Covid left many Republicans leery of public health. Not Indiana Gov. Eric Holcomb.

This year, Holcomb pushed a 1,500-percent increase in state dollars to local health departments through the GOP-controlled legislature, a significant victory in a state that consistently ranks among the bottom for public health outcomes.

It also marks a notable deviation from the approach the Republican Party — from state lawmakers to presidential candidates — has taken to public health post-pandemic as it leans into the sizable wing of the party skeptical of government and public health ahead of the 2024 election.

Pandemic backlash and anti-vaccine sentiment have coalesced into a growing movement hostile to government involvement in public health, and its enmity stretches beyond Covid vaccines and masks. Florida Gov. Ron DeSantis has touted his “medical freedom” bona fides as he campaigns for the nation’s top office. Rep. Matt Gaetz (R-Fla.) earlier this year called for abolishing the CDC. And Wisconsin’s GOP-controlled legislature last month blocked a meningitis vaccine requirement for seventh graders.

But Indiana may offer a conservative model for improving fragile and beleaguered public health systems and countering the growing opposition to them that’s dominating the discourse.

Holcomb, who is term-limited and will leave office in early 2025, spent more time talking specifically about public health in his State of the State address this year than any other governor — Republican or Democrat — according to a POLITICO review of each governor’s speech.

Holcomb knows the proposal put him on a political limb, but said the pandemic exposed the need to address the state’s historically poor public health metrics. Indiana has some of the lowest levels of per capita public health funding in the nation, and ranks poorly in several key measures, such as smoking and tobacco use, obesity and mental health.

“If we were going to make a mistake, it was not going to be because we were sitting around admiring the problem,” Holcomb said in an interview. “It worries me if someone believes there should be no government role in public health or public safety or public education or public infrastructure.”

Indiana offers lessons for public health advocates in states where politics has turned hostile, said Michael Sparer, professor and chair in the Department of Health Policy and Management at the Mailman School of Public Health at Columbia University.

“What Holcomb and others were able to do in Indiana — which is so unusual and so important — is basically say, ‘You know what? Public health is more than the pandemic. It’s more than masks and vaccines and school closings. Public health is about the health of your local community,'” Sparer said. “They were able to make that message resonate with enough — not with everybody, but with enough — of the political leadership of the state in an economically viable time to get some increased funding.”

Lawmakers, lobbyists and public health advocates in Indiana chalk the bill’s success up to a favorable budgetary climate that left lawmakers unusually generous, smart leadership by Holcomb and careful messaging from his appointed and well-respected foot soldiers — including a former state senator, Luke Kenley, who earned a reputation as a penny-pinching budget chair during his time in the legislature.

Medical technologists work at a computer in the PCR testing lab at Quest Diagnostics on Feb. 9, 2022, in Indianapolis, Ind. Holcomb said the pandemic exposed the need to address the state’s historically poor public health metrics.