out and done more stuff, but it just wasn't tenable at the time.

Mandy Higgins 41:30 Yeah. What have you learned about Kentuckian and Kentuckians--Kentucky and Kentuckians over this journey?

Dr. Stack 41:39 Well, [sighs]--it saddens me to see just how easily we argue over relatively minor things, and how intensely and passionately, we have conflict with each other, over things that are important, but where we shouldn't have such hostility. Because, when I travel around the state, and I crawl around in a gar--in a car, I mean, I don't fly around to places, I drive around to places. People have just been very kind and very wonderful, and we've gottta find a way as a society, and this is where individuals need to realize that it doesn't feel like it in the moment, but your individual actions have great importance to all of us. Because, how we choose to treat someone, how we choose to interact with someone, whether we choose to listen to people who disagree with us or see the world differently, or whether we just discount them as--is a nut job, or whether we label people. We shouldn't really label people because, once you label people, you start defining me versus them or us versus them, and then you provide-you insert distance.

So, when you don't call someone by their name, or when you don't describe what you're--the actual concept you're talking about, you give it a label or a tag, and then you attack the tag, it distances things. And that makes it easy to become particularly cruel, in a very dangerous and slippery slope, while losing sight of the fact that that would not normally be behavior--we would--that our parents raised us to find acceptable. So, we all have to do better about that, or we're gonna face other consequences for society, that history has also shown us before, and they're not good. So, what I learned, is that there's just a wonderful richness of the culture throughout Kentucky and it's a diversity of culture. If I go to western Kentucky, or central Kentucky or eastern Kentucky in Appalachia, the stories are different. The dialects are different, the traditions are different. There's pride--there's pride in people's culture, in their--their family. There's a desire to feel good about themselves and what their communities represent and who they are, and that's just wonderful to see. We just gotta find a way to focus more stories on some of that wonderfulness, and a little bit less on all the negativity that's out there. Because I mean, that goodness is still there, but we need something to unite us--to focus on that more.

Mandy Higgins 44:12 And last question, I've asked everyone we've interviewed for this series, how are you feeling today? That's June 23rd, '22.

Dr. Stack 44:20 Today, I feel much better. [laughter] I didn't--COVID--COVID was for me, what it was for many others, right? I gained weight, I didn't go to exercise. I--it was stressful, because we were having to make all these decisions and try to address all these problems. It was isolating, I mean, I had the same, I worked with people all the time, but friends that I normally would see at conferences around the country, multiple times a year, or friends that--we would get together for social--we didn't do those social activities. So, it was isolating, and it was hard, and I think we saw--I mean, I have a high school child, you know. So, she was doing home, you know, tele-schooling just like everybody--the other kids had of her age. So, we got to see what that was like. My wife is a practicing physician, you know, so she had to go through with patients the difficulties of navigating the healthcare system, when it was in a weird time. So, those were very, very hard, but when you ask how I am today, I'm much better because I can go out to a restaurant, and see people. I can smile at people. People can see my face and I can see there's, I can still be responsible. I was at a--a service yesterday, remembering someone who passed recently. I could still wear a mask if I needed to, but I could at a distance or make reasonable judgment about when I could take it off. Those things all--all have made it better now, and now I can go back to the gym, and take the weight back off and get back in shape. And so--and I've travelled a little bit more now, because I'm able to and so I feel much better now, right? But, you know, I wouldn't trade the journey. The journey was what it was, and it was a privilege to serve during that time of difficulty and to do something really meaningful. I know today is much better than it was this time last year or a year or two years ago.

Mandy Higgins 46:17 Thank you.

Dr. Stack 46:18 Thanks for the opportunity to be here.

Transcribed by https://otter.ai