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How Rhode Island, once a model for COVID-19 response, stumbled in its vaccine rollout
Last summer, Rhode Island was in the news for what appeared to be a successful response to the COVID-19 pandemic, and the state’s governor, Gina Raimondo, was lauded for her enterprising approach to the outbreak. Now, just seven months later, the state is struggling with surging deaths from the disease and allegations that leading health care companies unnecessarily vaccinated staff and volunteers not in direct contact with patients, while others at risk — including the elderly — were left waiting for their shots.
Rhode Island took a targeted approach to the vaccine rollout when it began in December, prioritizing hospital staff, long-term care facilities, and an especially hard hit low-income city called Central Falls, which is the most densely populated in the state. It was a plan that incorporated guidance from the Centers for Disease Control and also attempted to address inequities in health care.
Yet Rhode Island’s vaccine controversy typifies one of the pitfalls that states have faced in recent weeks when trying to get shots in arms: Creating highly specific, targeted policies can also inadvertently slow down vaccinations or arbitrarily exclude groups of people who would normally be prioritized under CDC guidance.
Controversy first erupted in mid-January, when the Providence Journal reported that Rhode Island’s two largest hospital groups, Lifespan and Care New England, had vaccinated not only their doctors and high-risk staff, but also board members and even remote workers. That meant low-risk, non-medical staff were getting vaccinated at least a month before unaffiliated dentists, eye doctors, and other private practice physicians throughout the state, as well as at-risk elderly individuals not living in nursing homes.
The news sparked public outrage and criticism from health experts, and now the attorney general is seeking answers.
In letters sent last month to Lifespan and Care New England, Rhode Island Attorney General Peter Neronha wrote that the companies appeared to have administered the COVID-19 vaccine to workers who didn’t meet the state’s criteria for phase one category individuals. The attorney general requested all correspondence received from state health authorities, information about those individuals vaccinated and how they were selected.
A spokesperson for the attorney general, Kristy dosReis, said the office is gathering information to “determine exactly what vaccine distribution guidelines were given to the hospitals by the Rhode Island Department of Health and whether those guidelines were followed.”
Lifespan did not disclose how many remote workers they employ, saying in an email that “the number of remote workers is fluid since these employees may work only partially remotely.”
Care New England did not respond to multiple requests for comment, but the CEO has defended its vaccination policy, saying no one jumped the line, a position the state’s health department has also maintained.
Hospitals were told by health authorities to start with people with highest exposure first, said Joseph Wendelken, a spokesperson for the state’s department of health, adding that “they were given enough doses to vaccinate their whole organization.” He pointed to IT and custodial staff as examples of important non-medical staff.
When asked about remote workers and board members, he said, “just because someone is not on site doesn’t mean they’re not an important part of the hospital.”
But for those health professionals who had to wait on vaccines, that explanation falls short.
“To be honest, it’s upsetting knowing that we were so far behind,” said Hashem Shehadeh, a dentist at Benefit Dental in Providence, who got his first vaccine on Jan. 29. “Pharmacists, technicians, staff in the hospital all got it, but none of them have as much face-to-face contact as us. People come in here and need to take their masks off. In my opinion, it’s more high-risk.”
Though much of the public’s anger has been directed toward the two companies, the Rhode Island Department of Health said that it gave Lifespan a green light to vaccinate low-risk staff and volunteers, which includes board members.
Lifespan said in an email that it reached out to health authorities during its rollout and received permission “to move through additional tiers of our own employees and volunteers down to our lower risk tier (such as non-patient facing employees and volunteers, including board members, who fall into the volunteer category).”
Wendelken, the health department’s spokesperson, confirmed that Lifespan was told to move forward with this plan. “When the hospital got to that portion when they were vaccinating non-clinical staff, we did ask them to start vaccinating more outpatient healthcare providers while they were vaccinating administrators, IT folks, other non-clinical people. We asked them to also use some of their vaccines to get some of their affiliated outpatient health care providers — the patient-facing staff — a little bit more quickly.”
However, this only includes Lifespan doctors who treat patients that are not admitted to the hospital, as well as doctors in Lifespan clinics that are located throughout the state, and not doctors in private practice. So while anyone with a Lifespan badge was eligible from day one, private practice physicians, dentists, eye doctors, and other patient-facing practitioners were excluded.
Rhode Island also ended up being one of the last states to start prioritizing people by age, opening vaccines to individuals 75 and older only in the last weekend of January. While a small number of seniors have been vaccinated, most cities don’t expect another shipment of vaccines until mid-February.
“We’ve been very targeted and very specific here in Rhode Island,” Wendelken said. “Who we vaccinate matters, so it’s a lot more complex.”
The goal of Rhode Island’s approach was to get the most at-risk individuals vaccinated first, which meant focusing on the large health care systems. Tom Bledsoe, a member of the COVID-19 vaccine subcommittee, vice president of the Rhode Island Medical Society, and an internist, said that the word “equity” was highlighted at every meeting of the COVID-19 vaccine subcommittee.
“I think there was a little back and forth on that. Should Lifespan just go ahead and vaccinate everybody because they have this infrastructure in place? And throwing it open to the outside world would be complicated,” said Bledsoe. “I don’t think the goal was to jump the line.”
The controversy over the state’s vaccine rollout comes as the state’s leadership has been in limbo while Gov. Raimondo awaits Senate confirmation as President Biden’s Commerce secretary. Though Lieutenant Gov. Daniel McKee has been in close contact with the health department in recent weeks, local news reported that, as of December, McKee and Raimondo had not spoken since the start of the pandemic. In the meantime, Rhode Island’s COVID-related deaths passed a new record, and the state has one of the highest hospital capacity usage rates in the country.
Some state officials are saying that the problem lies in the limited supply, while others say that they should, as a result, be more intentional and careful with where those doses are going. “Truth be told, we have major issues with vaccine supply,” said Michael Fine, the chief health strategist for Central Falls and the city of Pawtucket and former director of Rhode Island Department of Health. “We are only getting 14,000 per month. That’s definitely not enough.”
The state has recently received a small boost to 16,000 per month.
Yet Fine believes the state’s targeted approach is paying dividends. Central Falls, a city of around 19,000, which had the highest number of cases, is already 20 percent vaccinated.
Much of the stress in Rhode Island, as well as other states, is the limited allotment it is getting from the federal government, which means that even a few wrong turns in distribution can lead to anger and distrust, according to Fine.
“This is Rhode Island, where everybody knows a guy,” he said. “That’s where we have to be particularly careful because if we lose people’s confidence in the integrity and transparency of health care itself, then nobody is ever going to trust anybody, and nobody is going to get anything done.”
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