When Dr. Gregory Holzman took the job as state medical officer in 2015, he made a point to go around the state to introduce himself and get input from stakeholders in the public health community.
Five years later, that decision would pay dividends when he would become one of the public figures guiding the state through the coronavirus pandemic.
“The last time you want to be handing out business cards is in an emergency,” Holzman, 54, said in a recent sitdown interview.
After six years with the state’s Department of Public Health and Human Services, Holzman announced his resignation on Feb. 11. His last day was April 16.
“I’m tired and looking forward to some time off,” he said, adding that he had been thinking about resigning for a while and is excited to look at new opportunities, likely in the public health sector.
As early as last summer, 49 public health leaders across 23 states had resigned, retired, or been fired, a Kaiser Health News article — a testament to the pressure put on health officials by the pandemic.
Holzman submitted his letter of resignation one day after Republican Gov. Greg Gianforte lifted the state’s mask mandate. Margaret Cook-Shimanek, who has worked closely with Holzman, will assume his duties as interim medical officer.
During the pandemic, Holzman was a steady presence at news conferences with former Democratic Gov. Steve Bullock as the public health voice of the pandemic. Behind the scenes, he helped advise Bullock’s response to the pandemic and served as a liaison between state and local health departments.
When Holzman first realized COVID-19 could become a significant issue in the United States and that it would eventually come into Montana, he was at a conference in Washington, D.C., with health officials from around the country.
“We knew we were in for something when we started seeing things hit hard in Italy,” he said. Two years before COVID-19 hit, he, Todd Harwell, and Steven Helgerson wrote an article examining the effects of the 1918 Spanish Flu on Montana.
But even with that knowledge, he was not entirely prepared for what was to come.
“I knew that we were in for some challenges, but there’s a lot of challenges I did not foresee,” he said. “I didn’t think it would become this political, and I thought we would have a more unified federal response.”
Holzman, whose dad, grandpa, brother, and uncle are all physicians, first came to Montana in the ‘90s after doing his family medicine residency in North Carolina. Not wanting to go into private practice, he found a job as a staff physician at the Blackfeet Hospital, part of Indian Health Services.
While working on the Blackfeet Reservation, he would fall in love with Montana, the outdoor life, and the Blackfeet people and would make it a point to return.
Once he did, his practice of building a rapport with health officials across the state paid off when the pandemic hit, and it was time to get to work, said Ellen Leahy, a 38-year veteran of the Missoula City-County Health Department director.
“We were able just to jump right in and do the work, and that’s really what was needed,” she said. “Before the pandemic, seeing how sharp he is in terms of public health, you know on the ground, in practice at the local level, and being able to connect that with his medical background and put those two together was just so instrumental for helping us at the local level during the pandemic.”
While health officials in the state worked well with each other, Holzman said he wishes there was a more uniform response from the federal level.
With new information constantly coming out on best practices to curb the spread of the disease, he said, “We needed a clear messenger that no matter where you sat on the spectrum of politics, you felt this person was honest and transparent with you.”
During the 2009 flu pandemic, he said Rich Besser, then acting director of the Centers for Disease Control and Prevention served as that guiding figure.
The closest thing to that during this pandemic, he said, was Dr. Anthony Fauci, but even he has become too politicized: “He’s very polarizing because of the political aspects. A lot of people think whatever he says is completely wrong or completely right.”
When positive COVID cases started popping up in the Flathead, Hillary Hanson said she called Holzman on a weekend afternoon. “I definitely know I interrupted his personal life, but he still picked up the phone.”
At the time, Hanson was a Health Officer at the Flathead City-County Health Department. No matter the time or place, he would answer, she said.
“If I had a question, if I had a concern, if I needed help thinking something through, I could give him a call, and he would answer the phone and help me with working directly at the local health department, as to how they serve local health departments and tribal health departments,” she said.
Gallatin City-County Health officer, Matt Kelley agreed, saying, Holzman was a “calm and steady” presence that he could count on.
When Kelley had complaints about how the virus response was handled, he would call Holzman. “He always dealt with it with calm and professionalism and I really appreciated that … because as difficult and as heated as things could get during the last year he was always some who approached his job with calm and reason, and I think that’s what we needed.”
Ripe for politicization
In Holzman’s eyes, the current political environment served as kindling for the coronavirus to spread through communities, which he said made things even more challenging.
“As soon as a politician speaks, half the country has a different view because we’re a very politically divided community, so we needed to take this as best we could out of politics,” he said.
It irked him that a community divided could not come together to have open conversations about public health measures like social distancing, shutting down businesses, and wearing a mask.
“That was probably the most frustrating part about it,” he said. “If we could sit down and just have a discussion, listen to where they are coming from, what their concerns are, and be able to build that trust, and then let them understand where we’re coming from, from the public health science point of view, it would have been a lot easier.”
But that didn’t happen, and the vitriol that he saw toward local health officials upset him.
“They were doing what they could with the data and information they had,” he said. “A lot of these recommendations were coming straight from the White House, and in some cases were even less stringent than the White House recommendations.”
The pandemic was not the first time Holzman had navigated the intersecting worlds of politics and public health. Under Bullock, he said he was often asked to chime in on public health laws introduced in the legislature.
And before coming to Montana, he was the deputy director of the Office for State, Tribal, Local and Territorial Support at the Centers for Disease Control and Prevention. Before that, he was the chief medical executive for the Michigan Department of Community Health.
Holzman’s experience traversing politics and health showed when the pandemic hit the state, Leahy said.
“It got very polarized in a political way, and he never fed into that, he absolutely didn’t avoid it, but he never fed into it,” she said. “His comments were never on the political front; they were always: ‘this is how to you know make your family safe, and this is why we need to do this, and we’re requesting that you do this’ … so he did that in several arenas where he brought parties together that otherwise were having some tension.”
Tamalee St. James Robinson, interim public health officer for Flathead County, echoed Leahy’s praise for how Holzman handled the politicization of the virus.
Robinson resigned on Dec. 31, 2020, after continually butting heads with the county board of health over enforcing public health mitigation efforts like mask mandates.
“Montanans are fiercely independent, and it doesn’t always bode well for public health initiatives when people perceive that you’re taking their rights away from them,” she said, adding, that Holzman did a good job putting public health over politics.
As the response to the pandemic shifts from masks, shuttered businesses, and six-feet rules to vaccinating as many people as possible, Holzman is worried that the politicization of the vaccine, which he says now is the best tool in the toolbox, may hinder Montana and the country from completely controlling from the virus.
“It’s not like we’re going to eradicate this virus in the near future,” he said. “We are probably going to have coronavirus around for a while, but we can get to a place where we move on with our lives, especially if we can get the whole world vaccinated.”
Like masks, he said the vaccines are becoming too political. “Without the vaccine and other public health measures, we will have a very hard time controlling the virus.
“You get mutations when it replicates. The more it spreads, the more it continues to replicate, the more likely we’re going to have more viruses,” he said. “The virus that’s going to continue to be the strongest in the community is the one that can survive the best.”
And the more it replicates, he said, the more variants there will be.
“Right now, Gallatin is seeing the brunt of it, but that doesn’t mean that Yellowstone or Flathead should be putting down there,” he said. “We need to find the right way to pull back where we can because it does have effects in other areas of society.”
He said he hopes people can come together in the future because when they do, they will be more successful in addressing many issues, such as substance abuse.
“We need to listen to each other,” he said. “… When we deal with things like this, it has to be a ‘we’ mentality.”
As for the coronavirus, Holzman said he is encouraged by the numbers in Montana and commended Gianforte for shifting the states’ vaccination plan to focus on the most vulnerable.
Even so, he said, “I’m worried about a smoldering aspect of this continuing.” And when the next virus comes is not a matter of if, but a matter of when.
“It’s not like Old Faithful … we could have another one five years from now, it could be 200 years from now, but we will have another one.”