With Deep Appreciation: Michael Fraser’s ASTHO Legacy

ROBERT JOHNSON:
This is Public Health Review. I'm Robert Johnson.

On this episode, Mike Fraser leaves his job as ASTHO CEO at the end of this week.

MICHAEL FRASER:
We've done so much at ASTHO, it's hard to say goodbye.

JOHNSON:
Welcome to Public Health Review, a podcast brought to you by the Association of State and Territorial Health Officials. With each episode, we explore what health departments are doing to tackle the most pressing public health issues facing our states and territories.

Today, ASTHO CEO Mike Fraser prepares to leave his job after more than seven years leading the organization. He begins a similar position with the College of American Pathologists in a few weeks.

In his final podcast interview, Fraser remembers his conversation with the recruiter who introduced him to ASTHO. He recalls the pandemic and credits his team for a long list of organizational accomplishments.

So you're leaving?

FRASER:
I am. It's hard to believe, isn't it? It's been over seven years.

JOHNSON:
How's that feel?

FRASER:
It's really mixed, to be honest. I'm excited about this new challenge, but we've done so much at ASTHO, it's hard to say goodbye. It's part of who I am and I certainly gave my all to the job. I'm going to miss the team a great deal and miss the members a great deal. Hopefully, we'll still you know, keep in touch and have some connections in this new role.

JOHNSON:
Seven years is a long time and a lot has happened.

FRASER:
A lot has happened. We've been through incredible growth here at ASTHO. We've lived through a pandemic at ASTHO, we've experienced the latest version of our racial reconciliation in the world around us. We've seen epic record investments in public health infrastructure. We've seen significant administration changes. It's been a lot. Absolutely.

JOHNSON:
Yeah and if you take the global pandemic out, it still has changed quite a bit. I mean, there was a lot that had nothing to do with COVID that happened to this organization while you were here.

FRASER:
That's true. And that's part of what I do want to remind people you know, there was great, great work at ASTHO, pre-COVID. COVID, sped that up. It put us on steroids, if you will. But certainly the pre-work we did before prepared us to deal as effectively as we did with the pandemic itself.

JOHNSON:
Let's do this in chronological order, we'll back up to the point when Mike Fraser shows up at ASTHO. What were you thinking when you took this job?

FRASER:
I hope I can remember that far back.

JOHNSON:
Let's try.

FRASER:
You know, it was almost a homecoming for me joining ASTHO. You know, I was at the Pennsylvania Medical Society. I had a great role there as the CEO, I was working with physicians across the Commonwealth of Pennsylvania. Learning a lot about health care financing, learning a lot about state work.

And when I saw the ASTHO opportunity, I thought, "Oh, that's great. They'll probably hire another state health official." Because they had a tradition, the past few executive directors were former health officers. And the recruiter called me, someone that I knew professionally here in D.C. for many years, and she said "They'd like to invite you to be part of the process." And I said, "No. They're going to hire a health officer. I'm not going to waste my time." It's, you know, it's a risk. And she said, "No, no, no, they really, they don't want a physician necessarily. They don't want a health officer necessarily."

So, I put my name in the hat. And it was a great homecoming, when it all came together. There were people on the interview committee that I knew well from my former role as an ASTHO affiliate at the Association of Maternal and Child Health Programs, or AMCHP. And I had always worked around ASTHO, and I mean that both in orbit, but also tactically, when I was at NACCHO and certainly when I was at AMCHP.

So, the opportunity to come back and lead was a great homecoming, little serendipity, and I think for some people pretty ironic. So, it was a wonderful opportunity and it is. This is a great organization and we've managed to do some incredible things together.

JOHNSON:
Do you remember what some of your goals were, then?

FRASER:
Yeah, absolutely. And you've been part of those, Robert. And certainly one of the biggest goals I had was making sure that our communications, our external communications, had the voice of state and territorial public health in it.

When there was media, when there was outreach about public health, it really always had, you know, some academic opining from their ivory tower. No offense to, well, a little bit of offense to academic. I'm a pracademic. I like to combine them both.

But, or with CDC, you know, and there was never a health officer, not never, but there was rarely a health officer. And I really, with the team, you know, urged us to use the resources we had, which have grown substantially since, to tell the story of state public health and get out in the media. And every story, a metric for us was, you know, did they mention state public health? Did they mention ASTHO? It didn't have to be ASTHO in particular, but we got health officers in the news. And there was a lot going on that we talked about, we started our deskside briefings. So, certainly on the media side, there was a lot of success that I knew we needed to communicate.

And that reinforced another early goal of mine, which was to improve our advocacy work and be a more effective voice for state and territorial public health needs. And we have an incredible GR team. And they're linked, you know, side by side with our PR team very strategically. And are able to get on the Hill and talk to partners about what public health needs. And we were super effective prior to COVID, with new investments in opioid overdose in the Trump administration, and with a lot of good stuff.

So, that's why I say, you know, we built a foundation that brought us into the pandemic with a very solid base.

Another goal I had was looking at our technical assistance portfolio and how ASTHO supports its membership. And I remember early on, I went to visit a lot of health officers, that's the joy of this job, you get to meet everybody. And it's only, you know, 59 members, so it's easy to do. But, not a lot of executive directors of associations, have every single one of their members. But early on, I heard from members that they love what ASTHO did. And a lot of that's supported by CDC, HHS, grants and contracts. And they loved hearing from other states, but they really wanted to hear from the gurus, they wanted to hear from the experts, they wanted to be linked to what's happening, cutting edge in the world.

And so, we embarked on a pretty ambitious revamp of our technical assistance and capacity building work that included assuring that we were not just having that state-to-state exchange, which is one of our strengths, but also that we were putting the best in class in front of them when they came to us for learning experiences. So that was, that was huge.

And, you know, ASTHO will always be this very small, member association of 59 people. Small in the sense that our membership can't grow unless there's a new state or territory. But we expanded that circle to include their executive teams. So, we have a lot of robust offerings now for executives that work in health departments, not just a health officer, but their chiefs of staff, their senior financial people, their grants people. And in many ways, we go deep in health departments in the functional areas we support, including tobacco control managers, and environmental health directors, and preparedness directors, and many others. So, that's been a huge strength for us. It's not just the club of health officers but instead this very robust, support for public health leaders in state and territorial health departments.

JOHNSON:
So, all of that was going on for about three or four years and then the pandemic came along.

FRASER:
Yeah, the pandemic came along. And I remember this meeting we had with the executive leadership team, it was sometime in March 2020. And we knew something was happening. And we had the board in, we met with the White House for the first time in February, end of February. And there were problems with the early COVID test, if you remember that. So we had a conversation about that. And I remember sitting in the boardroom and reading the news alert across my phone that they had basically, in China, quarantined an entire city, Wuhan —10 million people—and thinking, "Oh my god, this is bad. We need to get ready."

So fortunately, we had the board here, we went over—this is during the Trump administration—went over to the White House. We met with—Mick Mulvaney was there—domestic policy people, intergovernmental affairs, and had a very good, robust conversation about response early on. But I remember this executive team meeting and our Chief Medical Officer, Dr. Marcus Plescia and I were having a conversation with the team about what we were going to do. And I was like, "Alright, well, you know, we'll shut down, we'll let people work from home. And we'll be back in four weeks." And that was really what I thought, I was like this, "How bad can this be?" And of course, we saw how bad it can be. And that crisis actually created tremendous opportunity for us in a very perverse way. And yet, what a unique opportunity.

JOHNSON:
We've talked about that before. Was ASTHO prepared to do its job supporting the members when that happened, do you feel? Or were you worried that you might not be able to meet the demand?

FRASER:
Honestly, I never doubted our team's capacity to respond. We have a very strong health security team. We had one of the national experts on the team at the time, Jim Blumenstock, and folks that work with him very closely, for many years. We were very used to smaller, within state or regional events, and supporting health officers during hurricanes, other infectious disease outbreaks that involve multi-state. I think the thing about COVID was, well there was a lot of things about COVID, that might be a separate podcast eventually. But you know, I think it was just the surge we needed to respond.

I mean, early on, we had our health security team stand up our emergency operations center. We were counting persons of interest, PUIs, trying to remember what that even meant. I've blocked it from my mind. But even early on, we started seeing states having different definitions, different response capacities. And with 50 states we knew what that meant, which was, there's not going to be consistency. And so early on, we tried to get states together. We actually, one of the first things we did, I remember John Wiesman was the health officer in Washington State where they had the first known case. And they started an airport strategy where pretty much immediately following that announcement, we brought the states together, the state health officers together, that had airport screening programs with CDC that eventually, you know, phased out because it's already been here.

But you know, that's just an example of how quickly we pivoted to bring states together. And throughout the pandemic, we routinely had two, sometimes three, all-state calls every week, for years, to continue to share information, meet with federal officials. And that's core to what ASTHO does.

JOHNSON:
Of course, the other thing that ASTHO members needed was moral support. Did you expect that?

FRASER:
Sort of. You know, again, as kind of a homecoming opportunity for me, I knew several of our members when they were local health officials, and through previous work. And so I knew them well, and was able to be that trusted source of support for them.

But again, the scale of that was pretty incredible. And the decisions that people were making were very significant. And ASTHO was able to be that rock for many.

And remember this, you know, we had a lot of health officer transition during the pandemic. We had people who, I think we had one state where we probably had within a one year period, five health officers rotate through. And so we were really in that, you know, day-to-day support to health officers, helping connect them to each other, which is where they really get the most support. As well as us both as people making hard decisions.

I mean, you have to remember, these were people who signed orders, basically saying you can't visit relatives in nursing homes. Well, these people had relatives in nursing homes themselves, these health officers. That literally, in some cases, moved their kids to live with other relatives, because the demands of their job meant they would be on call and at work seven days a week, for a period of time.

And that's why the pandemic took such a toll on us all. And I'm just really privileged to be in that spot where people call my cell phone and ask for help. I never would change that for the world. But many of our staff experienced that.

JOHNSON:
It's not really I think, something you expect to have to do as an association. You know, it seems a little bit out of the ordinary for the job description.

FRASER:
Yeah, there definitely is an element that's out of the ordinary. But you know, associations are communities, they're professional homes. I think we all tap into that in some way, when we bring people together, it's usually around celebrating versus suffering. You know, one of the most impactful meetings we had, and one that I'm really glad we were able to organize, was a meeting, I won't say after the pandemic, it was probably May 2022. You know, how you end it is, scientific question, but also political. I mean, we were able to as a group, process the pandemic. And our agenda, about two hours into the meeting, our agenda got thrown out the window. And basically, we had a group session with folks that needed to share their experience and check in with each other.

I think other associations that might be bigger or might have a different kind of membership, may not be able to have those kinds of intimate opportunities. But certainly for us, we play that role, we always have.

I mean, there have been folks who have been asked to leave their jobs and need to talk about that, you know, because of the politics in their state. There have been folks that are new and don't want to tell their teams, "I don't know what the heck I'm doing. Can you help me out?" So, they call us and say, "I don't know what the heck I'm doing? Can you help us?" So it's, you know, the vulnerability is, is definitely something that we see in all our members. And it just again, COVID made that all the more real.

JOHNSON:
And you have the background and the demeanor. You were in the right place at the right time.

FRASER:
Yeah, I don't know about the demeanor, but I managed through it. You know, this was something totally out of our control. And we just rode with it. And we managed to adapt. I guess that's part of my demeanor.

But the background for sure. I mean, I had actually been around for 9/11. I'd worked at CDC, I'd worked at NACCHO prior, we had built a lot of response capacity. I knew a lot of the players that are still here. I knew Jim Blumenstock really well and the team that he had. And we had aligned with some new leadership here to really get into a good place prior. So yeah, there was an alignment there. I wish it didn't happen that way, but it did. And here we are.

JOHNSON:
Thinking about your tenure, the last seven years, you talked about the goals. You talked about how some of those have been accomplished. But as you reflect now, on your way to a new opportunity, what do you think that you'll remember the most about this entire experience? What stands out for you?

FRASER:
Well, again, it's probably too much to enumerate the things that stick out, pop up all the time that we've been able to do. But I'll tell you, you know, one of the things that ASTHO's prioritized since I got here—it was an important part of the interview process, it's an important part of our strategic plan, it's an important part of my evaluation—is addressing the issue of health equity. And doing it in a way that all members can support.

And one of the things we did, actually, right around COVID was hire a new senior vice president for health equity. Over the last several years, we've had some pretty great programming on how health officers can address systematic racism in their jurisdictions on a number of levels, in all kinds of states.

And we've created what we call our Diverse Executives Leading Public Health program, or our DELPH program, to help build the pipeline of diverse executive leaders and public health programs. And to be honest, with all that we did during COVID, and with all that we've grown in terms of capacity here at ASTHO, that work to me, is the most important. And I hate to prioritize, because people who don't work in that area feel bad. And that's not true. I don't want people to feel undervalued. But if we're going to have the biggest impact on health overall, and certainly in public health, we're going to have to deal with those communities that disproportionately bear the burden of ill health, and do it in a different kind of way. And I think we've started that at ASTHO. And I, I certainly would love to see us continue to grow that.

That's a tough slog, unfortunately. And the support for that nationally, varies, and in Congress, varies. And I'm really pleased that we had the opportunity to be part of a very significant $2.25 billion dollar investment in addressing vaccine disparities, that was the result of COVID. But also helps states use it to broaden their equity portfolio.

When that money goes away, there's not a lot else that's specific to disparities at that scale. So I'm hoping you know, the new leaders in our, in our board will be able to figure out a way to continue that work.

JOHNSON:
Is that the biggest challenge you think they'll face after you're gone?

FRASER:
No. I think that's a long game. And there's a lot that needs to be addressed, to truly reach our goals around creating healthy, equitable communities.

The hardest part of this job has really been keeping your eye on the long term, while dealing with the fact that we work with members who transition frequently. I tried to count the other day, it's over 300 health officers that I've worked with.

JOHNSON:
Wow, 300.

FRASER:
In seven years, it's probably more honestly. I under-counted because there's some interims and we have a debate about whether, you know, how long they should be counted.

But getting those folks up to speed quickly is so important. And that's the hardest part of the job. That's what's difficult, because, you know, our board can turnover in a year, year-and-a-half.

All that we invest in health officers can go away. And that used to concern me a lot. But now the way we think about it is, let's build the capacity of these individuals to lead not just when they're health officers, but lead in their next opportunity. And I totally reframed this whole effort, because it used to feel like well, that was a flash in the pan. And now, it's like this is foundational for the folks that really want it or really need it. And look at where our alumni go. They go on to amazing jobs. They work in foundations, and philanthropy, and corporate, and academia, and are just wonderful leaders thereafter.

So what was the challenge for us, which was this perpetual turnover. I think we really made some lemonade out of that in terms of our leadership development work.

JOHNSON:
And a lot of them end up at the CDC.

FRASER:
They do! We've been very fortunate to have a number of alumni down there and be really great contacts for us in terms of again, sharing with their teams at CDC, what state health does. Remember not all those CDC people have worked anywhere else. And don't, they aren't always incented necessarily to go see a health department or spend time in health department. And yet they fund a lot of health department work. That's true with all the federal programs.

JOHNSON:
You're getting out of public health directly in the new position. But before we switch over to talk a little bit about that—because I think some people might be interested in knowing what's next for Mike Fraser—what should they be thinking about, in the next five years? 10 years? As it relates to public health.

What are the things that you would have tried to approach based on what you know today, if you were still here?

FRASER:
Yeah, well, I mean, there's a lot of things I would like to continue to do, and I'll certainly pay attention to, and the work of health equity is foundational and fundamental to that. And I know I can continue to look at that in my new role. It's just from a different vantage point.

But in terms of sort of the next few years in public health, we have had this perpetual—I want to, I don't know the right word without getting a little risque in my language—problem of trying to get support for public health infrastructure. And telling the story of what public health is and does. That has been a characteristic of pretty much every job I've had in public health for the last 20-plus years, 25 years.

And then we had the pandemic. And everybody knew what public health was, and everybody knows what public health is now. And I'm not sure they all like it.

But, we had this incredible investment in public health infrastructure, three and a half billion dollars went to 100-plus jurisdictions, to build public health capacity. It's time-limited. And people are gonna start to ask, "What did you do with that? How are we better off? How have we transformed? How are we better positioned?"

And I think the challenge for us is to get over this existential crisis of trying to get people to understand public health, if they don't know it now, it's not going to happen. And be concerned about whether they trust government or not. And that's a big issue for us.

But really focus on this infrastructure money. What those investments have done, what states have transformed with that, how they've used it to make things better for people, how they've used it to be better prepared. And the hard part of that is getting someone to tell that story in a way that doesn't go down the rabbit hole of public health-speak. And I think we're going to be able to do that, because we've seen some great changes in ways that states have pivoted, and use those opportunities to transform the way that states work with their county health departments, for example. Or some of the roles that they have.

So, I would really think the next big challenge is demonstrating the return on investment, might be overstating it. But the success of the public health infrastructure grant. Historic, biggest ever. Something we've been talking about for 20-plus years. Not letting that opportunity be wasted. And knowing that it wasn't enough. I hate to say that. It sounds like a lot of money but when you divide it by every state, and territory, and the big county metros that were part of it, it didn't go very far, over five years.

So expectations are high, telling the story is hard. It's a lot of pressure. But I think, to me, that's a big, big piece.

The other thing I think we would have needed to spend a lot more time on, and I know that new leadership is going to be, have to be, someone that can manage this, because it's just what's going to happen. But as we see, more and more health officers come from partisan backgrounds, maybe not just their scientific backgrounds, but also the political.

And COVID made people aware of the power that a health officer has. Some ways checked and some perception unchecked to close businesses or, you know, tell people what to do. Dealing with that in the boardroom and dealing with that as a consensus of members is going to be really hard.

You know, and we pride ourselves on being consensus, representing the voice of all states and territories, not half, or the blue ones, or the red ones, or what have you. And it's going to take a lot of work to continue to be able to say that when we have, even now, a few health officers that, you know, cast into doubt our ability to have a unanimous or a consensus of members agree.

And that concerns me, I think that's something we all need to be aware of moving forward to date. We've really, you know, by and large, had a wonderful group of members who are who are science-based, regardless of the politics. And if that changes, I think it is a significant problem for ASTHO.

JOHNSON:
And also trying to figure out how to continue the investment piece, right?

FRASER:
Yeah, it's part and parcel of that. I think, you know, in terms of continuing the investment. You know, we went into the pandemic weak. Not because folks didn't know what they're doing, we didn't have the scientific acumen, we didn't have the commitment, we didn't, you know, have the playbook necessarily. We went in because public health had been underfunded, under-invested. You know, second fiddle to the healthcare system for so long that to expect this was gonna go swimmingly was, you know, false assumption there.

I don't know if we can say that anymore. I'm not sure how much more it's going to take, but we need to be able to tell that story for sure.

JOHNSON:
Let's talk about the next chapter in the story. Where are you going?

FRASER:
So, I am going to the College of American Pathologists, the CAP. It's a national group that represents pathologists, which are physicians. There's a lot of pathology groups. But this is the only physician, sort of universal, big tent for all pathologists. It's based in, well, they told me Chicago, but it's not. It's north of Chicago, it feels like halfway to Wisconsin, but it's the northern suburbs, it's really nice. They've got a great facility there. They've got an office here in D.C.

And, you know, again, I worked at a medical society, many of our members are physicians, I love what they do. I am certainly intrigued by health. I have to learn a lot, I'm not a pathologist, I was a social scientist, not a, not a, natural scientist. And these are scientists par excellence. They're the doctor's doctor. I mean, they spend their day diagnosing, you know. A lot of folks are aware that pathologists are usually medical examiners, but that's just a small splinter of the group. It's a very diverse specialty. Not always, you know, patient-facing in the sense of you meet your pathologist, you usually send them things and they come back. But certainly a big part of medicine.

And I was really intrigued by it, you know. I wasn't looking. I had sort of had it in my mind, I would stay at ASTHO, which was probably the problem because you know, the divine intervention. Don't be so sure what your plans are gonna be, they always change. You know, I told someone, I would never leave Harrisburg because I loved it. I loved the house, we had there, and I loved being in that area. And you know, six months later, yes, that thing happened. Just like I told the executive team in June, in our Alaska retreat, I'm committed, I'm here to stay. And then this opportunity, and they all hate me for that, and call me a liar now.

But this group, it's huge. It's a large organization. It's a premier organization. It has some great service lines, not just in the member engagement and support, but also a very significant service line in laboratory accreditation, it's the premier medical laboratory accreditation. And it's all member-led, member volunteers, it's pretty amazing.

So, it gives me something else to think about. Some new challenges, I'm sure, but some great opportunities. And a lot of it, you know, from the outside, I'm going to really use what we've learned at ASTHO and prior. But, you know, they have a lot of communication they do that we'll look at, they have media goals similar to mine, when I started at ASTHO.

Nobody knows what a pathologist is, right?

JOHNSON:
Quincy, Quincy.

FRASER:
Yeah, Quincy. And then you know, you talk to pathologists about that, "Oh, he's not a real pathologist," you know.

They're international, which is really intriguing for me, and something that I think we would have moved into at ASTHO and they obviously still can. But, the accreditation business is global. And the opportunities are global.

But there's this wonderful connection to ASTHO in the role, because, you know, there's public health labs in every state and territory. And I got to know those really well during COVID. And we've got great partners in the public health laboratory community and they have some labs at CDC, apparently. And I've already been in, you know, offline conversation with folks there about, you know, what would it look like to have pathologists spend some time at CDC, if they're not there already. And there aren't a lot of pathologists at CDC.

So I think there's some really cool opportunity. But this group, my new group, is also really committed to equity. And they're also really committed to diversity. And, you know, the medical associations nationwide, they have huge opportunity to be impactful. So I think, you know, leveraging that is going to be really important. They have, you know, a real need to look at diversity in the pipeline to pathology. And what we've done here with the DELPH program is great preparation for that.

So there's a lot of crossover. And in fact, one of the big strategies of ASTHO was to look at clinic and community connections. And I think this job at the CAP is going to allow that and in fact, promote it. And again, one of those big trends that I think ASTHO's gonna need to deal with, and of course, we already are, but it's just gonna get greater, is data modernization. And it is the link between healthcare settings, facilities, offices, public health agencies, and reporting. And, you know, if you think about all the data that come out of a lab—and I know that public health labs think about this a lot, but if you think about the medical labs, and the hospital-based labs, and the private clinics, there's huge opportunity there.

And, you know, we're just starting to deal with AI in public health. Well, pathologists have to deal with AI too. I mean, I, I've been looking at a few things and, you know, the role of pathology is unclear in a world where software can read a slide and diagnose you.

So those are kind of neat, intellectual challenges that are not unique to pathology, but certainly very pressing. And I'll get to be part of those just like we started talking about what AI means for public health.

JOHNSON:
It occurred to me that the guided tour that you gave of the Virginia public health lab was probably basic training for this new gig.

FRASER:
Yeah, yeah. You know, I can honestly say, I've never been in a public health lab. No, that's not true. I tour a lot of labs when I go visit health officers. You know, there's, again, you go to a health department and usually it's, yeah, a cubicle farm in a state office building somewhere off campus from the state capitol. But when you go to the lab, you really see, you know, public health in action, in a different way. It's kind of cool. And so yeah, I was intrigued. And during COVID, I was very curious about, you know, how they do this. How are they testing for COVID? And man, we saw it up close and personal.

JOHNSON:
I don't know if that video is still on the ASTHO YouTube page, but we ought to put it in the show notes. For sure.

FRASER:
Yeah, put in the show notes. It's great. There's this thing that looks like, I thought it was a pizza oven, but it's actually some million dollar piece of equipment that everybody needs. So, you know, I think that it's adjacent, it's not separate from public health. There are labs, state public health labs, that have pathologists in them or running them. There are labs that are accredited by my next organization. That's exciting to me. And I think, again, I've got a lot to learn. But I think that the global piece is something new and will really round out my career. But I'm not going far from public health.

JOHNSON:
There's a rumor going around that you're going to be missed. So maybe this helps with that.

FRASER:
There's so many rumors, there was a rumor going around that I retired and I asked the person, "How old do you think I am? What the hell." I got, at least this job left in me, I was so offended.

But yeah, I'm gonna miss everybody here. And the good news is, it's so easy to keep in touch with people now. And there's so many wonderful friends and colleagues that are part of the ASTHO family, some wonderful alumni and partners.

The next two weeks for me, I think I have a dinner or lunch every day to say goodbye. And I keep reminding people, I'm not dying. And I'm really excited to stay in touch, because I will definitely draw upon their expertise in this new role.

JOHNSON:
What will you miss the most?

FRASER:
You know, there's so many things I'll miss. What I won't miss is the like 11 o'clock at night phone calls from a state health officer. I'm sure that'll be replaced by 11 o'clock at night calls from pathologists, which is fine. It's part of the job.

I honestly will say I will miss the team we've built at ASTHO. Predominantly because I had a hand in cultivating or recruiting or retaining pretty much every single one of them. And it's going to be hard to find an organization with a staff resource that is as expert, as committed, and certainly as talented.

And again, I'm not just saying that. I mean, I think when you compare ASTHO's performance, what we've been able to do, compared to either our peers or other organizations like us, we are leaps and bounds ahead of them, because of the special sauce that we've made with our staff. And that required some hard decisions and some transitions. But it's I think, a real testament to our organization that we continue to be an incredibly diverse organization. And that our management team stuck with us, with me, throughout the entire COVID experience. And is still here today. And we've had some changes, and we brought in some new people. But to me, that's the leader's role.

I'm not a health officer, I'm not a pathologist. That's what members are for. But the CEO, my primary job is to interface between what the board wants us to do, and what the staff, what we call the "how," what staff does. And you have to have both. But for me in an organization like ours, it started as maybe 100 people, I don't think it was more than that. Now we're at 300. You know, it's pretty remarkable.

JOHNSON:
Well, congratulations again, on the new assignment. I know that you will be missed here. But as you said, You'll be around.

FRASER:
I'll be around. Thanks to everybody, stay healthy. And you know, again, don't forget to share the success and celebrate. It's going to be, regardless of what happens this fall with the presidential election, it's still going to be hard for public health and we have to deal with that challenge.

JOHNSON:
Thank you for listening to Public Health Review.

If you liked the podcast, please share this episode with your colleagues on social media. And if you have comments or questions, we'd like to hear from you. Email us at pr@astho.org—that address again, P-R at A-S-T-H-O dot org. You can also follow us using the Follow button on your favorite podcast player.

Also, stay up to date on everything happening at ASTHO by tuning in every morning for Public Health Review Morning Edition. We cover news like this every day. Look for the link in the show notes and let us know what you think.

This podcast is a production of the Association of State and Territorial Health Officials.

For Public Health Review, I'm Robert Johnson. Be well.