PROVIDENCE, R.I. (WPRI) – The federal government says it has delivered Rhode Island about 87,000 more COVID-19 vaccine doses than the state has administered.
So where are the unused shots and why aren’t they getting into arms faster?
Rhode Island health officials have struggled to answer those basic questions, pointing to discrepancies in federal reporting, and more broadly touting the state’s hyper-targeted approach of first vaccinating people at highest risk of going to the hospital or dying.
“The targeted approach takes more time,” R.I. Department of Health spokesperson Joseph Wendelken said this week.
Target 12 has repeatedly requested a detailed breakdown of the status of the unused doses, but health officials had not provided one as of Tuesday afternoon. The Health Department’s publicly reported data about vaccine supply has not been updated for a full week, unlike the CDC’s.
The Health Department has also insisted — without providing hard numbers — that some of the 87,000 doses the CDC reports having delivered to Rhode Island might actually still be in transit, even though the CDC claims to have changed its reporting to only reflect doses that have actually been delivered.
In addition, Rhode Island leaders including Gov. Gina Raimondo have pointed the finger at CVS and Walgreens, the two pharmacy giants that are managing vaccination clinics at nursing homes and other congregate-living facilities through a federal program.
But nearly every other state is also participating in that program, and Rhode Island officials’ most recent estimate of how many doses are in limbo due to the CVS/Walgreens program is only around 20,000. That would leave still leave upwards of 60,000 doses the CDC says it has delivered to Rhode Island which have yet to be administered.
The state is withholding some first doses for use at its two new mass-vaccination clinics for adults 75 years and older, which are set to open on Thursday in Providence and Cranston. Wendelken said 7,000 to 10,500 doses would go to the two sites each week and more could follow.
“As more vaccine comes in, we will be increasing the number,” Wendelken said.
Wendelken also said about half of the state’s weekly vaccine shipment from the federal government is currently second doses. About 24,000 of the current unused shots are second doses, Wendelken added Tuesday night.
He pushed back on the notion that second doses were being held for any reason other than logistics, saying it can take up to 10 days for a dose to get administered after arriving from CDC.
“We do this to have a buffer,” Wendelken said. “The vaccine needs to get shipped, received, and redistributed, and then the person’s clinic may be a few days later on the calendar. So while those second doses may be in Rhode Island for a week and a half, it’s not that the vaccine is being held somewhere. That vaccine is in process.”
In addition, Rhode Island officials have suggested the CDC’s numbers exceed what the state has actually received — a frustration that was echoed by leaders of others states in a letter that the National Governors Association sent Monday to President Biden.
The group called on the CDC to be clearer about where doses are being delivered, and to differentiate between federal allocations that go directly to states versus those sent to other entities, such as pharmacies, which never come under the control of a state government.
“We believe it is important that the CDC in its reporting distinguish between these separate efforts to avoid confusion and provide a clear understanding to the American people,” wrote members of the NGA’s executive committee, among them Massachusetts Gov. Charlie Baker. “States also need visibility into the federal vaccination efforts at the facility level happening in our borders.”
‘Held in queue’
In Rhode Island, health officials said there are roughly 20,000 unused doses currently sitting in the public-private pharmacy partnership created to vaccinate residents and staff at congregate living facilities, such as nursing homes, assisted living facilities and group homes. (Data posted by CVS and Walgreens puts the number lower, at about 14,000 unused doses for Rhode Island in the program.)
The federal program has required the state to set aside about 7,000 doses a week – amounting to nearly half of its total weekly allotment of first doses – to CVS and Walgreens, which run the clinics.
That weekly allocation – which ended this week, freeing up about 7,000 doses for municipal clinics – was not tied to demand, resulting in oversupply and bottlenecks.
A CVS spokesperson told Target 12 the federal government determined weekly allotment based on facility bed count and then doubled it for staff, meaning estimates weren’t tied to the actual number of residents and employees at the facilities.
“Vaccine allocations for CVS are based on an estimate held in queue, not the actual amount of vaccine that will be ordered and used for a clinic at a facility,” CVS spokesperson Matthew Blanchette said Tuesday. “Actual occupancy is less than bed count, and staff uptake has been lower than expected.”
As a result, the state set aside upward of 52,000 doses for the CVS/Walgreens partnership through last week — a high number considering there were fewer than 8,000 nursing home residents in Rhode Island prior to the pandemic, according to the Kaiser Family Foundation. More than 1,200 Rhode Island nursing home residents have died after contracting the coronavirus since last March, according to the Health Department.
Health officials said some of those 20,000 unused doses will become available for the general public once the pharmacy program ends, but they did not respond to questions about when that would happen and how many might be freed up.
As of Monday, CVS reported it had completed all clinics at 47 participating nursing homes and was 29% of the way through its clinics for 162 assisted-living facilities and other congregate care centers. Altogether, the Woonsocket-based company reported it had administered 25,513 first and second doses.
Walgreens, meanwhile, reported Monday it was more than two-thirds of the way through its clinics for 35 nursing homes, and was almost done with its first round of vaccinations at more than 40 assisted-living facilities. The pharmacy reported it had administered 12,426 first and second doses.
Walgreens did not respond to questions about whether it planned to give the unused doses back to the state after it completed the program, or provide them through existing retail locations. State health officials likewise did not comment on what would happen to the doses.
Blanchette said CVS would work with the state to redirect “an appropriate portion of that allocation so it’s repurposed elsewhere,” suggesting that the federal government is holding the excess amount.
The inflexible agreement may have limited Rhode Island’s ability to be nimble more than other states because nursing homes and state leaders jumped at the opportunity to fully participate in the program. Early estimates suggested nearly every nursing home in Rhode Island, along with more than 100 assisted-living facilities and other state-run and private-run group homes, opted in.
Nearly all other states also participated in the public-private partnership, but many entered into separate agreements with pharmacies outside of the federal program. And that independence allowed some to move doses around more efficiently based on demand, as has happened in North Dakota, which is doing comparatively well.
West Virginia decided not to join the CVS/Walgreens partnership at all, and has now administered the highest rate of first doses per capita across all states, according to the CDC.
‘Finishing that more targeted approach’
R.I. Health Department Director Dr. Nicole Alexander-Scott, who leads the state’s coronavirus response effort, expressed mixed feelings Tuesday about entering into the partnership.
“Up front, you know, it was the right thing to do to make sure that we connect with a federal opportunity that was going to vaccinate as many of our seniors in long-term care as possible,” she told 12 News. “We definitely wish we didn’t have such drastic gaps in administration rate when you look at the pharmacy partnership and what we were doing with the rest of the state because it made the overall average be challenged.”
Connecticut has moved quicker than Rhode Island in part because it committed early to mass-vaccination sites, allowing it to move non-nursing-home doses efficiently. Massachusetts had been a national laggard like Rhode Island, but now appears to have picked up the pace since opening multiple state-run vaccination sites in locations such as Gillette Stadium.
Rhode Island’s strategy has been coming under increasing criticism. It ranks last in national rankings and received an “F” in an analysis by Harvard University last week. Lt. Gov. Dan McKee, who’s poised to take over as governor once Raimondo becomes U.S. commerce secretary, criticized the rollout strategy publicly on Monday after previously offering his support.
“Like most Rhode Islanders, I am not satisfied with the current administration’s progress on vaccine distribution, especially as we see our neighbors in Connecticut ranked among the top in the nation,” McKee, a Democrat, said in a statement.
Alexander-Scott defended the state’s strategy, saying the early targeted work will pay off in the long run because it will help tamp down infections, hospitalizations and deaths.
“We knew it would be slower because we wanted to be more targeted,” she said. “But as long as Rhode Islanders understand what we’re seeking to achieve, the data speaks for itself as to how significant our drop has been in hospitalizations and Rhode Islanders will see that the access to vaccines will improve.”
Health officials presented new numbers Tuesday afternoon showing Rhode Island hospitalizations have declined quicker in recent weeks than other states that have gotten vaccines into arms more quickly, including Connecticut, Massachusetts and even West Virginia. The presentation echoed a Target 12 analysis from last week that showed hospitalizations declining quicker in Rhode Island than the region and nation.
Alexander-Scott now nonetheless wants and expects the pace of inoculations to speed up in the coming weeks, pointing to the new mass-vaccination clinics, which will serve eligible recipients on a first-come-first-served basis.
Additionally, the state’s ability now to redirect the 7,000 weekly doses previously tied up in the pharmacy program could bolster local efforts. And moving to an age-based system of prioritization could expedite the state’s strategy, which had been much more restrictive until this point.
“We will do everything, and have been, and will continue to do everything we can to get it out to members of the public particularly now that we are finishing that more targeted approach,” Alexander-Scott said.
Kim Kalunian and Ted Nesi contributed to this story.