Health
Q&A with health director Clay Goddard
Springfield and Greene County’s health director Clay Goddard has been a familiar face at government meetings and in local media during the COVID-19 pandemic.
Last week, the leader of much of the community’s coronavirus response announced he’d be leaving the health department after 25 years to be the senior director of public health transformation at the Missouri Foundation for Health.
Goddard is still working in Greene County until the end of February, and he hopes to get a large vaccine effort well underway before he goes.
But in the meantime, the News-Leader caught up with him to ask about milestones in his career, the response to COVID-19, the ongoing vaccine effort and what he hopes to accomplish in his new role.
(This interview, which was conducted Thursday, Jan. 14, was edited for length and clarity.)
Q: To start, I thought we’d talk a little bit about your career at the health department. There was a story in the news release announcing your retirement that talked about how you were planning on getting an Air Force commission before you took an internship at the health department. I’m wondering, what was the first experience, or a formative experience that made you realize this was the work you wanted to do?
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A: I love data, and I had developed a real interest in health care because that had been a big part of the national debate while I was working on my bachelor’s and master’s degree. (President Bill) Clinton was talking about a health care plan and there was a lot of heated debate about that, and I became fascinated by health policy. But I just didn’t know what to do with that.
I was looking for an internship … and (the health department) actually had the need for an intern because they were going to do a health assessment. I got ushered in here for an interview, and I met Kevin Gipson (who would later become health director). I’ll never forget it: Kevin brought me into (health director Harold Bengsch’s) office, and there’s that great old lion Harold Bengsch sitting at his desk, and we just had a really good connection. They took a chance and hired me … and the more I learned about what they did here, I found it was different than my previous conception of public health. I was just fascinated by that intersection in public policy and outcomes. It just seemed to be a lot more connected than anything that I had seen before … at a state or federal level. This level of government fascinated me, surprisingly so, and I realized very quickly, I think within a week, that I needed to be in this field. Then I got fortunate that they decided to keep me around permanently.
Then obviously after you got hired, you spent the rest of your career there. And I guess I’m curious, you had a pretty big initial connection to the work, but how has your understanding of public health and how you do your work changed as you’ve gone through it?
Your perspective changes. Initially, you’re right in the middle of very specific projects. My first job here was an HIV/STD epidemiologist, so I was working hands on with clients and doing individual interventions. Then, you take a step out and you’re managing programs, so you’re really focused on people who are doing client interactions and trying to suppress disease outbreaks, break the chain of infections. Then, you take another step out and you’re more at that administrative level, and that’s where you get at the cusp of those policy changes, administering state and federal programs and then passing local ordinances.
Every step out is just a slightly different perspective, and all of them are satisfying in their own way. I really enjoy the bigger policy pieces (like) Tobacco 21, (which raised the age for purchasing tobacco products to 21 years old in Springfield). I was also heavily involved in the local passage of the prescription drug monitoring program, but I think perhaps the most satisfying thing that has happened in 25 years was putting together a really special team of people. It is amazing to work with people that are so capable, so motivated, that are here for the right reasons. Then to see them in the face of a once-in-100-year event rise to the occasion, I just get chills right now, and a little emotional, quite frankly, just thinking about it.
What is the biggest improvement you’ve seen in public health in our area since you started at the department?
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Well, I’m going to just focus on our department. I think it was our effort to go through public health accreditation. … It was hard because we chose to do it right. We really tore the house down to the studs and did a complete remodel. It changed this department fundamentally in how we do business, in how we do evaluation, on how we look at ourselves critically, about how we’re very purposeful in our relationships with other entities, in how we communicate. That, for me, that process from soup to nuts was really the greatest transformative process I’ve been through while here.
Is there a specific example you could give to people that would show that change from a public-facing perspective?
I think Tobacco 21 is a great example of that because we knew we had an issue with teen vaping, but to get that initiative through, we had to demonstrate from a data perspective that we had some problems. We were able to look at tobacco use based on census tract data, which really shows a maturing of our data and analytics that we really built up as a part of the accreditation process. We (also) had to engage members of the Healthy Living Alliance and get their buy-in. So it was really working, identifying a best practice, determining that the data really supported implementation, engaging community partners and then getting that buy-in and bringing it to our elected officials. It’s really how the process is supposed to work.
Before we shift our conversation to COVID, what do you see as Greene County’s biggest health challenge moving forward?
I’m going to encapsulate it in three pieces.
We know that tobacco is the biggest cause of preventable illness in Greene County, so we’re going to have to find a way to reduce tobacco use rates. I’d also like to point out food insecurity. That’s a very, very troubling thing to me. We shouldn’t have kids going to bed at night hungry, and we know that’s a demonstrated problem here in the community and it affects a lot of families people wouldn’t even suspect.
The last thing is a bigger picture thing. It’s something that … if we want to really get upstream as a community and address a lot of issues, there’s a couple of simple things we need to have as our north star. That’s reading at grade level at third grade and kindergarten readiness scores.
The data is pretty clear: if you’re reading at grade level by third grade, your outcomes in 10 or 15 years are going to be much better. You’re much less likely to go to prison, you’re much more likely to graduate from high school, you’re going to end up much more likely to be a productive citizen. We also know that if your socioeconomic status is higher, your health outcomes are higher, so I believe there are some real linkages that are natural there.
And that kindergarten readiness score means that you’re ready to learn when you get into kindergarten. If you’re ready to learn when you get into kindergarten, chances are you’re going to be reading by grade level when you get to third grade. And all of that, to distill it down, goes back to early childhood education. The more kids we can get into preschool, the better.
I guess we can switch gears here to what, if I could predict, will likely define your time at the health department: COVID-19. I remember that first press conference where you announced (a task force to deal with the pandemic) and nobody in the press really had any questions about it. It was such a new thing. And at least to laypeople, I think there was a misconception it might not impact us in the way it did. But I’m sure you knew the potential ramifications of it the whole time. What was your first thought when you heard about the new coronavirus?
It was very concerning. Any time you hear about a novel respiratory syndrome as a public health professional, alarm bells go off. We’ve been through a few of these — MERS, SARS, H1N1 — so you always know there is an opportunity for it to be a non-event or a limited event, but you also know that we’re overdue. So there’s a part of you that rationally wants to say, “Oh, this is not going to be anything,” but there’s also a part of you that knows this could be the next couple of years of your life.
We were talking about it really early on. I think I heard about it in late December from some initial reports out of China. It would’ve been right around the first of the year of 2020, and so that gets you locked in and you start to follow the news and get intelligence. But, of course, the problem was that the country was focused on the (first impeachment trial of President Donald Trump), and so there just was not a lot of chatter in the circles that we needed it to be in.
By the time February gets here, we’re starting to see this thing build, and then you’ve got a couple problems: we’re not seeing a lot of federal or state guidance come out, and we’re starting to realize that we’re kind of in charge of our own destiny here. So we started putting together information with very limited scientific guidance coming out, and, you know, the Chinese aren’t exactly the most forthcoming when it comes to these sorts of things.
And then you have to start figuring out … (how to) get the community to understand this. Really, that was one of the tougher things was figuring out how do you start to message this. When do you start to message this? What if it does turn into a non-event? You don’t want to lose your credibility. There’s a lot of calculations going on.
But really, the elements of an effective response are built off of very simple premises. … You really have to find the key, foundational, pillar issues. And for us, those were testing and containment and (mitigation). Then, you build that on a foundation of data, analytics and education. That was where we started.
Looking back on it, do you think the department was prepared to handle it?
I think we were as ready as anybody. I do think we have some challenges in the field of public health right now. We’ve largely de-invested in public health over the last decade. We’ve been fortunate here (in Greene County) that we’ve got incredible local support… but I don’t know I would say that’s the case across the country or even across the state.
We’ve talked a lot during the last several months about the response. And, in a lot of ways, we’re in a pretty good place with the vaccine coming, but in a lot of other ways we’re in the worst place that we’ve been as a country in terms of new cases and fatalities. How do our current situation and the trajectory of the pandemic compare with the worst-case scenarios that you thought of early on? In other words, is this as bad as you thought it would get?
You always worry the mortality rate is going to be significantly higher, and I think a lot of credit needs to go to our health care providers because even though we’ve lost more lives than I ever wanted to see, they are getting better at treating people. You have to remember, we’re talking about a highly transmissible condition. Respiratory virus is a really great Trojan horse because it starts to become very infectious when you’re pre-symptomatic. To contrast it with something like Ebola, I mean, Ebola gets you really sick in a hurry and it usually burns itself out. This one is really, it’s beguiling in how it can spread so effectively when people are not very sick. I think we’ve done very well locally dealing with it, especially given the nation’s resistance to mitigation strategies.
And that was a question I had, too, about that resistance and all of the misinformation that has emerged. What has it been like, from your perspective, dealing with that and trying to deal with a response when people don’t trust a lot of the information?
It’s really interesting. We seem to have lost faith in subject matter experts, but I will say that I don’t know that that’s necessarily the case in this community. There have been some loud voices, but I think the messages I get behind the scenes from people about what we’re doing far outweigh the negative voices.
I also want to make an observation. A (Centers for Disease Control and Prevention) group was here right before Christmas and they were doing some work on the effectiveness of mitigation in school settings … and while they were here, they sent me a picture that they had gone and taken in front of Great Clips (where two masked symptomatic hairstylists worked on 139 masked clients and nobody else tested positive).
The CDC workers were calling Great Clips the “Broad Street Pump” of COVID (which is a reference to a major scientific breakthrough during a London cholera outbreak in the mid-1800s when a physician named John Snow figured out that germ-contaminated water was the source of infection. His discovery is considered to be one of the foundations of public health). It’s fascinating to me that we were involved in something so significant that helped justify this pivot towards mask use, and it happened right here in little old Springfield, Missouri.
What are a few lessons that we as a state and a country need to learn about dealing with these types of events in the future?
I really am a big believer in local control when you have local issues, but when you have issues of this magnitude, I really think you need to have a solid, prescriptive, national approach that is adopted by the states and is uniformly applied to larger geographies. Now, that doesn’t mean you’d have to have it across the entire state of Missouri, but we’ve got to face the facts: When you’re dealing with something like this, the patchwork approaches are not as effective. And I really do believe that having plans that cover bigger geographies are very important.
And you’ve also talked about public health investment in the past. What needs to improve in our public health infrastructure? Missouri often ranks very low on lists of state public health funding. Is that a piece of it?
It’s a part of it, it’s an easy thing to point out, but I also think money isn’t the solution to everything. I think that we can improve funding, but I think we’re also not very efficient in the way that we’re structured. We’re not always adhering to best practices or to professional standards, and I think there’s great inequity in the public health system across Missouri so that you are not afforded the same level of public health protection if you live in certain places. We’ve got to do a better job of ensuring that we’re meeting minimum standards of public health protection in this state. I cannot confidently tell you that that is currently the case.
I think there are a lot of opportunities here. I think COVID has laid a lot of the cracks in the foundation bare. But I’m confident that we can take it on as a vocation, and I’ll be honest with you, getting better is a lot of fun. I love improving things, and I look forward to being a part of a process (at the Missouri Foundation for Health) where we can make the public health system in Missouri better, more responsive, and really, the end goal is making sure people live longer, healthier, happier lives. I think we can do that if we’re very purposeful and we’re willing to take a critical look at ourselves, and sometimes that’s a hard thing to do.
The governor announced today the state is moving on to the next phase of vaccinations. I’m curious, what role has the health department played in the past in vaccines and what role are you all going to play in this effort?
It seems like every five years or so we need to do some kind of mass vaccination effort. 2009 was H1N1, and that was a similar situation, that was a pandemic, but obviously not the same magnitude or as deadly as this one. We’ve done big Hep A interventions. … This is like those events on steroids.
With H1N1, we were a regional hub and we worked with many of the locals to make sure we had vaccination approaches for a bigger geography than just Greene County. We’re in a similar boat here, we received a grant (from the state) … and we are covering Highway Patrol region D and its 18 counties. The mission there is to work with basically all sectors to leverage an effective vaccination campaign. To zoom it in a little bit, we are currently talking to Cox and Mercy about (the latest, expanded phase) of this vaccine, which a pretty large (group of people who are eligible, including people over 65).
Right now, at least initially, we’re working through what that looks like. But I think our role is going to be to ensure that we have equitable distribution of vaccine, that we’re reaching those hard-to-reach populations, making sure that those that don’t have a relationship with a health care provider have access to the vaccine. And then we also need to take on this vaccine hesitancy issue, and that’s going to be real here.
What do you make of the vaccine rollout thus far? I know it was unprecedented in the speed at which the vaccines were developed, but there have been some criticisms that the vaccines are not getting out fast enough. What do you make of that?
I’m going to compare and contrast it to the front side of this pandemic. If you remember (with COVID-19 testing) … it took everybody a bit to get their sea legs under them and turn the corner, and I think that’s what we’re experiencing right now. There’s just not enough vaccine and everybody is very, very anxious. I have anxiety, too. I’ve got loved ones that are at very high risk, and I’m looking forward to a point in time when they can get vaccine in their arms.
These things naturally tend to be a little chaotic in the beginning, but the one thing I can tell you is if we’re going to use testing as that comparison, remember that we worked collaboratively as a community to stand up a very strong testing effort. We were not struggling with testing when many still were, and I have confidence that the collaborative nature of this community is going to rise to this occasion and figure this out. We’ll get there, it’s just going to require some patience.
We talk about ‘the new normal’ a lot, but I think people are anxious to get back to the previous normal. Do you think any aspects of public life are going to change in a post-pandemic world?
In the immediate term, I think you’re going to have people continue to use masking even when it isn’t required … but I think this will, at least for the short term, change some behaviors and cause some people to avoid those crowded settings they may have been more comfortable in before. But I do also think, if we’re being realistic here, that Americans tend to have pretty short memories.
I also suspect we’re going to be chasing COVID around in earnest for the next couple of years, and it’s probably going to be a background disease we’re going to be fighting probably forever, but having a vaccine intervention certainly helps in making sure it doesn’t become a problem of this magnitude.
To shift once again as we finish up here, tell us about your new job. What are you going to be doing?
Basically with the foundation, your role is to advocate and educate on how to improve situations. They look to eliminate underlying causes of health inequity and transform systems. I think they have interest in what to do to transform the public health system, and you do that by really working to do evaluation and then adopt best practices. We’ve got some good models out there. The state of Ohio is in the middle of that process, the state of Washington has done some of that and Kentucky has, too.
It’s time to see if we can find ways to improve the public health system in Missouri. I’m passionate about it, I think it needs to be done, and I think it’s something we’re capable of doing to respond to people’s needs.
Is there any message or thought you would like to leave for the community?
Since most of them know me from COVID response, I’m going to focus on COVID, and I’m just going to say: Please get vaccinated. If you have some hesitancy, do some research. I believe it to be safe and effective, and the quicker we get people vaccinated, the quicker we can get back to doing the things we love to do together.
Katie Kull covers local government for the News-Leader. Got a story to tell? Give her a call at 417-408-1025 or email her at [email protected]. You can also support local journalism at News-Leader.com/subscribe.
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