SISTER CAROL KEEHAN AWARD
By LISA EISENHAUER
Dr. Alexander Garza saw early on that the COVID-19 pandemic wasn't spreading its misery evenly.
Dr. Alexander Garza speaks at a St. Louis Metropolitan Pandemic Task Force news conference. Garza, chief community health officer for SSM Health, has led the group since it convened early in the COVID-19 pandemic to develop a unified response to the crisis. Hillary Levin/St. Louis Post-Dispatch/Polaris
Data about COVID infections, hospitalizations and deaths in the St. Louis region compiled by the St. Louis Metropolitan Pandemic Task Force he leads showed the pandemic was having a particularly devastating impact in ZIP codes where most residents were people of color and incomes were low.
As the head of the task force, Garza urged a public health response that ensured testing, vaccines and other resources were available to people in those ZIP codes. When supplies of protective gear were short, he organized mask drives, directing the supply to the high-risk communities. He was an outspoken advocate of mask mandates, safer-at-home orders and other precautionary measures to protect entire populations.
Because of his steadfast leadership during the turmoil of the pandemic and his advocacy for the medically underserved, Garza is the recipient of the 2022 Sister Carol Keehan Award. The award is named for the former CHA president and chief executive officer, a champion of social justice and health care access for all.
Guided by data
The St. Louis Metropolitan Pandemic Task Force was formed in April 2020 with support and participation from SSM Health, Mercy and two other health systems in St. Louis city and county as well as local governments and the business community. It has been a reliable source of information about the spread of the virus and how to avoid infection.
Garza says it took support from the top leaders of the St. Louis region's major health care systems and government officials to make the pandemic task force effective.
He points, for example, to the systems' willingness to pool their COVID patient data. The task force overlaid the information on positive tests, hospital admissions, mortality and other COVID-related analytics with data broken down by ZIP code on poverty, race and other social factors.
"It was abundantly clear that the metropolitan areas that had the highest inequities had the highest number of cases," Garza says. "Seeing it all layered out on maps like that made it clear where the effort needed to be."
C-SPAN broadcasts Dr. Alexander Garza's appearance before a Senate committee in October 2011 to discuss how the Department of Homeland Security is responding to bioterrorism threats. At the time Garza was chief medical officer and assistant secretary for health affairs at the department.
He adds that it should not have been a surprise to anyone that COVID took a larger toll on vulnerable communities, in the same way that conditions like diabetes and heart disease do. That harsher toll has nothing to do with race, he says, but rather the challenging social conditions that people of color and the poor disproportionately face.
Garza tried to get that across in his regular media briefings. "We wanted people to understand that it doesn't translate that these communities are at risk for the disease because of who they are," he says. "They're at risk for the disease because of the disparities."
Garza's full-throated support for science- and population-based responses to the pandemic has had its detractors, including Missouri Gov. Mike Parson. Parson opposed statewide mask mandates and bristled when St. Louis, St. Louis County and other municipalities imposed local mask mandates. When Garza complained publicly that the state was giving too much vaccine to rural areas where demand was relatively low and not enough to urban areas, the governor accused Garza of cherry-picking data about vaccine distribution and spreading "fear and panic."
Records provided to the St. Louis Post-Dispatch by the state of Missouri a year after the fact confirmed Garza was correct. The records showed the state's two most populous regions — St. Louis and Kansas City — consistently were shorted on what should have been their fair share of the vaccines, the newspaper said.
"We wouldn't be able to look ourselves in the mirror or go to sleep at night if we weren't doing these things," Garza says of his and the task force's advocacy work. "We knew it was the right thing to do. Once you have that moral clarity, then it becomes easier almost."
The right stuff
Garza was chief medical officer and assistant secretary for health affairs with the U.S. Department of Homeland Security from 2009 to 2013. An Obama appointee, he served under former Secretary Janet Napolitano. Part of his job was monitoring emerging health threats and creating plans to address how a severe pandemic might affect national security.
Napolitano and Garza were out front in the federal response to HINI swine flu, which the Centers for Disease Control and Prevention estimates infected more than 60 million Americans and caused more than 12,000 deaths from April 12, 2009, to April 10, 2010.
"Whenever he accompanied me to brief the president about our response to the H1N1 pandemic, testify in front of Congress, or just to visit the war wounded at Walter Reed hospital, I knew his public health acumen, combined with his compassion, would always lead us to the right path," Napolitano says of Garza.
Napolitano and Garza worked on other health care issues related to homeland security, such as the health needs of refugees from the Haitian earthquake in 2010. "It was always reassuring to have scientific and medical expertise at your side, and I had that in Dr. Alex Garza," Napolitano says.
Right person, right time
Garza returned to his hometown to accept a position at the Saint Louis University College for Public Health and Social Justice in 2013. Five years later, he moved to SSM Health as its chief medical officer.
Dr. Clay Dunagan, chief clinical officer of BJC HealthCare, says Garza came to the pandemic task force with a grasp of the technical issues and the public health aspects of pandemic response. "Certainly, for this leadership opportunity, he was the right person at the right time," Dunagan says.
Dunagan, the task force member representing the area's largest health system, says Garza has the integrity and gravitas needed to keep the task force from splintering or losing its credible, authoritative voice. And Dunagan says Garza was "front and center" in pinpointing populations and communities at highest risk of poor outcomes from COVID. I think he was an important spokesperson in terms of rallying resources to help."
Duty to country
In the thick of pandemic surges in the St. Louis area, Garza held press briefings three times a week to share the latest statistics and offer advice to the public and to policymakers on how to respond. In recent months, with the virus' grip easing, the task force has continued to meet but it only holds press briefings when there are major developments.
Garza has balanced his role with the pandemic task force with his leadership responsibilities at SSM Health. In August 2020, he transitioned to chief community health officer, a position he helped create to deepen the system's focus on social determinants of health, equity and social justice and to support its pivot to population health and value-based delivery.
Last summer, Garza took a leave from SSM Health and the task force for a three-month military deployment to Kuwait. He is a colonel in the Army Reserve and command surgeon for the 352nd Civil Affairs Command. His military service goes back more than 20 years and has included deployments in Iraq to help rebuild that nation's medical system after the U.S. invasion.
"I think people need to have something in their lives or in their careers where they've dedicated some aspect of it to their country. This is mine," Garza says.
He was able to delay his Kuwait deployment briefly to be on hand as his son began an Army career. The younger Garza entered the U.S. Military Academy at West Point, New York, in spring 2021.
Tackling a 'wicked problem'
With COVID appearing to wane, Garza says the pandemic task force is looking at the prospect of shifting its focus to other public health challenges in the St. Louis region. Unfortunately, he notes, there are many. Among them: obesity, gun violence and environmental threats.
"I tell people in some ways the pandemic was easy because it was a singular focus on this singular issue. It was a respiratory virus that was causing a pandemic, and everybody could focus on that," Garza says. "When you start moving into other issues, I think they become a little bit more complex."
At the root of those challenges, he says, is disparities that prevent the region from becoming an overall healthy place. "I think people recognize it, but it's like this wicked problem that we sort of just throw our hands up in the air and go, 'Well, that's just too hard to solve,'" Garza says.
He disagrees, but he thinks it will require a number of solutions — such as living wages, affordable housing, environmental improvements and access to quality health care — that require a regionwide effort.
If the task force decides to stay together and tackle another public health issue, Garza is willing to remain at its helm. "If it fits well with my role in community health," he says, "I don't think that would be a burden."