Anne Sosin was feeling optimistic.
The Dartmouth College researcher had just booked an appointment to receive her first dose of the Moderna vaccine and was preparing for a run when her neighbor called. It was bad news: The woman, who often provided child care for Sosin’s daughter, had contracted Covid-19.
“I was blindsided,” Sosin said.
Within the hour, she and her 8-year-old daughter were tested for Covid at a site in Fairlee, a 10-minute drive from their home in Thetford. Sosin would test negative, her daughter positive. After getting the go-ahead from the Vermont Department of Health, Sosin received her first shot two days later, hoping to outrun the virus. She did not — and tested positive a week later.
After a year of vigilance, Sosin had felt relatively sheltered from the virus. Yet she was startled by the turn of events, despite the ubiquity of her experience. On that Saturday in early April when her neighbor called, more than 220 other Vermonters would also test positive for Covid.
Sosin was certainly aware of the threat the virus posed to Vermonters. In documenting the rural response to the pandemic in her state and New Hampshire in her professional life, she had become increasingly vocal in her critiques of Gov. Phil Scott’s administration, aghast that Vermont appeared increasingly inured to booming case counts.
It is a “critical moment for us to stay the course,” Sosin had told Seven Days roughly a week before she would catch the virus herself, urging the state not to relax mitigation measures just yet.
The same story quoted the governor as saying, “We’re just going to have to get a little bit more accustomed [that] there’s going to be some positive cases. It’s a fact of life.”
‘Focused on action’
A public health lecturer and researcher at Dartmouth with a focus on equity, Sosin has spent much of the past year tracking how local institutions in four rural regions straddling the Connecticut River have responded to the Covid crisis. Through interviews with health workers, nonprofit leaders and educators, she and her team have documented the ways in which schools, hospitals and community groups have reimagined themselves overnight to serve their communities.
Like so much academic work done during the pandemic, hers has been public-facing. She and her research partner, Dartmouth anthropology associate professor Elizabeth Carpenter-Song, have issued a flurry of policy briefs and reports.
“The work has really been focused on action,” said Carpenter-Song. “Conducting the interviews, trying to distill core information, but then not wanting that to sit on a dusty shelf.”
At first, their research highlighted the successes and lessons learned from the region’s handling of the virus. Sosin was interviewed by Vox last November touting the benefits of Vermont’s decision to house those experiencing homelessness for the duration of the crisis.
“If we look globally,” Sosin told Vox at the time, “the countries that have done better [with Covid-19] prioritized their vulnerable populations.”
Sosin and Carpenter-Song’s research gave credit to state leaders for acting quickly and decisively in the early days of the pandemic. But it also focused on the ways in which community organizations, mutual aid groups and health care providers leaped into action at the local level in the Twin States.
“The Vermont story is so much more than what we see at the podium, week in, week out, at the press conferences,” she said, referring to the Scott administration’s twice-weekly briefings.
‘Dismaying to see’
Their research tracked the two states’ diverging paths last fall. As Vermont became stuck in a second wave this winter, battling ever-climbing case counts, Sosin’s work and commentary grew increasingly critical of a state once hailed by Dr. Anthony Fauci as a model for the country.
More often lauded for its handling of the pandemic, the Scott administration has rarely been criticized directly by the state’s public health experts. (One notable exception: The governor’s decision not to prioritize Vermont’s prison population for vaccination, which led the state’s own vaccination advisory panel to leak a dissenting letter to the press.) But Sosin has been blunt in her criticisms, even when others have been more circumspect.
Frequently, she has been vindicated.
As early as January, Sosin questioned the wisdom of allowing indoor sports over the winter season as case counts remained stubbornly high. “I don’t see this as the time to increase or to take risks in this way,” she told VTDigger at the time.
Administration officials defended the move as a mental health intervention, and said they would keep a close watch on cases.
“Should data emerge that indicates evidence of Covid-19 transmission or significant disruption to academic instruction because of sports-related activities, additional restrictions may become necessary,” Secretary of Natural Resources Julie Moore said in early February, as officials gave the green light for interscholastic competition.
But even as transmission began flaring up in February, games continued, and athletic teams would ultimately be linked to the vast majority of the largest school-based outbreaks this academic year.
In February, Sosin called on the state to follow Centers for Disease Control and Prevention guidance and prioritize essential workers for vaccination, warning that those on the front lines were at higher risk for infection.
State officials have repeatedly defended their age-banding vaccination strategy, saying it prioritized saving lives above all. Sosin countered that this made little sense once the oldest were immunized, and ignored the growing prevalence of young, healthy people developing chronic conditions after infection.
It’s impossible, at this point, to know whether targeting frontline workers would have tamped down transmission overall. But occupational data would later show that the lowest-paid workers, and particularly those who work in food service, had the highest rates of infection in the state in February and March. (Vermont did eventually prioritize Black, Indigenous and people of color, who are overrepresented in the state’s essential workforce, for vaccination, though it waited until April to do so. Racial disparities in immunization rates persist, though they have narrowed.)
“A large part of the state’s success was that prioritization of vulnerable populations,” Sosin said. “And so it’s been dismaying to see a much more narrow conception of vulnerability in the context of vaccination.”
‘Moment of clarity’
Sosin grew up in a Chicago suburb before leaving for Dartmouth College in 1998 to pursue an undergraduate degree. Soon after college, she flew to Port-au-Prince, helping to document the human rights abuses — and particularly, sexual violence — that followed a pair of coups d’etat that plagued Haiti in the early 1990s. Instead, the government was once again forced out in 2004, and Sosin found herself interviewing survivors as violence erupted anew.
Bill Quigley, an emeritus law professor at Loyola University who regularly volunteered with the Institute for Justice and Democracy in Haiti, the nonprofit Sosin worked for, recalled a tireless advocate who didn’t pull any punches — despite her unassuming nature.
“If something was wrong, she was going to do something about it,” he said. “And she would not be deterred.”
Sosin also truly embedded herself in the community, Quigley said, learning Creole, traveling to neighborhoods many human rights workers wouldn’t venture into, and building friendships and partnerships with people on the ground.
“Some people come to Haiti to work for people, and there’s others who come to Haiti to work with people,” he said. “She was definitely one of the people who came to work with people.”
But the ceaseless violence on the island wore on Sosin. She had what she described as a “moment of clarity” when a woman she met in the capital’s Cité Soleil slum died of sepsis after initially surviving a gunshot wound to the chest. Instead of “just cataloguing abuses or depravations” that lead people to die, Sosin decided to help build systems that might keep them alive.
“The thing I really didn’t like about conventional human rights work — it was just like, documenting and then maybe denouncing. And I’m just way too practical,” she said. “I don’t really want to just be an observer to suffering.”
Sosin returned to the United States in 2007 to get a master’s degree in public health from Johns Hopkins University in Baltimore. And then she left again, this time headed to Rwanda, where she took a job with Partners in Health, a Boston-based nonprofit, to work alongside the government in rebuilding the country’s health system in the wake of the 1994 genocide.
“I wanted to go to Rwanda to see a country getting it right,” she said. “I needed to understand that something else was possible besides what I had lived through in Haiti.”
Sosin was stationed in Burera, a remote district on the border with Uganda. For a while, checking email required a drive down a mountainside to collect gasoline and run a generator. The work was deeply unglamorous, she said — rebuilding supply chains, creating trust between the local government and the NGO, and helping to oversee construction of a new, 150-bed hospital that opened in 2011.
“It looked like spending a lot of time in sort of dusty administrative buildings, listening to leaders, getting to understand what their priorities were, what the challenges they were facing were,” she said.
Once decimated by political strife, Rwanda’s health care system now offers near-universal health coverage for its citizens. And in March, the hilly country became the first in Africa to administer the Pfizer vaccine, despite the need to keep the shots stored at ultra-cold temperatures.
‘Time to bring global health home’
Sosin has been back in the Upper Valley for about seven years now, where she has toggled between teaching courses at Dartmouth and Colby-Sawyer College and overseeing global health initiatives at Dartmouth’s Dickey Center for International Understanding. But she often draws parallels between her work in the U.S. and abroad.
“It’s time to bring global health home,” she said in a TEDx talk in 2018, urging her audience to consider the implications of America’s steadily declining life expectancy, driven mostly by mortality rates among the poor.
Listening to the way in which people talk about rural regions in northern New England, Sosin is often reminded of how people talk about low-income countries, dismissing communities as “backwards” and incapable of progress. That overlooks the very real strengths present in such places, she argues, and it misunderstands their true vulnerabilities — chiefly, poverty and a lack of resources.
Sosin had hoped to write a paper with former colleagues comparing Vermont and Rwanda, the latter of which has been held up as an exemplar for its management of the virus. The country has at times been criticized for being heavy-handed in its lockdown measures, but it has also earned plaudits for centering equity in its response.
While many Americans survived the virus only to receive financially ruinous hospital bills, those who tested positive in Rwanda were quarantined, lodged, fed and treated — for free. To date, the central African nation has recorded roughly the same number of cases and deaths as Vermont, despite having a population more than 20 times its size.
For now, that project is on hold, as Sosin struggles to decide what she wants to say about this last phase of Vermont’s experience with the pandemic. The Green Mountain State may have outperformed the rest of the U.S. in its handling of the virus, but she says it’s hard to hold it up as a global model.
For so much of the pandemic, Vermont “demonstrated how to get this right,” she said, and it was disheartening to see it fall prey over the winter to a sort of “pandemic nihilism” — a notion that resurgences of infection are inevitable, that little could be done to avert the vast disparities in outcomes seen in more marginalized populations.
Now out of isolation and officially Covid-negative, Sosin is recovering well so far, and her daughter is entirely symptom-free. Still occasionally out of breath when she lectures or walks up stairs, the lifelong runner went for a low-intensity jog Wednesday, the first time since she was sickened by the virus. She’s still trying to make sense of it all, and her emotions are mixed.
“Being forced to slow down a little bit, it did give me some time to reflect on both a sense of gratitude — for my experience — but also a little bit of mild grief for what so many others have gone through,” she said.