Rhode Island will soon hit a tipping point in COVID-19 vaccinations – a point at which there will be more vaccine available than the demand for it, according to public health professionals.
And that’s not necessarily a positive development.
So-called vaccine hesitancy, the term health officials use to describe reluctance or unwillingness to take a vaccine, is going to become a bigger issue in the months ahead.
The issue was discussed at the PBN Health Care Summit on April 8 by panelists who considered the potential impact on communities, as well as the state’s effort to reach “herd immunity.”
While the state has done a good job with its vaccine distribution overall, the issue of hesitancy is going to become more prominent by May and will represent a policy and a social challenge, said summit panelist Dr. Ashish Jha, dean of the Brown University School of Public Health.
“We will have a chunk of Rhode Islanders who are unvaccinated, and we’ll have plenty of vaccines,” Jha said. “And we will have to work really hard on issues of hesitancy, issues of access, making sure we’re making it easy for people, making sure we’re engaging trusted voices to become advocates for vaccinations. That is a lot of hard work. The hard work of getting people comfortable with the vaccine remains.”
Until that happens, he said, “We’re not going to be able to get this pandemic under full control.”
Several trends have emerged in the state’s progress that have caused concern:
• Women are more apt to seek vaccination than men. Gov. Daniel J. McKee said on April 8 that 60% of vaccine recipients are women; 40% are men.
• Several communities remain under-vaccinated. Although the state has prioritized 16 high-impact ZIP codes, based on infection and hospitalization rates, in several of these communities, vaccinations are still lagging. The state is now directing more vaccines to community-operated clinics in these areas to try to increase impact.
• Across communities, people of color and Indigenous residents also are under-vaccinated, compared with their previous exposure, which health officials use to determine risk. The state recently held its first “high-density community” vaccination day at the mass-vaccination center in Providence to try to boost rates of vaccination.
• Retail pharmacies and mass-vaccination sites – where most of the vaccines are distributed – remain appointment-only destinations for vaccine recipients. And the vaccination system is largely dependent on access to a computer. The state only recently unveiled a registration system that allows people to be notified when an appointment is available. Those first notifications started late last week.
‘The hard work of getting people comfortable with the vaccine remains.’
DR. ASHISH JHA, Brown University School of Public Health dean
“We are doing everything we can to make the vaccine as accessible as possible, especially in the communities that have been harder-hit,” Dr. Nicole Alexander Scott, director of the R.I. Department of Health, said recently. “People are encouraged to vaccinate and follow that advice when it comes from people that they know, people that they work with and people that they love.”
During the PBN summit, Dr. Karen Tashima, who directs clinical trials for Lifespan Corp., and who was the principal investigator for two Remdesivir studies in Rhode Island for moderate and severe COVID-19 cases, said she is concerned that computer-based appointments remain an obstacle for many people.
“There are a significant proportion of people who are hesitant,” she said. “There has been a good effort in Rhode Island to get to ZIP codes and areas of the cities where access would be predicted to be lower. But we’re still not where we need to be in those areas. The challenge has been having to make appointments, having to do this online. And so many of my patients don’t have the capability of doing that.”
Christopher Palmieri, CEO and president of Commonwealth Care Alliance, which has expanded into Rhode Island, said his company has made a priority of reaching people who are homebound, and who cannot get to vaccination appointments. In Massachusetts, the company is trying to reach 25,000 people, he noted.
While the R.I. Department of Health has noted that pharmacies and clinics dispensing the vaccinations are located within a 15-minute drive of all Rhode Islanders, those appointments must be made in advance.
As part of the panel discussion, Tashima asked Dr. Kirsten Anderson, senior director of clinical solutions for New England for Aetna Inc., a CVS Health Corp. company, whether any of the CVS pharmacies allowed walk-in inoculations. The answer was no. CVS has, however, been directing more doses to the clinic locations where its data shows people are underrepresented in being vaccinated.
Tashima said her patients often lack access to computers or tablets that would allow ease in appointments.
Primary care offices reaching out to advise patients of appointments being available would be helpful, she said.
Peter Marino, CEO of Neighborhood Health Plan of Rhode Island, said the state’s effort to focus on equity, by distributing vaccines to community clinics and cities and towns, has brought the vaccines to locations closer to many Rhode Islanders than in other states. “As we get further down the path here, we are going to meet some of the at-risk populations that others are going to struggle with,” he said.
Mary MacDonald is a PBN staff writer. Contact her at Macdonald@PBN.com.
