This is Vermont edition.

I'm Mikaela LeFrak.

This month marks the five year anniversary of the start of the Covid 19 pandemic.

During the tumult of those early months, Vermonters repeatedly turned to one ma for guidance doctor Mark Levine.

Back when the pandemic struck in March 2020, Doctor Levine was in his third year leading the state's Department of Health.

As health commissioner, he provided guidance on public health concerns like opioid addiction, teen substance use and lead exposure.

Prior to his appointment by Governor Phil Scott, Doctor Levine was a genera internal medicine practitioner in Shelburne and a professor at UVMs Lerner College of Medicine.

With Covid Doctor Levine's job and life transformed.

He was a steadying force through the early days of the lockdown, a conduit of quickly evolving health guidanc and an advocate for the vaccine.

Now, at the end of this mont and his eighth year in the role, Doctor Levine is retiring.

He joins us today to look back on his career and discuss the future of public health in Vermont.

Doctor Levine, welcome to Vermont Edition.

Thanks so muc and always wonderful to be here.

Now, most of your tenure in your role was either during Covid or in this post-pandemic world that we live in now.

So broad one to start with.

But how do you feel about that?

Were you hoping or thinking that your role as health commissioner was going to, be something different than what it was?

Yes and no.

I alway knew there would be emergencies and urgent situations, because that is what public health can be.

But I also know that public health is really looking at the long term because so many of the problems we try to solve, so much of what we're trying to do is prevention.

So we're looking down the road hoping some things don't happen as opposed to do happen.

So it was sort of a mixed bag.

When you haven't had a true pandemic for 100 years, you don't thin it's going to be on your watch?

It's not even in the front of your thoughts.

We had a little experience with H1n1 influenza, back in the early 2000 teens.

But nothing really, you know, had Zika, little things that sort of erupted.

And then flared out and didn't become much of an issue.

So when Covid arose, it was really so unique.

And though I felt a sense of being privileged to be the perso who was commissioner of Health at that point in time, it was also, a very intimidating time because we knew collectively as a public health world that this was something that had never infected human beings before.

And this was kind of novel.

So though we had playbooks for many things, this was a very novel kind of pathogen, affecting the human race.

I want to play a clip for us from one of the very first Covid press conferences back in early March of 2020.

You'll hear Governor Scott' voice first followed by yours, Doctor Levine.

As we face our first case here in Vermont.

It's more important than ever for everyone to do their part by following the simple, common sense steps used to prevent the spread of flu.

With that, I'll now ask Docto Levine to give further details.

Doctor.

Thank you, governor.

Late last night, the State Public Health Laboratory reported to me the presumptive positive test for Covid 19 in a Vermonter.

While this is sad news, it is not unexpected.

You would go on to participat in dozens of press conferences like that.

It's also interesting for me to hear the governor compare Covid 19 to the flu, because at that time, you know, we were like, wash your, wash your hands, and we'll probably be okay.

And things would change so drastically, so quickly.

Do you remember that that first case.

I vividly remember that.

I also remember not dozens, but literally several hundred press conferences.

But more, impressive to me than that first conference was the one we had just 7 or 10 days later, which was announcing to Vermonters who had died of Covid.

That was such a somber event, and it was really a reality test for everyone, not just those in state government and in health, but people in the public.

Because all of a sudden that makes it very real.

Literally within a week or two of having the first case present, you're starting to talk about people who are already having the worst outcome possible.

How did it feel for you to be on the front lines of, of a pandemic that turned out to be so very deadly?

I mean, can you remember wha that level of, of responsibility felt like?

Yeah.

You know, i it felt like it does when you're being somebody's personal physician and you're trying to get a good outcome from whatever is afflicting them and you want to make sure that they have a vibrant, healthy life ahead of them.

And you reminded me of times when I was up in the ICU and there were peopl who were not going to do well.

And you knew they weren't going to do well, and and then they tragically died.

And it was a feeling of, oh, my gosh, this could happen on a population wide basis.

And so really, the the whole goal, we dedicated ourselves to was trying to prevent as many of those tragic outcomes as possible.

And thank goodness, and I say this frequently.

We live in Vermont and people in Vermont, were very responsive to the guidanc we gave throughout the pandemic.

People in Vermont, you know, come to the table, with a sort of ethic of protecting your family, protecting your community, your friends.

This is a state of town meeting day where we have some civic engagement, and everyone sort of says it's my role to sort of be there for everybody.

And that kind of ethic that's present in the population.

When really, really far when it came to our ability to provide appropriate guidance and count on people to actually listen to us and implement at times.

Yeah.

Very, very important.

It wasn't true for many of my colleagues and, state health officials around the country.

And I just really am so thankful that we had what we had because, you know, in the end, Covid, was hard on everybody.

It's hard when we talk about the kind of outcomes we've been discussing here with that.

But even just in terms of impact on people's lives, what they had planned on doing, what they couldn't do because of restrictions because of fear about the virus.

Ultimately, of course, we talk about impacts on our kids and their academic achievement, their social emotional development, etc., etc., etc..

So with all of that sort of at stake, it was really, really important to try to get as much right as possible at a time when not all the facts were available and not all the medica knowledge was established yet.

On that note, I want to play one more clip from one of those early press conferences.

This one was from March 24th, 2020, right when lockdowns were beginning.

Let's listen as we look at the challenges ahead.

Public safety must come first, which is why yesterday I issued the stay at home, stay safe order around the country.

And here in Vermont, we've seen an increasing number of cases which continues to grow.

This is not unexpected.

And while each and every step we've taken is needed, they have been difficult decisions to make.

That was Governor Phil Scott announcing the stay at home orders.

And difficult decisions to say the least.

Some of our listeners might have heard this recent episode of the New York Times podcast, The Daily that came out last week, and it drew into question the effectiveness of stay at home orders.

They discussed this study that found that stay, stay at home orders were 2.5 times longer in blue states than in red ones, but there ended up being no difference in Covid mortality rates until the vaccine appeared.

And one of the people they interviewed in this, in this episode said that lockdowns didn't work because, quote, human beings could not comply with them over the long haul.

And now, of course, it's very easy to to look back with all the hindsight that we have and critique decisions.

But I am curious to hea how you look back on that, that pre vaccine lockdown period.

Yeah.

Well first let me extend my comments I made before about Vermonters.

Yeah.

Being so important to this who did obey everything that we said.

In addition we have other ingredients for success.

We just heard from the governor.

The governor was the governor who said explicitly said, I prioritize public health and public safety.

If I get nothing else right.

I have to do those things right.

We had a leadership team across government sectors, and we had a very strong group of people in our health department that I'm privileged to have worked with all these years.

To really deliver the same message and be honest with people.

But the reality is, people want to look at the pandemic as the pandemic, like it was one event.

And what I try to do when I'm explaining to people is say, it probably was 4 or 5 different epidemics, all with the umbrella of one pandemic.

So when you look at lockdown, lockdown at the time it was done.

And here we're talkin rapid fire decision making over literally a three wee period of time in the beginning of this pandemic.

Lockdow was not something we addressed.

We we, approached, cavalierly and we approached it over a period of time where we made lots of smaller decisions restricting, you know, bars, restricting restaurants, wondering about should we close schools, should we not closed schools?

All of those kinds of decisions that people remember were made over a several week period.

And the penultimate one was stay home, stay safe.

That was appropriate at that point in time.

I agree that, there's a lot of, discussion using the retrospective scope, as we like to say, about how long should that have lasted?

In Vermont, we ended up putting together, I think, very sound policies, like when we closed things, using a data driven and evidence based approach as much as we possibly could, usin transparency and communication and letting people know what we really did know and what we didn' have as much information on yet.

So we were telling them about a decision that, wasn't 100% evidence based because we were all learning about the virus at the same time, but we also basically said we're going to reopen the same way.

So we had a deliberative approach to reopening everything, meaning getting rid of all the restrictions of the lockdown, using data and using, the way the population was performing vis a vis the viru and the outcomes we were seeing.

So, it was very carefully calibrated.

If it went on a little too long.

It was becaus we were being more conservative and wanted to again, as the governor's comments, just revealed, protect public health and public safet to the greatest degree possible.

And that's sort of how that all evolved.

Easy to say.

In time, blue states may have looked different.

Red states, what have you.

We've done some analysis, and I've compared our state to several other states that had Republican governors that had, the priority of those states being keep the economy open and keep the economy vibrant and comparing a lot of economic parameters and public health parameters.

And it turns out that states that did not protect public health to the degree we did, but chose their economy first, actually had very similar outcomes economically to our state, which you may argue delayed things a little bit in terms of how we reopened.

All of the aspects and sectors of society.

We, on the other hand, had incredibly superb public health outcomes.

And some of those other states had devastating public health outcomes.

When you look at the number of people that died, etc..

So we feel pretty comfortable about those early decisions that we made.

I won't argue about duration or things because, again, we had an approach that was dat driven to try to resolve that.

But when people look at the pandemic, they really need to look independently at that great unknown period.

In the beginning, when the susceptibility of the population was high and then when the various mutations came about, whether it would it be the the British variant, the South African, the delta, which wa a particularly severe variant.

And then this long period of time that we actually are still in with Omicron and newer and newer subvariants, but they're all part of the same Omicron stream coming to us at a time when the population's immunity is much better than it was early on.

And when vaccine suddenly plays a very significant role.

Doctor Levine, you came on Vermont Edition, a number of times during the height of the pandemic.

And, you know, in the 2021, 2022 era through these variants that you just listed, you and I have spoken many times and we've welcome listeners, calls and questions and, those calls and questions have, have really ranged in their, in their topics and in the the information that people are relying on around Covid and communicable diseases.

It's really always striking to me, the, the variety of, questions that we get, particularly around Covid.

Was it satisfying in a way, to, to suddenly have everyone be really interested in your line of work or frustrating to suddenly be surrounded by a lot of armchair epidemiologist some of us considered ourselves?

There's a little bit of both, for sure.

It was very satisfying because you need people to be engaged and you need people to be listening.

That there was a frustrating part with some of the armchair epidemiologists.

But the reality is, as I've said, we need to have all those viewpoints on the table and indeed, people think that, you know, what we did in state government, you know, we we knew what we were doing.

We had one decision to make.

We made it and moved on.

Well, no we had a roundtable of people.

This is what government should be, where we have people from all sectors, including health, and we have people with different opinions.

And so when it comes down to should we mandate masks this time, should we mandate vaccines, how do we deliver vaccines when they just arrived and they're scarce?

Who gets them first?

These are not thing where you have one person say, here's what we're doing.

And everybody chimes in and goes, yes, and move on.

We had a lot of vibrant discussions and debates and many, many hours of al hours of the days and weekends really dedicated to tryin to come to the right decision so everyone can have their opinion, in society as well.

And we have to respect that.

But doesn't mean if we've made a different decision we're wrong, they're right or vice versa.

It just means there are many ways to address this, and you have to take many factors into play.

And I have to just add in on when portant aspect of things, even in my own public health circles, there were varieties of opinions.

And if you want to do things purely by public health teaching, things will be very strict most of the time, and that may help everybody, but there may be some casualties along the way in terms of what happens.

That was unanticipated.

So when we were making decisions, I like to use the term pragmatic public health or applied public health.

We were using important publi health teaching and knowledge, but we were also trying to say, what else have we got to pay attention to right now?

And there were points in time where it was more important to pay attention to the overall mental health of our population, to what was going on in schools with kids, to what was going on with substance use, to what was going on in terms of other physical factors and chronic diseases that were spiraling out of control or people's own lifestyle behaviors.

And suddenly you couldn't be just by the book.

You had to actually integrate in thinking about what's going on in the state of Vermont and our Vermonters.

And sometimes you back off on something that you might have been full steam ahead on earlier in the pandemic, because it's the right thing to do at that time, because you have to counterbalance all these other factors.

We're speaking with doctor Mar Levine ahead of his retirement as Vermont's health commissioner.

Jeff from Putney wrote in to say that there are nurse practitione and director of health services at Landmark College in Putney.

Early on in the Covid pandemic, a group of health care providers met with Doctor Levine to discuss the emerging health crisis.

This working group was a lifeline for me and other clinicians who often felt isolated while the world was shut down and slowly reopening.

I'm so grateful to Doctor Levine for his acumen of infectious diseases, his warmness, and especially his humor.

It helped guide me and my team to do the important work of keeping Vermont college students healthy.

We also got an email from Julie, who writes, Doctor Levine has an amazing voice.

It's calming, courteous, and kind.

His explanations are understandable and said without judgment.

He should do a podcast, I would listen.

Thank you for all your dedication to Vermont and its people.

What do you think, Doctor Levine?

The Retirement Podcast has added the cards.

Wasn't the first thing on my list, bu I could always entertain that.

And I do appreciate those those warm comments.

And I'll say hi to Jeff because I see him on my zoom screen right now just thinking about those conversations.

He illustrates an important poin that we had so many convenings.

We had convenings of physicians.

We had convenings of health care administrators.

We had convening of pediatricians and the school community.

We had the higher education community, All the colleges in Vermont represented, sharing their own experiences and working with us to try to create the best protocols for whatever they needed, whether it was testing vaccination, how to get kids back on campus and in classrooms again.

Our guest today is doctor Mark Levine, Vermont's health commissioner.

He's retiring at the end of this month after eight years at the helm of the state's Department of Health.

He led his department through the Covid 19 pandemic and other ongoing health crises including the opioid epidemic.

What role does the health department play in your life?

What do you expect of a person in this role?

Give us a call at 863 92211, or send an email to Vermon Edition at Vermont public.org.

We have Amy in Cabot on the line.

Amy, thanks for your patience.

Go ahead.

Yes.

Thank you.

And congratulations, Doctor Levine on your retirement.

I'm Amy horn blasts, and I've been trying to get a hold of you for a while for five years now, actually.

I'm director of Vermont Stands Up, an organization representing Vermonters who feel tha we need to have a thorough cost benefit analysis of Vermont's Covid response.

So, as you can imagine, this conversation is just thrilling me.

Really?

As you see, many folks, when they experienced those Covid lockdowns and health measures, their experiences were not necessarily all positive.

And there are many harms that we can look at, right?

That we should definitely be weighing in the evaluation and following the trends of, but if we just want to look at the tip of the iceberg at the Vermont Department of Health's vita statistics reports over the past five years, they're available through, I believe, 2023.

And you can find them on the Vermont.

I'm sorry.

I mean, I'll just ask you to to ask a question to Doctor Levine.

Yeah.

Yes.

So when we compare the death statistics over time we see that in 2020, there were there was a dramatic increase in deaths.

Very dramatic.

You can see it in the chart, you know, 505 more deaths than usual.

And that than the year before.

And only 144 of those were attributed to Covid.

You know, so so we know those those measures, you know, could cause a lot of other effects.

But then in 2021, it continued with another 419 deaths, which brings us up to over 900 extra deaths.

And in 2022, it continued to rise by 92 more deaths.

And so, you know, I'm just curious, you know, and these Vermont deaths continue to rise while you can see that the U.S. average has dropped.

And let me I' Amy, I'm just going to jump in to, like, Doctor Levine can respond.

I think we we understand th gist of of your concerns there.

And a request for more information about the statistics from those early days of the pandemic.

Doctor Levine yeah.

So we actually have an interest in just that topic and looking at death to see how different or similar they were, compared to other times.

And though there is a lot of, contribution from chronic disease in those deaths, and if you look at the most susceptible to death, it was alway people who were older and people who had significant, what we call comorbidities, other diseases that were present.

So the analysis, we have actually done some we actually don't have enough deaths to to make everything statistically sound as we'd like to, compared to looking at the population of a whole country versus the state.

Oh, because.

Vermont's population is so, so.

Small.

Okay.

But the reality is, in the continental US, the death rate from Covid in Vermont was the lowest, of any other state.

Which is an important thing to go by.

And regarding my previous comments, the cost benefit analysis not only looks at, the cost of these, these, interventions on.

Do you live or do you not live, but it's also, economic indicators.

It's also academi and school age kid indicators.

And it's also the indicators about other diseases that got exacerbated.

So there's a whole host of factor that have to be weighed in this.

And it's a pretty complex analysis, actually.

But I would still submit that as lockdowns go down and as the harsher aspect of dealing with the pandemic go.

Vermont was not, an outlie having, such an extraordinarily long period of time that it didn't pay off.

We believe it wa the appropriate amount of time.

Well thank you, Amy, for calling in.

And I hope you can connect more in depth with the Department of Health in the future as well.

I want to shift us a bit, doctor Levine.

From the the Covid pandemic, which I'm sure we will, will come up again but towards the opioid epidemic, which has been going on long before you stepped into this role and unfortunately will continue long after.

Listener Tim Leslie asks, do you consider opioid use intervention as urgent an issue as Covid 19 was?

Oh, always.

Yeah.

Yes, absolutely.

When there are people that are dying from something that might be preventable.

That raises it on the urgency scale.

Clearly, the good news is that we are having decreasing rate of deaths from unintentional overdose from opioids.

Can we can I add some data there?

In 2023, around 23 people died from drug overdoses in Vermont.

And preliminary data from last year shows that that number dropped to 170 between January and November 2024.

But the the health departmen hasn't released final statistics for 2020.

Still some cases that are pending.

Yes, but but it will be less guarantee and probably less than the three year average as well, which is important.

A whole host of factors responsible for that.

Vermont isn't the only state, though.

Not every state is having that decrease.

But it's not the only state.

So a lot of people are chiming in about what are the possible reasons for that.

I big, strong one, of course, is what I've called flooding the streets with Narcan with the reversal drug that can help save a life.

There's a lot of intervention in what we call harm reduction.

That try to keep people safer.

All of our years during the pandemic, especially when we look at who died from an opioid overdose, it was always people, not always, but predominantly people who were at home and were alone.

So they had no one there to rescue them.

Should they have an adverse outcome from fentanyl, which of course is in everything nowadays.

I do think people ar looking out for each other more.

Part of this, unfortunately, is because many people are more publicly using drugs and they're perhaps having housing insecurity and hence in small communities of their own that, they see each other, but they actually are telling us they look out for each other more and they have Narca just like everybody else does.

And I think that factor is a huge contributor.

Others have said, well, maybe the fentanyl isn't as strong, or maybe they're not.

You know, th the illicit drug dealers aren't giving us the same stuff they used to.

It doesn't seem like that's playing a huge role.

But there could be a very multifactorial set of reasons why.

And, you know, we're talking about fatality rates here as a measure of the, the opioid epidemic.

But, you know, we don't have a number of how many people are out addicted to opioids and using them, even if they are surviving.

We think tha number's probably pretty stable.

Yeah, but still could be lower.

Obviously, other numbers are how many people are actually in treatment, and is treatment available to people who want treatment?

And we have a great treatment system in Vermont.

You know, the hub and spoke system.

It has a lot of people who have successfully gone through it.

We're analyzing our greater treatment system, for those who are more needed, more intense environment, an inpatient environment.

We're looking at the residential treatment system and trying to really, fill any gaps there that might be, available to help improve care as well.

Governor Phil Scott has yet to appoint your successor in this role, but when he does, what is your advice to that person when it comes specifically to dealing to addressing the opioid epidemic?

Yeah.

So, my advice is to always be poised, on the side of being innovative, coming up with novel strategies, being creative because the, illici dealers will be one step ahead.

You're always going to have to try to, match what they are doing with good strategies.

We need to continue to work on the prevention side from adolescence on.

And we have lots of good programing in this state.

In prevention coalitions around the state, in school based programing and in after school programing, which is probably the most important.

Giving young people a feeling, that they have value to their community.

Giving young people options t doing things like experimenting.

By having better activities that they contribute to.

That they've had a voice in.

I think those are very important.

I think continuing to, use opioid settlement moneys in creative ways, because there will be more opioid settlement money coming into the state.

And, again, making sure any gaps in our treatment system are satisfied, work even more intensively in harm reduction and in recovery.

Because recovery isn't just I'm not using drugs anymore.

Recovery is I have a roof over my head, I can eat, I have transportation so I can get to a job.

I've had workforce training if I needed it to get back into the workforce.

All of those supports, and those are the things we're working on right now to try to really, enhance because recovery is more than just abstinence from a drug.

It's reall what kind of life can I lead now and get back that I didn't have because of drugs?

Well, as we look to the future, Doctor Levine, we got a question, from Allen.

Who is wondering if the stat during the Covid pandemic ever reached a point where people who needed a respirator couldn't get one because of shortages?

And if so, how do we prepar for future respiratory illness outbreaks and deal with supply chain problems in general?

What are the takeaways from the pandemic for the future?

You know, that was such a, a critical point in time when we said, oh my gosh, the ICUs will be full.

People will need to be on respirators.

We had a whole bunch of Vermont entrepreneurs working on very small model respirators, that they could try t manufacture quickly and deploy.

Turned out the need wasn't there so much.

First of all, we protected the population for such a long time that, we didn't have as many acutely ill people filling the, hospitals and intensive care units.

We also learned in the care of patients, we meaning health in general around the country how to manage people better so that they might not get to the point of needing to be put on a ventilator.

There are lots of noninvasiv and drug means to try to work on people to, prevent you from getting to that point in your course.

That's not severe.

So, the thing we learned is we can quickly energize and activate a whole bunch of technical and entrepreneurial, resources in Vermont.

And it seemed like we could turn that on, as quickly as we needed t so that it would became a need.

We had it just like when we tried to deal with.

How do we test for Covid?

How do we have enough supplies to test for Covid?

How do we, increase our workforce for contact tracing?

How do we deploy the vaccine and get it into as many arms as quickly as possible?

We had cross-sector help all across Vermont volunteers, EMS services.

We had, retired medical people.

Everybody pitched in.

And if it came to that point again, I have no doubt that we would have the same, really vibrant response from our workforce and from our our public.

If you're just joining us our guest today is doctor Mark Levine.

He is retiring at the end of this month after leading Vermont's health department.

And in many ways, the stat through the Covid 19 pandemic.

Prio to becoming health commissioner, he was a UVM Medical School professor and had his own general internal medicine practice.

We got an email from Kare in Morristown who writes, Doctor Levine was such a steadying, comforting voice during the pandemic shutdown.

Once I saw hi in the state House and I said, oh, Doctor Levine, it's so good to see you.

As I walked by that, I thought, he has no idea who I am.

So I went back and said, I just feel like you have been in my living room these past years.

And he graciously responded, I understand.

We are privileged to have him as health commissioner.

All that time.

I'm sure you get that a lot.

Doctor Levine, people say I feel like I know you and you maybe say, I probably talk to you more than I talk to my own family.

I continue to hear it to this day, actually.

And, being out in public can be a challenge.

But I do.

Quite tall, so think people can.

Start to hide.

Even in the time of masking, it was hard to hide.

But I do always want to say what I will say to you.

That, nothing that I did could have been done without the work forc I have in the health department.

And without the work force we have in state government, and with the governor being who he was.

Well, let's take another call.

Here we have Roberta in then on the line.

Roberta, go ahead.

Thank you very much.

And thank you, Doctor Levine.

Everything you have done fo we Vermonters, despite the CDC approval and recommendation 65 and up, cannot get a second dose or booster of this season' Covid vaccine because Medicare cannot pay for it until the FDA approves it, which it hasn't and doesn't seem likely to occur soon.

My sources are both my pharmacy and a human employee at Medicare who had to put me on hold to to check on this.

I've reached out elsewhere.

The only result so far is playing phone tag with Senator Sanders office.

My thinking is that perhaps the best route to rectify this as quickly as possible might be for Attorney General charity clerk to spearhead a lawsuit with other ages.

Roberta, I'm going to jump in here and, I hear you.

And I know Charity clerk has, been filing many lawsuits against the Trump administration right now.

I'm sure there are more to come.

I don't know the specifics.

I don't know if you do, Doctor Levine of this the approval of another booster.

But I hear Roberta's larger concern about, public health in this time when so, so much regarding the federal government and its funding is, is shifting.

Absolutely.

So one thing that she needs to understand that we're trying to do in Vermont, we have a tremendous vaccine program in Vermont.

Vermont, vaccine purchasing program, that purchases vaccines for children and for adults up to the age of 64.

And it's been a very, very successful program.

All of the providers around the state are delighted, delighted with it.

We save a lot of money.

We have all the vaccines we need for people's vaccination needs.

One thing we're trying to accomplish right now as we speak, is making sure that people in Medicare who are 65 and older, also can benefit from a program like the one I've described.

So you're going to hear more and more about that in future months, about how our approach is trying to improve on that.

And that should potentially help the problem that you've, presented to us.

So public health agencies, though, are rushing to comply with a number of vague directives from the Trum administration in recent weeks.

And federal funding for medical research at universities and the National Institutes o Health, DNA, each has been cut.

What does it feel like to to step away at this, this uncertain tim in the world of public health?

It's a very challenging time in public health.

Yeah.

I don't want people to equate the timing of my stepping away with.

I won't have to deal with this now.

Because it was coincidental, unfortunately.

You've done your time.

You tried your time.

No, I understand.

But the reality is, I am very concerned.

I have a lot of reason to feel very optimistic about the future for public health, but I'm also very concerned, based on who's been appointe to various leadership positions.

The fact that there are a number of leadership positions, like head of the CDC, head of the FDA, etc., that are still not appointed totally.

And we don't really hav clarity of direction from them.

But we have seen literally a barrage of executive orders and, decisions that have been made, not the latest of which was I think, in the last day or so regarding the office that manages long Covid.

That was a significant initiative from the office of the assistant of the Secretary of Health, who was a close friend of min in the previous administration.

And, that program is critical.

Many Americans who still have long Covid are counting on all of the work that comes out of offices like that.

And that office is now being closed.

So those kinds of things concern me to some degree.

We had CDC unable to communicate with the public health community for a short period of time.

I'm happy to announce that has really improved now.

And they're able to make some publications.

We have pretty clear lines of communication, as we've always had with them.

So something major happens here or around the world where we're kind of tuned in.

But these are appropriate concerns that everyone has, and we are only in the beginning, so we don't really know where they're going.

Especially without leadershi of all these different agencies.

We have a caller named Mike, I think has a question on this topic, Mike in Danville.

Go ahead.

Yeah.

Hi.

Doctor Lane as Doctor Levine.

Mike Bruce, I'm a former chief medical officer at Northeastern Vermont Regional Hospital, and we spoke many times during the pandemic.

Hi, Mike.

And.

Hi.

And, you know, you already kind of addressed my question a little bit.

I'm really concerned about, you know, where we're at as far as, trust in public health.

The public's, feeling about all the public health measures past, present and future.

And where do we go from here?

And how do we get back on track?

Yes.

So it's trust in public health as a subset of trust in science in general.

And there's a lot of science denial just like there's vaccine denial etc.

going on.

Many felt that what we call public health authority, the ability of public health to do things.

Usually we're in the background, but during a pandemic, peopl saw us more in the foreground.

So public health authority in many states was challenged.

People talking about lockdowns and their freedom, etc.. We are, of course, in Vermont, as I've pointed out during the call had a little different approach.

And we're abl to do everything, by and large, with the cooperation of our entire population.

And much less on the denial side of things.

This is a challenge because, you know, if at the very top of leadership in the country, we see elements of denial of science, denial of sound evidence that vaccines work and that vaccine harm is not autism or other things like that.

You're referring, I think, to to Robert.

Kennedy and and his boss.

You know, these are these are concerning things because this is what, is leading the country now and setting the tone.

So it's it's a real challenging time.

Will it have some silver linings?

Well, if what RFK says about chronic disease and our food supply, gets supported with policies and funding, maybe will actually impact the rate of chronic disease, which is the biggest category that takes up all our health care dollars at this point in time.

So there could be good things that come of that, but we don't want to see casualties along the way in terms of sound public health practice being questioned.

So again just like during the pandemic, transparency and communication, being honest about what you know, and what you don't know, why you made a decision, why a decision may be under question.

These are all important characteristics that we exhibited here in Vermont, and that I think nationwide.

People need to really start exhibiting more of, because in public health, you want to be credible and you want to be right, and you want to do things at the right time.

And, we need to see modeling of that at the federal level.

Otherwise it's going to be every state to themselves.

Doctor Levine, you, served in this role of health commissioner for eight years.

But prior to that, you ha a long and multifaceted career.

What do you hope your legacy as a doctor will be?

Well, my legacy as a doctor, I think there's a little bit of, a fork on one side of the fork is three plus decades of taking care of people.

Working one on one, whether there was in the exam room, whether it was in the hospital setting.

And the impact I had on their health and the way I communicated with them about their health and tried to achieve goo outcomes and prevention, etc.. And then on the other part of the fork is this new world for me.

I sa new it's been eight years now, but the world of population health, where I went from one on one with several thousand patients at a time to now 600 plus thousand patients, all of whom live in Vermont.

And, for better or worse, I hope I've ha very favorable impacts on them, not just in the pandemic, of course, but in all the other arenas that were involved in, in public health and across state government.

What are yo going to do in your retirement?

Nothing for a short time.

You know, there's a bit of guilt about time with family and spending more time with family.

Guilt in that you haven't been able to.

Haven't been able to do as much.

You know, my my granddaughter, who's now five, was born a few months before the pandemic.

I was actually in their home, when she was, like, six months old, on the night that everything hit me and my phone was off the hook, I couldn't even have a proper visit.

That's early March 2020.

Yes.

And thank God I decided to come home right away because I might not have ever got a plane again.

To do that.

And so, of course, the first couple of years of her life, I couldn't be as involved in a direct way because things were happening here.

So more time there for sure.

More travel.

More time to do some of the hobbies and activities I like to do.

And then, there will be time.

I'm fully confident to contribute more in public health, but as I'm fond of saying, and perhaps a more focused an less intense way than I do now.

Well, let me share a couple more emails with you before we have to go.

Nora wrote to us to say that during the pandemic, due to your superior communication skills, I learned so much and felt safer and understood that I could control my situation which in turn kept others safe and dmorris.

And Wilder writes a word of thanks, especially durin the early years of the pandemic.

Doctor Levine's daily reports were an absolute lifeline for me, a calm voice of reaso in the darkness and uncertainty.

I will be forever grateful for his major contributions.

Doctor Levine, what does it feel like to to hear these words?

It's it's it's wonderful.

Thank you so much for that.

In a way, it makes it all worth it.

So certainly I don't need that kind of reinforcement.

The I think the the call to duty for public health is so high and the opportunity and I'll say this to whoever my successor is.

The opportunity to be involved in so many positive things that can have a great impact on people's life and health and ultimately on the state's health.

It's been a real honor and a privilege.

And, they should, take that opportunity and run with it.

Just making sure that they realize there are way more problems to solve than they can handle at one time.

So there will need to be some prioritization.

But they should have fun, because in the end, any job that you're passionate about should, should be fun.

As well as rewarding to, all the people that you want to, help serve.

Well, Doctor Levine, I can't tell you how much fun I have had speaking with you today, and I so appreciate your time over the years on Vermont Edition.

Thank you so much.

It's been great.

Thank you.

Vermont health commissioner, doctor Mark Levine.

That is all the tim that we have for today's show.

It was directed by Mary English and produced by Danielle Cafiero.

Our call screener today was Rick Barrett.

Thank you so much for listening.

And we'll catch up again soon.