Below is a lightly edited, AI-generated transcript of the “First Opinion Podcast” interview with Sandy Tibke and Josh Gryniewicz. Be sure to sign up for the weekly “First Opinion Podcast” on Apple Podcasts, Spotify, or wherever you get your podcasts. Get alerts about each new episode by signing up for the “First Opinion Podcast” newsletter. And don’t forget to sign up for the First Opinion newsletter, delivered every Sunday.
Torie Bosch: Sandy Tibke and Josh Gryniewicz wanted to spark productive conversation around vaccines in North Dakota. At a time when discussing vaccines often means yelling, not listening, they actually accomplished their goal by teaming up with churches, cowboys, chiropractors, hairdressers, and veterinarians.
Welcome to the “First Opinion Podcast.” I’m Torie Bosch, editor of First Opinion. First Opinion is STAT’s home for big, bold ideas from health care providers, researchers, patients, and others who have something to say about medicine’s most important and interesting topics.
Today, I’m speaking with Josh Gryniewicz and Sandy Tibke. Josh is a national bestselling author and founder and chief narrative strategist for Odd Duck. Sandy is executive director of the Foundation for a Healthy North Dakota.
After a quick break, I’ll bring you our conversation about how they teamed up to fight anti-vaccine bills in North Dakota and spark genuine conversation beyond.
Josh Gryniewicz and Sandy Tibke, welcome to the “First Opinion Podcast.”
Josh Gryniewicz: Thanks for having us.
Bosch: So, Sandy, I want to start with you. How long have you been in North Dakota?
Sandy Tibke: I’ve been in North Dakota since 1998, but I also went to college for undergraduate and graduate school at University of North Dakota, so a good deal, over half of my life.
Bosch: That’s great. And where were you before North Dakota?
Tibke: I grew up in Hibbing, Minnesota.
Bosch: Oh, home of Bob Dylan.
Tibke: Yeah. So I grew on the Iron Range in Northern Minnesota.
Bosch: And so how long have you been working in public health in North Dakota specifically?
Tibke: More community wellness, community advocacy than public health necessarily, but I’ve been working in nonprofits since 2003, I think, off and on.
Bosch: How would you describe the attitude toward vaccines in North Dakota before the Covid pandemic?
Tibke: Before the pandemic, I would say that it was just a given that the majority of North Dakotans would vaccinate. And it just was a thing that you did. We have a high rate of vaccination in the state traditionally without mandates. And there’s requirements, of course, for schools, but not mandates. And you can opt out at any time for most reasons. But in our state, we have a higher rate of vaccinations, regardless.
Bosch: And did that change with Covid?
Tibke: It did. There’s a higher rate of opting out for the kindergarten shots for schools and higher rates of opting out, you know, for in businesses and all those sorts of things. Yeah. There’s a decline and certainly a decline of flu vaccines.
Bosch: Josh, I want to bring you in here. Your company, Odd Duck, is a storytelling for social change consultancy. What does that mean exactly?
Gryniewicz: Well, you and my mom ask that question all the time. So, basically, we do everything in terms of helping shape and share stories for impact. So that could look like in advance of an engagement, like with North Dakota, actually hosting listening sessions, trying to harvest stories that we know would have impact, all the way to doing, you know, comic book series and animations for different programs around the country. So it kind of runs the gamut. We really focus on what we refer to as a narrative framework, which essentially is identifying who your audiences are, what action you want them to take, the barriers they have to taking those actions, and then helping appeal with stories that are curated to overcoming those barriers and taking that action.
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Bosch: And now tell me, whoever wants to take this, when and why the two of you teamed up.
Tibke: I’ll start, Josh can finish. So I was approached to start an immunization coalition within the state of North Dakota in the summer of 2022. We did not have one. And traditionally speaking, like I said, we always had a high rate of vaccinations within the state and usually teamed up with South Dakota, and it was going well, but what we were seeing was that decline and then mistrust of vaccines. And so we need to start a coalition. So, I had … considered starting this coalition, but I saw a broader scope.
During the pandemic I was watching city commission meetings, county commission meetings, school board meetings. And I was seeing a lot of behaviors within those meetings where people, it was us against them, you know, dehumanizing. Getting deeply concerned about the fabric of communities being destroyed with this division and not being able to agree that a pen was a pen, to even have those conversations.
And so, not only was I concerned about the decline of vaccinations, but I was even more concerned about the fabric of communities and what we’re for and not what we are against and switching that. So I had agreed to start a coalition, but I also wanted to add in bridge builders. So we work with food as medicine and talk about access to nutrient-dense foods. And we also work with maternal health, working with doula services, Medicaid reimbursement, really bringing communities together so we can work on what we’re for instead of what we are against. So that’s when I got started in November of 2022.
Shortly thereafter, I was on a webinar trying to put the language together on how do we approach when we can’t even agree on a pen is a pen. And Josh was presenting at a meeting, a Northwest public health meeting, public health institute meeting, and was talking about mis- and disinformation and all of the information surrounding that. And talking about that upstream work, but also in a way where it was building bridges and bringing community together.
And that’s what I was looking for too, but with a broader understanding on communications. And I was emailing Josh before he was even done presenting. Because I knew we needed a vehicle to build community and have a name for it and bring that authentic conversation at the local level, all the things he was talking about. So that’s how we first got connected. And then Josh, I’ll let you do the second half.
Gryniewicz: Awesome. So for Odd Duck, the origin was a bit different. Like so many in the health communications field, we were sort of dragged kicking and screaming into and mis- and disinformation. We were launching a five city, what we thought was a standard health communication campaign right at the start of the pandemic. So just as things went into lockdown. And it quickly became apparent that it was going to be derailed by disinformation. And we basically, my team and I were like, “We have to throw out whatever playbook we’re using, the standard sort of issue playbook, and figure out something new.” And there were, it was very trial and error, Torie, lots of starts and stops. Essentially we boiled it down to taking kind of like these five keys. So long story short then, we basically identified what these five keys were. We ran a yearlong campaign using those keys. Then we were very fortunate to pair with RISE, which is part of the WE in the World network, who were working with 2,500 communities across the country. And we were like, “Hey, we’ve got this model.” And they were like, “Hey, we’ve this model,” and we were like, “Let’s get our models together and see what’s working and what isn’t.”
So that was a lot of data for us to sort of test what we were doing and say, “OK, this is definitely working. This might need some adjustment. We like this over here.” We published a misinformation guide for community-based health workers. And that’s where Sandy and I connected because she saw me presenting on that guide and those findings.
Bosch: So tell me what you were teaming up on exactly. So you were working to fight anti-vaccine bills in North Dakota. What were those bills?
Tibke: So I’ll give an example of one of the bills. One of the bills would have made it so we couldn’t access mRNA technology within the state for humans or for animals. So that’s one of them. And then also taking away requirements in schools was some of the latest. So those are just a framework of the anti-vaccine bills.
But when we met and first started working together, it was work that needed to be done even before that. And so, and having that framework to bring to communities because the vaccines for me weren’t the focus initially. It was trying to talk to rural and frontier communities and urban communities and rebuilding trust without pushing people further into their ideology. But those are some of the examples of the bills that came forward.
Bosch: So you write in your First Opinion essay that you held listening sessions. Tell me about them. So how many were there? Did you go to the same area repeatedly? Who came? How did you get people to come?
Tibke: I’ll start and then, Josh, add in just on some of those. So we had a lot of meetings ahead of time as far as deciding strategies. And we started with key informant listening sessions and talked to different trusted leaders across the state and then moved into community listening sessions where we worked alongside trusted organizations and leaders within the community.
We chose outside of public health specifically because public health needed support and they needed assistance and they need someone else to bring the community back together. And so that’s how we got started. And because we’ve worked along trusted community organizations and leaders, we were able to attract or retain more people to attend listening sessions. In addition, we always offered food, and food was super, it’s super important, and it’s a unifier and it brings the guards down.
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Bosch: So what sorts of organizations were you working with?
Tibke: So Ministry on the Margins is an organization within the capital community of Bismarck, North Dakota, that works with the homeless population and unhoused and people just in need of services in general. Sister Kathleen Atkinson, we worked with Sacred Pipe Resource Center, which is an urban Indigenous organization within the capital Bismarck-Mandan region. We also worked with Standing Rock Reservation through Sacred Pipe and we worked with a faith organization in Medora, North Dakota, Safe Kids in Grand Forks, a maternal kind of home care organization up in Minot, North Dakota. So those are the organizations that we worked with.
Bosch: Did you approach any organizations who declined?
Tibke: No, North Dakota is a wonderful state in as far as we’re rural frontier. We’re under 800,000 people. It is actually one community. So everyone knows basically everyone and there is no, there isn’t a lot of bureaucracy. So if you want to create change or do something to create positive momentum, usually people will jump in.
Gryniewicz: And just to zoom out for a moment, Torie, like, one of the things, you know, as Sandy mentioned, we spent probably about three to six months just kind of planning, getting the logistics in place, saying, you know, like, who do we need to, what areas do we need to work in? What counties do we want to focus on? And who are the best possible partners from a community-based organization perspective to actually collaborate with?
So by the time we were actually approaching and having those conversations of like, “Hey, we want to bring a bunch of people together, and it may get heated,” right? They were already prepped, they were already prepared, and they knew what they were getting into and wanted to play a role in that. So there was a lot of strategy that went in on the front end, just to get like the right, the right people at the table.
Bosch: So you’ve got your partner organizations, you’ve got your food, how many people are coming, how are they feeling? I mean, to me, it seems like if you have this sort of thing, it’s mostly going to attract maybe people who already feel strongly about vaccines one way or another. So were they sort of tense? If I walk into one of these, what does it look like? Who’s there? What are we doing?
Gryniewicz: So we primarily had probably about two dozen, usually no more than that, although a couple of the sessions went over. Certainly folks who came in were strongly entrenched in their opinions, and that’s what we wanted. Although the folks we really wanted to be able to influence and reach were the folks in the messy middle. Right? The folks who are being swayed one way or the other by these very dominant voices in the conversation.
So a lot of that preliminary work was spent identifying who are our core audiences before we even got to the point of identifying these organizations to partner and co-host, who are our core audiences and who do we want to reach? And that was, you know, educators, faith leaders, right? Because a lot of misinformation was being spread, unfortunately, from the pulpit. And a lot of that was being done because of political affiliations, not because of what was in the best interest of the community. Health care providers, but we took a very holistic approach. So we wanted, again, going back to what Sandy was saying, this is a rural state. There is a health care shortage in the state, right? And so a lot times people are leaning on chiropractors or, you know, holistic practitioners to be their primary health care source and their primary health care.
And that’s unfair to both sides, right? It’s unfair to the professional who may not be equipped or have the background and education to best advise their client. And it’s unfair the individuals who are coming to them, right? And so that’s where you have a lot of this breakdown of folks polarizing. So in answer to your initial question, you know, the folks who are coming in, were representative of the community across the board, right? And what we did, again, very strategically, in our facilitation, was we asked very open-ended questions. And we didn’t lead with like, “This is why vaccines are good for you.” Right? We asked them, “Tell us what will make your community healthy.” And by asking those open-ended questions and engaging in, you know, facilitated conversation, we were able to bring a lot of the issues underlying this to the surface and effectively mitigate them.
Bosch: What did you hear at the listening sessions that surprised you?
Gryniewicz: So in one [session], I was sort of just planted in the middle of the room and more attending to making sure that we’re documenting everything and had some, we let everybody know the sessions were gonna be recorded and transcribed later and so on. And there is a table behind me that’s all ranchers and ranching housewives. We decided that if, if this didn’t work out, we could do, “Ranching Housewives in North Dakota” reality TV. I would watch that. I would absolutely watch that.
And the thing that was significant is, you know, they were talking and they were like, “This isn’t what I thought this was going to be at all.” And one of the women said, “I had come here to pick a fight.” Like literally had said that verbatim, but the thing is, the nature of this was really to engage. You tell us what, how you define community health and what is gonna make your community feel healthier and safer. And with that, what are you butting up against, right? And so it’s sort of neutralized and created sort of a safe space for people to just vocalize what their concerns were and they did vocalize, right?
I think that was probably one of the most stellar examples of things that, you know, we maybe suspected, but when we actually got in the room, we were like, “Oh, that’s absolutely validated.” And the conversation would go, you know, all over the place, but in the most meaningful way possible.
Bosch: Sandy, what are some of the top-level concerns about vaccines you heard the most at these sessions?
Tibke: Well, from what we were hearing and what we’re still hearing is that they’re not safe, right? And that, you know, there’s information out there that is being changed by, say, pharmaceutical companies like Big Pharma, and that people wanted that individual choice and to decide what went into their bodies, really. And that’s been the shift, specifically with the Covid vaccines, but that has extended past that now. That’s the main point of it, that they don’t feel like they’re safe anymore.
Bosch: So the listening sessions were, as you said, not persuasive sessions. So what came after the listening session?
Tibke: Well, I’ll give you, for the one community that we went to out in Western North Dakota. They asked us to come back and give a readout of that session. So we did another community meal that they helped to host and, you know, that first listening session, like Josh was explaining, there was other facilitators, they were really questioning them because they weren’t from North Dakota and were feeling like they had an agenda, and by the end of the evening, they were driving an hour back in from their ranches to let them into the Cowboy Hall of Fame, right? And so for me, what came out of it …
Bosch: Wait, literally, they had the key to the Cowboy Hall of Fame?
Gryniewicz: That is correct. They have the key to the Cowboy Hall of Fame, and we got a private tour. Yep.
Tibke: Because it was closed during the winter. So, and so I think what came out of the listening sessions is a little bit of trust that we went back again, so much so that we were back again because they knew we weren’t coming with an agenda and humanizing each other and seeing each other as community members and valuing each other’s opinion and maybe next steps on how we could help that community get to what their goal was: a treadmill in town. You know, to walk on during the winter, right? And so when you do that, you have that follow-through, you build relationships and trust, which when you have tougher conversations, you can at least hear each other. And then maybe you get to the point where a pen is a pen.
Bosch: What are some examples of helping or a conversation leading to the conclusion that a pen is a pen? Was there one example of a misunderstanding that you thought you were able to clear up well?
Gryniewicz: You know, even from the start, our focus was never explicitly just the bills or just to increase vaccination rates, or we wanted to facilitate these conversations as Sandy said, to start fostering, you know, some of that healing, bringing people together and starting to rebuild some trust, right? And so we have certainly seen examples come out of that, of rebuilding the trust. But, you know, in our piece we shared, you know, a lot of the stuff that happened were amplified or, you know, kind of ripple effects out of these listening sessions. So we heard from residents who would talk about, you know, like, “Oh, I was hesitant [to get my child vaccinated] because of concerns about autism, for example. But I had a conversation at church with somebody in the greeting line afterwards, who was a nurse. And because I had this connection to her now, I was more receptive and understood better.” So like, that was the dispelling of, of mis- and disinformation, right? Because it was built on this foundation of trust.
Bosch: Right, so the exact same conversation you think would have gone differently had they not established trust in the listening sessions.
Gryniewicz: I don’t know that the conversation would have happened at all. Because, you know, so much of this was so entrenched when we were doing what Sandy had mentioned earlier, part of our preliminary work was doing these, you know, key informant interviews. So Sandy and I road-tripped around the state. You know, she has a much stronger bladder than I so, you know, she, we would have covered a lot more ground if it weren’t for my coffee habit. We met with two dozen, you know, folks who were representative of these key audiences, right? Including, a Republican leader who sat down with us, you know, was very welcoming but told us quite frankly and bluntly — this is, again, in the beginning before anything else, when we brought up the topic of vaccines and we were having this conversation with him, he bristled. His shoulders went up, he went ghost white, and he just sort of shivered. And he said, “Look, I can’t even engage in that conversation. Even if me and my family were vaccinated, I couldn’t talk about it, right?” So that’s what we were up against, right? So going back to that conversation in the church, it just wouldn’t have happened. People were sort of in this like, we’re gonna shut down these conversations or we’re coming to pick a fight or what have you because things had gotten so entrenched and so politicized and polarized that there was no groundwork for that.
Bosch: So after these listening sessions, after going back and having more listening sessions, what were the next steps?
Tibke: So from a programmatic standpoint, we moved into partnering with Shackle Free, which was started in North Carolina. And what they do is they work with barbers and hairstylists throughout the state and train them on modules. So they almost become community health workers because they’re a trusted source. You see them regularly, oftentimes more than your doctor. And so we started putting that program together. And that was, for me, the next step on trying to embed trusted community members across the state where people could just have conversations and that they could get fact-based information and then make their own choices for themselves and their families. Then the budget cuts came in last March and that program has to stop for right now until we find additional funding. But for me, from a practical standpoint, that’s the next step. And then also, we’ve created deeper partnerships with, say, Sacred Pipe Resource Center within Bismarck and trying to plan out different community meals we can have to continue those discussions.
Gryniewicz: And there were two main objectives, Torie, to the listening sessions themselves. The first was to establish common ground, to bring all these people together, and to have conversations where we could agree a pen is a pen, right? And facilitate that.
The second was that we actually were harvesting, you know, ideas of what was going to make the community healthier, and what was going to, you know, be able to be implemented. So you know, Sandy just mentioned the Shackle Free organization that the whole idea of like, developing kind of like a community health worker per professional workforce in the state. Again, going back to some of the issues that we identified, you have a rural community where people are leaning on professionals who may not have or be best versed in, you know, articulating what the problem is, or what the solutions are. And they’re being looked at as like the source of all information, right, so having a community health worker approach helps amplify that. But we identified several sort of like recommendations out of all the listening sessions, the interviews, everything else. The first was community activations about health and wellness, so never explicitly leading with like, “Hey, we’re going to have a vaccination event,” but always trying to fold it into something else that was going on, having a bouncy castle and a barbecue, and then, you know, then the truck can roll up, The second was establishing community-based partnerships, which we began to do with those listening sessions, but those were very deep engagements. Sandy and her team were working with some of those organizations on an ongoing basis throughout. And being able to leverage some of those relationships to amplify the reach of these, this community health worker network, creating value-neutral and nonjudgmental spaces and language — communications that lead with curiosity.
So all of our pieces, whether they’re listening sessions or a campaign as a whole, trying to facilitate those conversations. Normalizing vaccines by folding them into other community events, and then using, you know, the strategic storytelling piece to sort of push out some of this messaging, whether it’s the video series, the sheer volume of incredible webinars that Sandy and her team have curated, you know, training community leaders and public health professionals on shaping and sharing stories, all of those pieces.
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Bosch: And so there’s sort of two different tracks going here, right? So there’s the big picture, long-term, how do we develop these relationships? How do we start working with the community to kind of define a pen as a pen for everybody? And then there was the sort of short-term combating these bills. And I wanna focus on the bills just for another couple of minutes, since I think that’s so relevant to what we’re seeing in lots of other states and federally right now.
So tell me a bit about what happened. How did these listening sessions end up affecting or not affecting the bills that had been proposed in the North Dakota statehouse or in the North Dakota legislature, with whatever it’s called there?
Tibke: The legislature. Well, you’re just building a relationship so you can make some phone calls to either gain perspective of a region to talk to a legislator or so in my case making sure that you’re connecting with the state veterinarians association, the stockman’s association, and then of course physicians, hospital systems, and all the professional organizations attached to health care within the state. But also, you know, one of my board members and now our board president is a pediatrician and an integrative medicine specialist. So making sure that people see that we believe in integrative medicine as an organization so chiropractors feel safe to talk about their perspective and I can talk about ours.
But the impact really from listening sessions was being able to bring a group of people together and then have different people testify. I never asked for physicians or public health workers to testify because what I was seeing in the 2023 and 2025 sessions was that legislators, especially in human services on the House side and in Senate, not all, but the majority, didn’t take to heart the physician’s perspective, that they felt like they were coming from an agenda. And that they were listening to out-of-state organizations and in residents, which is good that they’re listening to residents. But what came from those listening sessions being able to pull in the people that had a little more influence, which would be the stockman’s association, the veterinarians association, and different groups that had heavier lobby that hadn’t split yet from the legislators as far as trust goes.
So that was a good outcome from the listening sessions. And then developing trust with groups that didn’t agree with us so you could at least have conversations and agree to disagree, but there wasn’t such venom or such othering and dehumanizing discussions that were occurring, which is what I was trying to flip the narrative to what we’re for, not what we are against each and every time over and over and again, so we can start disciplining ourselves that way.
Bosch: And so ultimately you were successful, right? None of these bills that you were particularly concerned about in, was it 2023, ended up passing?
Tibke: Yeah. Yep. Right. We were successful by and large. I think that it will take many sessions to get back to the point. Each session will be a challenge. Ours is every other year. And right now we’re starting our Grandparents for Vaccines chapter within the state of North Dakota. There’s been a lot of interest from our older population. They believe in vaccines. They were around when polio was around. … Until you see it, you’re not understanding the impact as much. So we’re going to have to keep working very hard and keep bringing together, you know, the influential people into the session. …
Bosch: So then I suppose you could say that the result is not just defeating the bills in 2023, but preparing to fight them again in 2025, 2027.
Tibke: Exactly. I foresee this to be a decade long before it starts to calm down. I’ve had a lot of experience with community change and change management around tense situations. And it does take time to bring that trust back and consistent work and work that you can’t quantify, meeting in person over a barbecue. You know, it doesn’t sell to, to a philanthropist necessarily, but the culture starts to shift over time. And then that’s what benefits a community.
Gryniewicz: A lot of this is contingent on those cultural levers, which isn’t something that public health is — that’s not the default, right? So public health traditionally doesn’t go to cultural levers unless it’s doing a PSA with a celebrity spot, right? And I think part of what this overall strategy is when doing kind of that narrative framework and the listening sessions and all of this is let’s actually focus on those cultural levers.
Bosch: I think that’s a pretty great place to wrap up. I do have one final question. Do you have any events planned with the Cowboy Hall of Fame?
Tibke: We should because it was truly amazing and it was the best of what I know about, I’m sure anybody in any part of this country, when you are face-to-face and you have a meal together and visit and humanize each other where you’ll go out of your way to do something, right? And a neighbor helping a neighbor. So it was lovely to see at the time.
Gryniewicz: And they gave me a friends and family discount at the gift shop. I got a kickin’ denim hat with a lasso and a rodeo theme, and it was 10% off. …
Tibke: Well, and we went ax throwing with the nun.
Bosch: Wow, we came to that way too late.
Gryniewicz: Yeah, no, that had never been on my bucket list until it happened. And I was like, oh, this really should have been like, you know, ax throwing with a nun. I think I was wearing a Slayer shirt as well, so it’s really, it’s just bringing people together.
Bosch: Yeah, you talked about the, the ranch wives of North Dakota. I think the reality show really should be just following you guys and your team around North Dakota, I would watch the crap out of that.
Josh Gryniewicz and Sandy Tibke, thank you so much for coming on the First Opinion Podcast.
Gryniewicz: Thank you for having us.
