Dr. Anne Zink
Former Chief Medical Officer, State of Alaska
A Wary Populace
Alaska comprises a range of cultures and subcultures including 226 federally recognized Alaska Native tribes, religious groups seeking isolation, and others with reasons to distrust authorities. Zink and her team were acutely aware of their state’s diverse population and knew they needed distinct approaches to keep everyone engaged.
“I feel like our sense of society and connectedness is so fragile, and the connective bonds among families, compared with the bonds across states, aren’t the same. Those bonds are stressed by something like a pandemic–people were stressed because their kid couldn’t go to school, or they didn’t have a job. When we, as public health officials, talked about doing things for the ‘greater good,’ that made some people feel like we were not with them. That’s when we saw more and more fracturing begin to occur and a breaking of the bond of trust among people we were serving.”
Hyper, Hyper, Hyper Local
To ensure messages were accepted, Zink recognized they needed to be delivered by locals and for locals. She and her team engaged with community, tribal, and elected leaders as well as local medical professionals. Those conversations helped them identify the most prevalent form of communication in each community—anything from Facebook Live to ham radio to Zoom sessions.
I had to become hyper, hyper, hyper local—to make the messaging as relevant to that person and that community as possible. The more we were able to lean into individual decision-making, that’s where we saw successes throughout the pandemic. Ensuring as much sovereignty as possible for individuals, communities, tribes, and localities was critical to people feeling they had at least some control and could make choices over how they protected themselves.
“As soon as we’d had that first case there and we were working with the hospital, we would say, ‘Can we set up a public information meeting with your community via the media of your choice?’ And we would recommend that I would be there, our epidemiologists would be there, but then their health provider, their tribal leader, their elected leader would also be there. We would run through beforehand who was going to say what. Basically, we would let the local community message about what they were doing and how they were going to respond. We would just message, ‘We’re here to support THEM. These are YOUR decisions. We’re here to give you the information. We’re here to support YOU. These are your decisions. We’re here to give you the information. We’re here to support you.’ That really helps empower local leaders to be the trusted voice.”
Re-Branding Federal Messages
While national strategies were critical, Alaskan communities needed to feel the information was coming from sources they trusted and was directly applicable to them.
We have to have a national message. We have to have a national pandemic plan and CDC has to have your data. But our team focused its messaging on what Alaskans needed – what Alaskans should do. We avoided saying ‘the White House said’ or ‘CDC said.’
Defining Roles, Reaching Compromises
In addition to keeping channels open with local officials, Zink communicated constantly with the governor and other state officials. While they did not always agree, regular communication helped them hash out a unified approach, determine their specific roles, and maintain consistent messaging.
The governor never tried to be the scientist, but he also never asked me to be the governor. The governor said shutting down businesses — that’s on me, I am the governor who declared the disaster declaration — that’s on me. And I think it was really important that we divided those two roles. We always messaged together. I really appreciated that he never said to me what I had to say, what I could say, what I couldn’t say.
“We would have hard discussions offline. When the governor’s chief of staff and I had different opinions, he finally said, okay, you two get on the phone together. The governor just listened and the two of us talked. At the end, the governor understood we had to respond to this pandemic, but also wanted to do everything he could on the back end to support the economy. We worked through conflict.”
The Mask Mandate Conundrum
Although she got pushback from her medical colleagues, Zink came to terms with the governor’s opposition to a mask mandate. Even without a mandate, the state promoted masks’ value in reducing transmission.
Mask mandates were a real tension point in Alaska from the very beginning. The governor was against the idea that the state government mandate was going to have enough of an impact on individual behavior, that it would truly have an impact on the population. And that was a line too far for him. But, he let me speak to it: ‘The mask is going to help you, it’s going to help me.’ He would just say, I don’t think it’s government’s role to tell you how to live your life. Ultimately, I decided that messaging together about the value of masking was more important than a mandate – dividing our messages would have made it even harder to communicate. So that’s what we did at a statewide level.
Making it Personal
Zink found she had the biggest impact when using her own voice and social media platform. As an emergency room physician, she was experienced at rapidly making a personal connection with sick or injured patients, and she drew on those skills to gain trust.
“When things got really heated, there was increasing pressure to release messages that were bland and often not tailored. But I think that that ability to lean into your own social messaging and have your own voice was an important tool for me. And it was important to explain to individuals why these health actions were important.”
“I told people to wear a mask for humility. I’d say, ‘I don’t know if I have COVID. It’s clear that people can spread the disease before symptoms arise. I don’t know if the person near me is battling cancer, cares for an elderly mom, might be fine or may not, and I want my community to thrive, businesses to stay open, employees to stay healthy. Keeping a lid on it helps us all keep a lid on COVID.’ I really tried to message about why it’s about the bigger picture rather than just saying ‘you should wear it.’”
Learning from the Past, Preparing for the Future
Alaska’s experience of the 1918 pandemic provided invaluable lessons for responding to COVID-19.
In Alaska, the impact of the 1918 pandemic can’t be understated. It was this incredible gift to be able to lean into the historical experiences from that pandemic, and those experiences drastically changed the ways in which we were able to respond to COVID-19. The 1918 flu pandemic entered Alaska from fishing and from mail. This time around, we didn’t see a single COVID case that we know of that went from the fishing industry into a rural community despite the fact that it’s the second biggest industry and where we had mass numbers of people moving to areas that were rural, remote with incredibly vulnerable populations.
Zink hopes Alaska will draw enduring lessons from this pandemic, too. Toward that end, Zink said, the state is now using communications channels established through the COVID-19 response to address ongoing health issues, including development of a mental health roadmap
We’re going to communities with listening sessions — really creating a two-way dialogue like we did during the pandemic. The goal is to say what’s working and what’s not working in your community, using local trusted sources, using radio…to bring them into the conversation.
“I think that how we recover out of this pandemic is going to be even more important than how we responded. The stories we tell are going to be fundamental to the way we not only build our structures to think about the next major challenge, but also how we meet our everyday challenges.”