Women & Hi Tech was excited and honored to kick off our 2021 programming with a Special Edition Executive Women’s Forum (EWF) featuring Indiana Health Commissioner, Dr. Kristina Box. This EWF event was hosted by Women & Hi Tech’s Past President and EWF Director, Angela B. Freeman and Linda Calvin, respectively, on February 11 during Black History Month, and on the International Day of Women & Girls in Science as declared by the United Nations General Assembly. The event was also an incredible way to celebrate the excellence that manifests when all women and girls, including diverse women and girls, are allowed full and equal access to participation in science.

Let’s recap what Dr. Box shared about her professional journey, her achievements as a medical health professional, and the state of Indiana’s nationally-leading efforts to conquer COVID-19.

About Indiana Health Commissioner Dr. Kristina Box

Before becoming Indiana’s Health Commissioner, Dr. Box worked as a gynecologist and obstetrician for 30 years in Indianapolis. She was responsible for building the first multidisciplinary Women’s Center at Community Health. She also spent the early half of her career focused on reducing infant mortality in minority populations, as well as leading efforts to ensure all women could access preventative health screenings in their community.

“When I first got the call about stepping up as Indiana Health Commissioner, my thought was that I wasn’t qualified. I didn’t have my Master’s in Public Health,” she shared. “I assured Governor Holcomb I would continue to volunteer and help with my areas of passion, reducing infant mortality and helping with substance abuse outreach.” Dr. Box was proud to add that Indiana’s infant mortality is at its lowest rate since the 1800’s, and that mortality among Black infants has dropped by 30%. “However, it’s still 1.9x the White infant mortality rate,” she added. “So, though we are making inroads and programs are resonating, the situation is still unacceptable. There is still work to be done.”

When the Governor’s office called her back the very next day to ask again that she meet, Dr. Box’s daughter, Lauren, encouraged her to go. Dr. Box ended up accepting the state’s Health Commissioner position in 2017. In the early days of her tenure, she helped Indiana cope with a Hepatitis A outbreak and launch a public education initiative about the dangers of vaping. “Many students and young adults had no idea they were even using nicotine and now a whole new generation is addicted. Plus, Indiana experienced some of the most deaths related to vaping nationwide.”

But the COVID-19 pandemic has been a more overwhelming challenge than either of those crises. “I get daily emails from citizens demanding why a woman like me, a gynecologist, is leading Indiana at this time through this crisis,” Dr. Box shared. “The answer is-- leadership isn’t about being the expert in the area where you are trying to lead. Leadership is about who you surround yourself with, not your own area of specialty.”

Facts About Indiana’s COVID-19 Numbers and Response

Dr. Box started her summary about Indiana’s COVID response on a high note—the continuing decline in Indiana’s COVID positivity rate. “I keep kidding Fred Payne, our Commissioner of Workforce Development, that his unemployment rate is down to 4% and I want numbers like his,” she said.

She also took the immediate opportunity to recognize the excellent women she has surrounded herself with to help Indiana conquer the pandemic. “Dr. Lindsey Weaver, our Chief Medical Officer, has helped coordinate our vaccine strategy. Dr. Jennifer Sullivan, with the FSSA, has been instrumental to our testing efforts.” She also acknowledged the contributions of Marion County Public Health RN, Teri Conard, in helping her with infant mortality initiatives.

Dr. Box shared insight into community partnerships that made Indiana’s COVID-19 response possible. “We started making our own PPE in Indiana to outfit ourselves, since we couldn’t rely on the national stockpile. As it became challenging to keep up with new science and data, we partnered with WISE at the Indiana University Research Center, to answer all our questions or concerns immediately. They have been so helpful and we continue to work with them.” Another academic partner is the Fairbanks School of Public Health. “We saw through contact tracing in Indiana that asymptomatic people were transmitting the virus and took action to educate Hoosiers about that news before the CDC did. As we were doing early testing, 45% of those who were positive reported no symptoms at the time of testing.”

Dr. Box then dove into Indiana’s COVID numbers. She shared that while only 23% of cases have been in individuals age 60+, 93% of statewide deaths have been in that population. One-third of cases have been in those under age 30 while 45% of cases have been in those age 30-60. Dr. Box said some of these cases have been because of ignoring mandates for self-isolation and masking, but many more have been because following those mandates wasn’t always possible.

Emotionally, Dr. Box reflected on the impact of Hoosier frontline workers. “We asked many professionals to stay on the economic and healthcare front lines before we fully understood what the risks were. And they did it—they did it in overtime with no days off. It is so honorable and incredible. Not just our healthcare workers, police, and fire, but the individuals who stocked our grocery stores, kept our lights on. We weren’t clapping for them, saying ‘good job for heating my house.’ But a lot of people have stepped up from all walks of life, to give something to the community where they lived. That’s why Indiana is so great.”

Facts About COVID-19 Vaccines in Indiana

Dr. Box shared insights about the process and reasoning behind Indiana’s strategy to distribute COVID-19 vaccines. “We engaged a statewide external advisory with clergy, community leaders, diverse minority leaders, healthcare professionals, and more, to judge ‘is the vaccine appropriate?’ and ‘is our strategy to distribute it ethical?’”

What many people might not know is, vaccines for coronavirus have been in development for a decade or more. There just wasn’t profit in companies marketing and producing them. “People heard ‘Operation Warp Speed’ and thought the full vaccine development process was accelerated. But really these vaccines were made by capitalizing on years of coronavirus research and were being manufactured for shipping alongside the Phase 3 trials—so that if the vaccines were approved, they could be shipped immediately.”

Dr. Box also explained how the coronavirus vaccine works. “None of the vaccines will prevent you from getting COVID, or from carrying it,” she clarified. “What they will do, is make the illness less severe so that you are less likely to be hospitalized or die.” By causing your body to produce the spike protein, your body can develop an ability to fight the virus without any changes to your cells.” This also explains why new variants may prove to be more vaccine-resistant, and how COVID booster shots may be needed to help your body develop or maintain immunity in the future.

After shedding some light on the science, Dr. Box went on to explain that Indiana is leading the nation in vaccine strategy and distribution, though faulty national data visualization is causing us to not get the credit. “We have 92 health departments across the state, as well as our nationally-ranked hospitals, and private pharmacies, all helping with the distribution effort—simply because we asked,” she said. “When I get on the national status calls, other states are stunned that we haven’t had to issue an executive order to get this done. Some even asked if we issued threats,” she said with a chuckle. “But they don’t understand this is just another example of how Hoosiers have stepped up to the plate, as usual.”

One area where Dr. Box and her colleagues are still extremely focused is vaccine awareness in rural and minority communities. “There is a very real and justified fear in minority communities resulting from past injustices like the Tuskegee Experiments. We seek to address this by sharing information with community leaders who can spread the message. We are so appreciative of these partnerships and are continuing to identify such leaders in every single county. We want to educate anyone who wants to learn about the specific efficacy of the vaccine in their population.”

Dr. Box shared that Indiana is receiving 100,000 vaccine doses a week. Over 250,000 people have been fully vaccinated and over 900,000 have had a first dose or have scheduled an appointment. “As we prioritize individuals whose age and pre-existing conditions make them a high-risk group, as well as those in frontline industries like healthcare, emergency response, and retail, I absolutely expect any Hoosier who wants a vaccine will be able to get one well before the end of 2021.”

Takeaways About the Future of the Pandemic in Indiana

Dr. Box echoed the predictions of other sources that by the end of the spring, the UK variant of COVID will be the dominant strain in the US. “This changes the spike protein and makes it more transmissible, though we aren’t sure if it makes the disease more severe. But, we do know an increase in numbers means more hospitalizations and deaths, even if the illness is not worse.” To help get a handle on these new strains, labs at facilities like Eli Lilly and Purdue are conducting genomic testing that is being shared with the CDC.

“Masks will be continuing into the fall—or depending on the variants, maybe even longer,” Dr. Box forewarned. “Around 5% of people may not even respond to the vaccine. Traditionally, individuals like the elderly whose immune systems don’t work as well may not develop antibodies.”

She said though we will need 70-80% population immunity before masks can be left behind, it’s also essential for the elderly to get back to safely spending time with their families. “My grandson can’t see me without a big hug and kiss. I include him in my bubble even though he goes to daycare, for my mental health. If I had underlying conditions, I might have needed to rethink that. Whatever it is you do as a family—do it. But maybe eat a meal in different rooms if you will have masks off. There is still a reason to be careful. But I also know we must balance mental health.”

She also explained the changing recommendations around a safe post-COVID quarantine period. “Technically the safest is still 14 days. The chance of a post quarantine infection after this time is less than 0.1% percent. After 10 days, if you are going back to work, you need to be totally fastidious. If you get tested on day 5-7, you must be negative to go back to work,” she said. “Seven days has been offered to schools because we know it is so important. We are also providing rapid tests that can be done in school. This way kids who need testing, but whose parents can’t take them, have a place to get help too.” She emphasized that the numbers at ourshot.in.gov are updated every 24 hours, along with the provided answers to COVID FAQs, and encouraged attendees to seek that site for updated information.

Dr. Box shared her final thoughts. “You never know what is planned for you,” she said. “Even the best-laid plans will require you to pivot. Never be afraid to disagree—after you have listened respectfully--or say, ‘I don’t know the answer and will get back with you.’” In conclusion, she called on us all to give grace to each other and ourselves. “We have all been through a lot and deserve patience and kindness,” she said.

Women & Hi Tech is so immensely grateful to Dr. Box, and her team, for spending her incredibly valuable time to inform and inspire the attendees of this Special Edition EWF. From the practical scientific insights about the virus and vaccine, to the behind-the-scenes look at Indiana’s COVID strategy and national impact, to her inspiring personal story and advocacy on the behalf of women, we loved every minute of listening and learning. We also appreciate the empathy and emotion demonstrated by Dr. Box that captures the essence of why women are uniquely positioned to positively impact science and health outcomes in our communities.

Women & Hi Tech also encourages all who missed it to view the recorded session of our Special Edition Executive Women’s Forum with Dr. Box and visit our website at womenandhitech.org/events to attend our next events! Thank you.