Meet America’s Hidden Health Heroes

240507_Conversations_USPHSCC_01.mp3

Speaker 1 [00:00:04] The recent fight against Covid was the largest deployment in the 223
year history of the United States Public Health Service Commissioned Corps. The
pandemic highlighted many of the core strengths, but its vulnerabilities as well. This is truly
an unprecedented situation. What it's done is it's it's put a mirror up to our public health
system. It's allowed us to see the problems that exist at its roots. We literally have had to
build public health systems from scratch in many communities to respond to Covid in order
to be able to make testing available in order to vaccinate people. These are things that
should have been done a long time ago.

Speaker 2 [00:00:45] Gene Migliaccio holds a doctorate in public health, and he served as
a commissioned officer in the US Public Health Service. He's now the president of the
Public Health Service Commissioned Officers Foundation.

Speaker 3 [00:00:57] We've become becoming the unknown in public health. We became
the known and then we became the vilified, in in short order and just a matter of about a
year plus time span. And it was it was really, rough to take with a lot of the misinformation.

Speaker 2 [00:01:14] This is conversations on health care.

Speaker 1 [00:01:24] Jeanne Migliaccio. Welcome to Conversations on Health Care.

Speaker 3 [00:01:28] Thank you so much. Really appreciate your invitation.

Speaker 1 [00:01:31] Yeah.

Speaker 3 [00:01:31] For sure to check in today.

Speaker 1 [00:01:33] I think many in our audience know about the US Public Health
Service Commission. Or maybe we haven't done our job. But there's still a lot of confusion,
even at the highest levels of government. The Commission Corps is the only uniformed
service in the world dedicated to public health. Perhaps you could start by. Asking you to
explain the core and what it does.

Speaker 3 [00:01:59] Well, do you, appreciate that? A it's a really a good question. We're
going to talk about hopefully a little later on about the invisible core. But we are a strong,
mighty core of about 6000, individuals that, represent a number of different specialties.
And I'll talk to you about it. As we, as we go on today. But I wanted to highlight some of the
recent work that the US Public Health Service Commission Corps has been doing to serve
the nation. So we we our roots go back to 1798, where men and women have served on
the front lines protecting the nation's public health. In what we know today as a
commission corps, the United States Public Health Service. We trace our origins way back
to the U.S. Marine Hospital Service that was implemented to protect against the spread of
diseases that were coming into the country, traditionally by seaport sailors who returned
from foreign ports and maintained the health of new immigrants. So, today, we are. One of
eight uniform services everyone knows about the Army, the Navy, the Air Force, the
Marines, the Coast Guard. They know about the Space Force. And they may know about,
national, know what? National, Atmospheric Administration, but not a lot of people know
about the United States Public Health Service. So we're one of eight uniformed services
with a 200 year history. We're led by an assistant secretary for health. Many people know
the United States surgeon General. And that those are our leaders. We have about 6000

officers, that are full time, highly qualified public health officers and specialists. And so I
mentioned, we have a number of professions within the public Health Service includes
physicians, dentists, nurses, pharmacists, clinical, dietitians, engineers, health service
officers, etc. that make up, there were 6000 officers were deployed to many of the federal
agencies throughout the Department of Health and Human Services. We also support ten
other federal departments with their health missions. And we're actually 800 locations
throughout the United States in the world. So, and just a little bit of a commercial on the
core. Their sole mission is to protect, promote and advance health and safety of the
nation. And so they do that in a variety of different missions and be more than happy to
chat with you more about that. Yeah.

Speaker 2 [00:04:28] Well, I want to thank you for that great overview. And I think
particularly your your last statement about their mission and purpose, really important
message for the country. But I want to follow up by giving you an opportunity to explain the
role of the group that you now lead. The Public Health Service Commissioned Officers
foundation. What's the mission vision of this group?

Speaker 3 [00:04:49] Well, the it it's an important mission. So the foundation has started
has was created about 24 years ago. And and the sole purpose of the foundation is to
provide support to, to those, commissioned officers of the public health service and build
partnerships, between the, the Commission corps, the active duty corps members and the
larger public health community. We focus on, on a number of important areas.
Professional development. We run a symposium, an annual symposium for our officers,
yearly, we focus on providing scholarships, to officers and their family members. We look
at the preservation of, the history of, of the Corps, and we also focus on, on research and
studies to advance public health, information and knowledge, to our broader audience of,
of the nation.

Speaker 1 [00:05:45] Oh, that's that's such important work. And and your nonprofit is part
of a new documentary, titled Invisible Core Near, narrated by actress Ali MacGraw. And
the piece is trying to raise awareness about the core and also how the public health has
become political ized. Testing had a very slow start, as you know, in the United States.
And I called all the experts from the Commission corps, many of whom were over at the
Diamond Princess or in Wuhan, who had been testing everyone brought in a bunch of
logistics people, environmental health officer people had some people from FEMA. And we
basically camped out in my office for 48 hours to develop a national plan for drive through
testing. There were only ten drive through testing sites throughout the country. By the end
of the weekend, we had a plan for 41 starting from scratch in in those first 41 sites, which
were implemented within ten days. All around the country were all run by Commission
Corps officers. I think we all lived through Covid. I think there was a good part of the early
Covid where public health was thought of very positively, and we had many, guests on
who were talking about this resurgence in and young people thinking about attending,
college and focusing in on, on public health. But, things changed along along the path. But
I'm wondering, about things that might have changed. What was the impact to the core,
that Covid brought about?

Speaker 3 [00:07:16] Well, your points are well spoken and well well taken. We and I think
about it, we have first of all, we from becoming the unknown in public health, we became
the known, and then we became the vilified, in, in short order and just a matter of, of a
year plus time span. And it was, it was really, rough to take with a lot of the misinformation,
and, the, pundits that talked about, you know, public health talked about, the response to,
to Covid, over, over the years. And, I think it brought, tremendous, discredit to a lot of the

work that, individuals do in public health in general across the United States. Be there, be
they in the US, Public Health Service Commission Corps, or be they in in federal, state or
local health department. So it, it's there's been a little bit of a disservice, based upon the,
the experience that we all went through during Covid.

Speaker 2 [00:08:19] Well, June, during the pandemic, I think you were probably one of
the very first, units that was called up. The Public Health Service Commission Corps,
deployed more than 2 or 3 of your 6100 officers, which means people leaving their homes
for who knows how long to go and serve, mobilize them from across 11 professional public
health and medical disciplines. Certainly. We all remember the outbreak, on board the
Diamond Princess cruise ship in Japan. We remember the first, cases in the state of
Washington, and your people were right there. So when you look back, as I think we all
have on, the time of the Covid pandemic and try and learn from it, what what do you think
the Corps did right during Covid? Where did you, you'd look back and say, we really hit it.
And where do you see opportunities? Should there be something like this? Hopefully there
won't. But should there be something like this again, or just for the ongoing, focus of the
Corps?

Speaker 3 [00:09:13] Yeah, I think the what we did right was, it was our mobilization. And
just in terms of bringing the best minds together within the, Commission Corps, the Public
Health Service, to start to think about, how we're going to, look at testing. When Covid hit,
we didn't have testing centers. Right. And it started slowly. And then all of a sudden there
were hundreds of them. But, that took a tremendous amount of effort by some of the best
and brightest minds, within the Department of Health and Human Services. And our core
officers were at the front lines, in terms of coming up with many of the, of the plans. And
then, most importantly, in terms of the implementation and the deployment of, of
resources. So I think, what we did right was our immediate response to, bringing together
and conceptualizing the plan that we needed to implement to, combat Covid. And there
was a lot of unknowns, along the way. And, and so various organizations, as we know,
pivoted in terms of making decisions that sometimes might weeks and months down the
lane, we had new knowledge and we were able to, to, enhance our decision making and
continue to, of course, correct along the way. From a quality perspective, I think that's
critically important. Some of our, our folks, within, the, the, the world and had decided to
use that opportunity to basically state that, we didn't have a game plan. We were pivoting
too quickly. But I think we had a lot of new information, a lot of new knowledge. That was
what was coming out that we were actually deploying and implementing at the same time.

Speaker 1 [00:10:56] Well, those were really difficult times. The Biden administration was
responsible for the vaccination process, and they turned to the corps. Right. 2021, to be on
the front lines. And people should remember, this is dangerous work. And you really,
helped lead the charge. And I'm wondering, subsequent to that, are you now playing, any
role in the upcoming fall vaccination efforts, but also maybe just reflect on, the, the time in
2021 and, the bravery that was shown by by the Corps?

Speaker 3 [00:11:34] Yeah. You know, I think of, the time in 2021, our assistant secretary
for health, Brett Giroir and our, our US surgeon general, Jerome Adams, they were front
and center, daily, in terms of some of the briefings that were given to the American people,
they were at the front lines in terms of the deployment, and working with folks over at,
CDC and, National Institutes of Health on vaccine development and starting that the initial
thought process, doctor, 2040 was front and center. Also a prior corps member. So, I think
that the efforts that took place in 21 were able to actually help us as we started. To,
develop a vaccine and then move forward with a vaccine, deployment plan throughout the

nation. And the tremendous partners that were that were actually brought in to, to work
with the, the federal government from the private sector, to actually work on the
deployment of that vaccine. And so that's a lesson learned. In terms of future pandemics,
in terms of that playbook, in terms of what we need to do in terms of, taking. We're working
with our, our scientists, our public health scientists, and working with our community
partners, for, rapid deployment of vaccines. And, and that's an outtake in terms of what
we've learned, what we also learned. And I just want to share with you, we learned that our
our public health infrastructure, it's been well stated and well said in our environment and
the public health environment. But for your audience, I just want to certainly tell you that
we still have fractures throughout the public health system. And there was a recent study
that was put out by the Document Foundation. And what we see in here is that today, we
still have about 80,000, full time equivalents that were short in public health. And that's at
the local health departments and state health departments. We're 50,000 short in the local
health departments for professionals in public health and 30,000 at the state health
departments. And what I thought what we would see is, is more an outpouring of of more
federal resources for, training of, of, individuals coming into the health professions for
scholarships and to bring more and more individuals into the world of public health. It has it
materialized for a short period of time, and now we're on to something different. So that
that's a concern, you know, in terms of where we are today in 2024. Just a short time, past
the pandemic. But the infrastructure needs a tremendous attention. And I'm concerned
that, we're not there and it's going to take some time to get there. So we're going to see
another pandemic some time, hopefully not in our lifetimes, but there will be more. And so
what we've learned, in terms of the fractures in our and our public health infrastructure,
community level, state level and even federal level where we need to put more resources.
And I'd like to see more emphasis being placed in that space.

Speaker 2 [00:14:38] Well, that sounds like a good strategy, Gene. And anybody who's
involved in health and health care, particularly public health, maybe has to be a little bit
thick skinned about what gets thrown at you in terms of critiques, because you wouldn't be
out there in front and they wouldn't be talking about you if you weren't doing very difficult
work. But still, there is this, need to educate the public, inspire the next generation of
people, and build those partnerships across the country. And I would imagine when you're
in the commissioned corps, one has certain limits around, you know, how much one
communicates and how one communicates. But with your foundation, I'm wondering how
much of an effort are you making to fundamentally, get that message out there about the
work of the Corps, about the opportunity for young people no different than Peace Corps,
AmeriCorps, other opportunity opportunities for service that people have had. What do you
what are you doing to get the attention of young people to be on the campuses and in the
schools and in the communities?

Speaker 3 [00:15:38] Yeah. You know, one of the things that we did and, the foundation,
can be that voice for officers that are part of, established, governmental organizations. So
as a foundation that we can use our voice, to actually articulate some of the areas where
we can continue to strengthen the Corps and also strengthen the health and the public
health infrastructure of the nation. So one of the things that we came up with in just in
terms of bringing the voice forward, was a documentary on the Invisible Corps. And, you
know, it kind of traces the roots of, of the Commission corps going back to, to our earliest
days of 1798. But it's really a story about public health in the United States in terms of how
we've developed as a nation over the past 200 years, with the Commission Corps being an
integral part of that. That history of, of development from, from, from diseases coming in
through the seaports in terms of coming up with strong, public health, systems and
programs throughout the country. The Corps really has and has an important role. So one

of the thoughts that we came up with is, is in terms of just trying to get more attention
brought to public health, and we've put forward a documentary, called The Invisible Corps.
Term invisible is because many times you don't know about public health. It's silent. You
know, if you're drinking water from your faucet or, if you buy bottled water, it comes off
pure. You don't have to worry about it. If, if there's no air pollution in your community and
the climate is great. You don't think about it. It's when things start to break, that you start to
realize about, the the really the, the, the individuals that support the public's health with
some of the systems that they, that they're engaged with. So I think that, the what the
foundation has done, is, is brought an, a renewed awareness to, public health in general
with our documentary not only to talk about the Corps, but to talk about public health in
general. And we've also, put forward, in terms of developing we every year we, we
educate, and provide a symposium where we focus on public health leadership for our
officers. And the important thing in terms of education is to is really to strengthen not only
our officers, but the work that they do on a daily basis so they can have a major impact on
the health of, of, Americans throughout the nation.

Speaker 1 [00:18:14] You know, I want to pick up a thread of, what we were talking a little
bit about earlier, because foundation's got a number of, of, opportunities to be the voice in
vehicle for for combating some very difficult problems. And one is this, contagion of anti-
science has become one of the greatest threats to the health of our communities. I'm
wondering how you're going about that. Do you have the right resources in place to do
that? Tell us a little more about this effort. It's so important because we've seen, as you we
talked about earlier, the early part of Covid, everybody was looking to the science. And
then all of a sudden there became a backlash. And you've got a lot of false narratives
going on.

Speaker 3 [00:18:59] Yeah, I wish we had more resources to combat some of the
misinformation out there. I think it's going to take, quite a bit of time, before we can finally
look on the on the other side, because, individuals are, no matter what we look at, within
the United States, just focusing on the states, you're going to have individuals that, that
really look to government for solutions and you're going to you have individuals that look
away from government for those solutions that are coming at you. I think in the area of
public health, we we haven't been question like this, for perhaps our history. But for now,
there has been a vocal, push to question the science, to question the delivery, to question
decisions that are made by public health leaders. So I think we have a tremendous amount
of work to do. We have a tremendous amount of work to do with our elected officials to to
get the resources that we need to really start to, to try and put some, solid information out
there and combat the misinformation. So that's, that's critically important. So that to
continue to tell the story about. Individuals, like the commission corps of the Public Health
Service. That does. Good. As that only uniform service in the United States that really
does good it throughout the world. We're the only uniform service you had mentioned that.
But, you know, when you think about. Our work in terms of touching Americans every day,
from that fluoridated drinking water to eliminating malaria in the country, to caring for
veterans, and and focusing in, on some of the major disasters that we've seen from the
nine over 11 attacks, the Hurricane Katrina to Ebola outbreaks in Liberia to Covid, as we
as we discussed, to other, plagues of opioids, gun violence, industrial accidents that we
see and so many, many more things. And we were doing those things right. We will start to
rebuild that trust that, that's been challenged, through through Covid in terms of some of
the politics, the politicization that we've gone through. But when we start to do things right.
We'll we'll start to regain that trust. I really believe that, we had another major deployment,
a number of months back with the Commission Corps, with the fires out in Maui and
Hawaii. We've been at many of the, any of the major shootings that take place within the

United States. Although unfortunate, the Corps is always there from working on behavioral
health. And and so we're continuing to deploy. We're continuing to do good. And I think
that that will tremendously, tremendously help rebuild those that trust within community by
community, by community along the way.

Speaker 2 [00:21:56] Well, telling the story, as you are doing is so important, to building
support. But we all know the pragmatic reality that funding is critical to the strategy of how
you actually take those resources and get out there. I was surprised to learn, I think you
don't have a specific line item in the federal budget for service operations, but this is
something that you're advocating for. Tell us about that. Do you have the challenges of
going to Congress every year looking for support for the Corps, or is that built into the
federal budget already?

Speaker 3 [00:22:31] Yeah, the foundation doesn't have that, as a, as a foundation. We,
we we leave that to our association and the commission officers Association is association
does a lot of the lobby work in terms of trying to get resources for the Commission Corps?
And I know that, the agency's due to, the department really pushes hard, but it's we're
strained. We're underfunded, underfunded. An under-resourced, are we? Our commission
Corps, unfortunately, is not as strong as it used to be. We're down in numbers. We used to
be, approximately around 6400. And now we're less than 6000. So we lost many officers
after Covid. And, and, there has been an issue in terms of, trying to onboard more officers
and into the Corps. So that's a challenge for us, too. So, we're we're feeling the effects.

Speaker 1 [00:23:24] And, Jane, if you look at that pipeline, I'm wondering what you're
seeing in terms of, young people's interest in public health careers. We talked about this a
little earlier, that early on phase of the Covid, there was an enormous amount of interest.
What's public health? And people finally got what public health was. Then there was a
drop off. But right now, what are you hearing or seeing, across the country in terms of
young people wanting this as a profession?

Speaker 3 [00:23:53] Yeah. Thanks. That's your excellent question. It kind of hits at my
day job in terms of, my work, as as an associate dean over at the, School of Public Health,
Milken Institute School of Public Health at George Washington University. So, after Covid,
we're the largest school of public health in the United States in terms of student size,
because we have a massive, online presence. Our enrollment was through the ceiling. It
was just amazing. Right after Covid, there were so many, so much interest and, public
health, a lot of people interested in epidemiology, for example. But then over the last few
years, probably around, two and a half, three years, we're starting to see that I start to
decline back to where it's been typically now we belong to, the university, as many schools
of public health long to the associated schools and programs of public health. And the
numbers across the board from all schools of public health is down from our height from
from, a few years ago. I think there was this, this groundswell. I think we got some great,
students that have come into public health, and I think it's going to be wonderful as we
start to graduate, our students, enter the workforce and hopefully they can take many of
the jobs where there's, openings and vacancies and, and, and as we call it, governmental,
public health and federal, state, local health departments, I believe that, that, that'll be a
wonderful, benefit for our, for our communities in terms of making brand new, individuals
that are public health trained. So, I'm excited about about that. We're starting to see, you
know. More and more, physicians and nurses and pharmacists. There was a large
groundswell across all health professions, not only the field of public health. All right.

Speaker 2 [00:25:43] Well, maybe I could get you to speak to just one more specific area
before we begin to wrap up. But certainly, we have had many wonderful colleagues who
were former members of the Indian Health Service. And I understand that it's actually the
most common agency for commissioned officers to serve in the IHS in the course of just
developed a seven year strategic plan to really improve this recruitment and retention of
public health service officers with expertise in health, but also engineering and
environmental health. What are the specific challenges of recruiting officers to work with
the Indian Health Service, and how is that work progressing? Are you making inroads with
that, and perhaps are you able to recruit from within the native population as well?

Speaker 3 [00:26:27] Yeah, that's the key. You know, recruiting from the native population
is ideal. They really have, it people, you know, identify from within their communities. So
we do see a lot of individuals, from, Native Americans that are actually, entering the health
professions and actually going back to their communities to really make a difference. And
and that's wonderful. One of the I think one of the most difficult things that you find in
recruitment, not only within the Indian Health Service, but just in terms of rural America.
And a lot of our, our, our reservations are, not in urban areas where you typically are able
to attract a broad, group of health professionals, but they're in, in rural areas, and it's really
difficult across the board. And, and Native Americans, they have some really unique,
health issues that are so critical to, to bring professionals in from, not only in terms of the
clinical specialties, but basically, in the area of behavioral health, in the areas of, of
nutrition, etc.. So it's it's It's really important that the Indian Health Service is actually on a
recruitment drive because, there are health professionals that really want to, to. Number
one, support, Native Americans. Number two, special populations. And number three, they
really want to come into the United States Public Health Service as a commissioned officer
to to do good. And, and the Indian Health Service is a wonderful organization, welcoming
an organization that, will take care of officers throughout their careers if they stay with the
Indian Health Service. They've got wonderful facilities, throughout the United States.

Speaker 1 [00:28:16] And there.

Speaker 3 [00:28:17] Are some are second to none.

Speaker 1 [00:28:19] Being, thinking about doing good. I'm wondering if you could tell our
audience about your service. We understand one of the key moments was coordinating
the federal health care response to over 200,000 Katrina evacuees in Houston. Tell us
some more.

Speaker 3 [00:28:38] Oh, thanks. I got to go back in the memory bank, but it's a that's a
wonderful question. It was one of my highlights of of, being a public health officer. To to
support a mission. So when Hurricane Katrina came, came roaring through, New Orleans,
a lot of individuals took shelter in the Alamodome. And so the thought process, back in the
day was there would be a dome to dome transfer with, some of the, the issues that were
taking place in New Orleans with, the Superdome, infrastructure being depleted. It went
through a hurricane. It had, holes in the ceiling. And, it wasn't a really a safe place to
house somebody individual. So, there was a plan afoot was to move, it was a dome to
dome. Transferred Superdome to Alamodome in Houston, Texas. And they brought
busses into to, to move people out. And when that mission was over, not only those
16,000 people came, but about 200,000 people migrated to Houston, Texas, from New
Orleans and put a tremendous strain on the community. And we saw that, migration from
New Orleans and many different areas in Texas. There was, you know, we saw it not only
in Houston, but we saw it in Dallas and San Antonio, and we saw it in Mississippi. And we

saw it in other places. So public health officers were deployed to various, cities to, work
with the, with the infrastructure. So in my particular case, I was assigned to the mayor's
office in Houston, Texas, to be the at the time, the secretary's representative for the
federal response for, the city of Houston. And I immediately, engaged, actually with a
colleague of mine that I had known from my, uniform service days who was actually
leading the charge for Houston. And we were colleagues, and, he was running the, the,
public health, hospital system, in Houston. And I was able to connect with them to find out
their needs. I also worked with, the, Houston Department of Health to just find out what the
needs were. Their resources were totally strapped with over 200,000 people coming in
their, convention, their Superdome was full, their convention center was full. They were
placing individuals and, in a lot of temporary shelters. And, so our response was, to
mobilize, medical assets outside of Houston because, they had their population to take
care of. So we actually worked, for our Houston case. We actually worked with wonderful
organizations in California, Scripps Health and, Kaiser, who sent in, hundreds of of
medical professionals, physicians and nurses and, and behavioral health specialists. And
we were able to federalize them and they were able to, not only help out in areas like the
Alamodome or, but they were also able to help on the convention center and also provide
resources throughout the city. So it was a wonderful experience in terms of the
collaboration that we received from our our federalization and mobilization of, private
sector. But in terms of working with, the city of Houston at the time, the mayor and his
senior health staff, it was phenomenal. Every day they met, talking about, a number of
things, housing, but medical and health, public health was front and center. So it was it
was a great experience in terms of the work that you that we that we did. I spent about 60
days, in the city of providing, sort of support wherever the city needed. My job, the
secretary told me, was whatever the city needs from a public health response, let's make it
happen. That's your your orders. And then you just figure out how you're going to do it.

Speaker 2 [00:32:37] Well. Our show. Thank you so much for your time, for your insights
and for your service. And thanks for our audience for being here. Be sure to subscribe to
our videos on YouTube, find us on Facebook and X with our account named CHC radio.
And as always, you can go online to CHC Radio.com and sign up for email updates. And
please share your thoughts and comments about this program. Jean, thank you so much
for joining us here today on Conversations on Health Care.

Speaker 3 [00:33:05] Yeah. My pleasure.

Speaker 2 [00:33:09] This copyrighted program is produced by Conversations on
Healthcare and cannot be reproduced or retransmitted in whole or in part, without the
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