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‘Speed versus equity’: RI vaccine rollout slowed by targeted approach

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12 on 12: Vaccine 101

PROVIDENCE, R.I. (WPRI) – When Dr. Wilfred Giordano-Perez heard about 900 people getting vaccinated at a Providence municipal clinic last weekend, he was shocked to later find out that more than 50% of the recipients who showed up lived in the city’s East Side neighborhood.

The East Side is the city’s most affluent neighborhood, where nearly 80% of the residents are white. It has one of the lowest infection rates in Providence, where the majority of the city population is people of color, according to data compiled by the R.I. Department of Health and U.S. Census Bureau.

Giordano-Perez, a member of the state’s COVID-19 Vaccine Subcommittee, a panel of mostly doctors that advises state leaders on the vaccine rollout, expressed disappointment that the clinic — which he lauded for being put together so well and effectively under pressure — seemingly departed from the state’s overarching goal of integrating “equity” into vaccine distribution.

“We focused on speed this weekend and when we focused on that, we lost equity,” Giordano-Perez told his colleagues during a subcommittee meeting Friday.

Giordano-Perez’s anecdote highlights the challenges currently facing Rhode Island’s vaccine rollout strategy, which has been criticized both locally and nationally for moving slowly compared to other states. The approach – guided in part by the vaccine subcommittee members – has focused on giving special consideration to neighborhoods hit disproportionately hard by the pandemic.

The subcommittee has dubbed this guiding principle “equity,” which is supposed to be applied across the state’s broader mission of ensuring safety, minimizing morbidity, distributing vaccine efficiently and ensuring access to all.

For example, vaccines were first made available to health care workers, nursing home residents, first responders and some inmates – groups that are at highest risk of contracting the virus. But the state has also allocated more than 7,500 first doses as part of a pilot program for Central Falls, where local health officials estimate more than half of the city’s 20,000 mostly Hispanic residents have been infected at some point during the pandemic.

The state’s initial plan met with little pushback through the first month of inoculations, as Rhode Island jumped out to an early lead nationally when it came to getting vaccines into arms quickly – despite frustrations over the limited supply provided by the federal government.

In recent weeks, however, state leaders have come under fire for not moving quickly enough as Rhode Island has slid down the national rankings for vaccination rates, to the frustration of many who are anxiously awaiting their turn.

“We have come up against the push for speed versus equity,” R.I. Health Department Director Dr. Nicole Alexander-Scott said at the meeting Friday. “For us as a state, and with your support as a subcommittee, we have really focused on equity – going for the individuals who are at the highest risk. That ends up coming with some cost to speed.”

Last week, the Health Department moved up its timing for starting vaccinations of people 75 years and older, offering municipalities 5,000 unused doses left over from other Phase 1 clinics, and the announcement spurred a frenzy.

Municipal leaders quickly implemented piecemeal plans for how to offer the vaccines to eligible adults, and in many places, they defaulted to a first-come-first-serve approach – giving no special consideration to people disproportionately affected by the pandemic.

The dynamic played out in real time at the clinic Giordano-Perez talked about during the meeting.

“This is the hard place we’re in,” Alexander-Scott said after listening to Giordano-Perez. She added, “We actually have an active focus on combating [inequity], and we’re still faced with what you shared.”

Now, health officials are grappling behind the scenes with how to best move forward on an approach that’s both equitable and quick. The state has indicated it will begin allocating about 7,000 doses per week to municipal clinics beginning Feb. 14, and the Health Department plans to send even more to some densely populated neighborhoods where infections have spread the most.

The hardest-hit neighborhoods outside of Central Falls – located mostly in Cranston, North Providence, Pawtucket and Providence – are also largely made up of residents of color. Since the beginning of the pandemic, Hispanic Rhode Islanders have made up 30% of all infections and 27% of all hospitalizations, despite only representing about 16% of the state’s overall population.

White Rhode Islanders, meanwhile, have made up the vast majority of deaths – about 84% — while representing about 71% of the state’s population, according to state data. Many were residents of nursing-home and assisted-living facilities, where 65% of the state’s more than 2,200 coronavirus deaths have occurred. As a result, vaccines have been offered at those locations first.

The highly targeted approach in the broader community has been praised by people advocating on behalf of hard-hit communities, but it’s also fallen flat among older adults and people with underlying health conditions who live outside those neighborhoods and feel like they should also be getting the vaccine more quickly.

M. Teresa Paiva Weed, president of the Rhode Island Hospital Association and former president of the R.I. Senate, said many of those people are reaching out to her directly through calls and text messages.

“There are a lot of seniors in our community that feel they are not being reached, that they are not being heard,” Paiva Weed said. “I really feel the need to say something.”

The state has entered into a new partnership with pharmacy giants CVS Health and Walgreens, which could speed up vaccinations for people outside of the targeted communities. The state plans to initially allocate 2,000 doses to each company next week, which could increase later depending on supply, and the retailers announced they will begin accepting appointments over the weekend.

CVS has already announced where it will be offering inoculations, while Walgreens did not immediately respond to a request for additional information.

CVS is separately partnering with the federal government to also start vaccinating eligible individuals in Rhode Island and Massachusetts, meaning the company will get additional doses delivered directly without having to go through the state first.

And health officials are hopeful expanded availability of vaccines at pharmacies, municipal clinics and state-run vaccination programs – such as a mass vaccination site now being put in place at the Dunkin’ Donuts Center in Providence – will bring Rhode Island more in line with the pace of vaccinations seen in other states, while also allowing them to do more targeted work in hard-hit communities that might otherwise be left behind.

Whether they will be successful in striking that balance, however, was a source of concern among some on the subcommittee who already see what they describe as a troubling trend in the data available.

“Even with the emphasis on speed and the fact that we have taken a proactive equity posture with our vaccine, the percentage that are going to people of color is still low,” said Dr. Pablo Rodriguez, a Care New England physician and subcommittee member.

The Health Department’s limited data on vaccine demographics so far shows only 6% of the doses administered have gone to Hispanic and Latino recipients, while 56% have gone to white recipients. More than a quarter of Rhode Islanders who have received at least one shot – 27% — either declined to disclose their race and ethnicity, or it was otherwise unknown.  

“I continue to get messages of criticism about our effort,” Rodriquez added.

The rollout plan is only further complicated by the limited supply of doses coming from the federal government, as well as the anticipated spread of more contagious and possibly more deadly variants of the coronavirus first identified in the United Kingdom, South Africa and Brazil.

Alexander-Scott announced the state could see its weekly supply of first doses from the federal government increase from 16,000 to 19,000 by the end of the month, which would give the state a near-term boost. There are also more potential vaccines on the horizon, as Johnson & Johnson this week requested emergency FDA approval of its vaccine – a one-dose regimen that has proven highly successful in preventing severe disease and death.

But how quickly that might translate into more doses for Rhode Island if federal regulators approval the J&J vaccine isn’t clear, as supply would likely be limited at first, with an ultimate goal of 100 million doses for the United States by June.

Meanwhile, public health experts such as Dr. Ashish Jha, Brown University’s nationally renowned dean of public health, have warned the next couple of months “may be very tough” as a result of the spread of new variants.

Nonetheless, Jha is bullish that by the time summer arrives there will be “way more vaccines than people.”

“By summer, some things won’t be ‘normal’ like large indoor gatherings,” he tweeted Friday. “But backyard BBQs among vaccinated friends/family? Safe and effective.”

Eli Sherman (esherman@wpri.com) is a Target 12 investigative reporter for WPRI 12. Follow him on Twitter and on Facebook.

Correction: An early version of this story incorrectly described Dr. Wilfred Giordano-Perez’s involvement with the Providence clinic.

Copyright 2021 Nexstar Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

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