PROVIDENCE, R.I. (WPRI) – More than 380 people with the coronavirus have died in Rhode Island since the first person received a vaccine nearly a month ago.

The ever-growing death toll now exceeds the total number of Rhode Islanders who died during the Vietnam War. Combined with the spread of new and more contagious variants, the situation is fueling a rising sense of urgency surrounding the state and federal COVID-19 vaccine rollout after a slow start.

“We need to acknowledge that it’s not working,” former FDA Commissioner Dr. Scott Gottlieb said last weekend on CBS News’s “Face The Nation.”

“We need to hit reset and adopt a new strategy of trying to get it out to patients,” he added.

Limited supply and at times inconsistent communication from the federal government has disrupted state planning and operations, while Rhode Island health officials are grappling behind the scenes with logistics and how to prioritize who should get the vaccine next.

Where the state turns from here is still being debated, but unlike the vaccine rollouts of the past – such as H1N1 and polio, which both prioritized children over adults – most people who want the coronavirus vaccine are feeling anxious to get one.

The process is one of the biggest challenges facing Lt. Gov. Dan McKee, who is poised to become the new leader of the state’s pandemic response after Gov. Gina Raimondo accepted a position in the Biden administration. McKee and Raimondo are expected to appear together publicly on Wednesday for the first time since Raimondo agreed to leave the state.

“We really need to get this vaccine out more quickly because this is really our only tool – our only backstop – against the spread of these new variants,” Gottlieb said, referring in part to a new variant that has been raging across the United Kingdom. The new strain is roughly 50% more contagious and is beginning to show up in the United States.

“If we can get a lot of people vaccinated quickly, we might be able to get enough protective immunity into the population so that this stops spreading at the rate that it is,” Gottlieb said.

‘At the mercy of the federal government’

Internal documents shared with Target 12 show state leaders are trying to vaccinate a Phase 1 group of about 200,000 people by April.

The group includes hospital workers, nursing home residents, high-risk inmates, police and firefighters, dentists and people 75 years and older. Injections are underway and are expected to be done in that order.

The state so far is on track to hit the goal, assuming it receives the weekly shipments promised by the federal public-private Operation Warp Speed vaccine program, which hasn’t always been the case. In December, a weekly shipment was cut by nearly 40%, without much explanation, sending health officials into a scramble.

“We’re really at the mercy of the federal government and the manufacturing process and what they can deliver,” Dr. Philip Chan, R.I. Department of Health’s consulting medical director, told 12 News on Tuesday.

As of Tuesday afternoon, Rhode Island had administered about 47% of the 80,225 vaccinations it had received, according to U.S. Centers for Disease Control and Prevention. On a per capita basis, Rhode Island is doing better than most other states, but it ranks second-to-last in New England, behind only Massachusetts.

Health officials say they expect there will always be some gap between how much vaccine is received and how much is administered because of redistribution and scheduling. The weekly process is triggered whenever the federal government confirms how much vaccine is coming into the state each week, which makes long-term planning a challenge.

“There are a lot of steps involved in getting vaccine into someone’s arm,” Health Department spokesperson Joseph Wendelken said.

There are also unforeseen issues that have come up, which health officials say are likely to continue happening throughout the rollout.

Earlier this month, hundreds of people tried to jump the line for injections when health care workers eligible for vaccines passed around an unsecured vaccine sign-up link among ineligible family and friends. The improper appointments resulted in cancellations, delays and unplanned labor, meaning frontline workers who should have been vaccinated had to wait longer.

Beginning in April, the process could become even more complicated when the rollout is projected to move into Phase 2. The next phase will likely include far more people who are not living or working in highly controlled settings – such as hospitals, nursing homes, group homes and prisons — which will complicate everything from keeping delivery schedules to ensuring each place gets the same number of syringes as doses.

State leaders must also answer the ever-looming question: who should get vaccinated next?

“This is going to get controversial,” said Dr. Pablo Rodriguez, medical director for community affairs at Care New England and a talk-show host on Spanish-speaking radio. “Once you start vaccinating one population, some will feel they are being discriminated against.”

‘Using one criteria is tricky’

Currently, Rhode Island is considering whether to prioritize the next vaccination group based on age, underlying health condition, geography, occupation or some combination of those factors.

And everyone has an opinion.

During an R.I. Health Department COVID-19 Vaccine Subcommittee meeting last week, members of the panel offered varying opinions about who should go next. And while the group didn’t make any decisions, internal documents suggest the state could be leaning toward prioritization based on age.

Even now, health officials say they would like to expand the Phase 1 vaccination group to include people 65 years and older – which would match new federal guidance released Tuesday – but nevertheless for the moment are sticking with the initial plan focused on people 75 years and older.

“We very much want to expand the vaccine to this population when we have adequate supply,” Wendelken said of those ages 65 to 75. “Right now, our Phase 1 prioritization is focusing on ensuring a stable health care workforce and protecting our vulnerable residents in long-term care facilities.”

COVID-19 has disproportionately killed older adults. Rhode Islanders ages 60 and older make up about 31% of the adult population, but they represent 94% of the state’s nearly 2,000 coronavirus deaths since March. Fewer Rhode Islanders died during World War II.

But age isn’t the only consideration. Health officials are also looking at whether to prioritize people with underlying health conditions, ranging from cancer and heart problems to obesity and smoking, according to CDC definitions.  

Like older adults, that group is at higher risk of dying after contracting the virus, and because many older adults also have underlying health conditions, there’s crossover between the two groups.

“Using one criteria is tricky,” Rodriguez said during a subcommittee meeting last week.

The third consideration is focused on where people live, as some communities have been hit harder than others during the pandemic. Central Falls, with 20,000 residents living across roughly one-square mile, has the highest rates of infections and hospitalizations. Smithfield, Johnston and Woonsocket have the highest rates of deaths.

The state last week launched a pilot program in Central Falls, distributing roughly 1,500 doses, and health officials there argued that the city should be prioritized because of how many of its residents have suffered from the illness.

“Central Falls has been one of the most infected places in the United States and perhaps the world,” said Dr. Michael Fine, the city’s chief health strategist and the state’s former Health Department director.

“It makes sense that if we’re going to stop spread of the virus, we stop it here,” he added during a recent interview with 12 News. “We want to stop it here so we can stop it in the state as a whole.”

Interested parties

The final main consideration is arguably the most controversial.

The state has identified about 220,000 people considered frontline essential workers who did not qualify during Phase 1. The group includes people from manufacturing, food and agriculture, government, transportation, energy, financial services, IT and communications, legal, media and other critical infrastructure jobs.

But at the top of the list is what’s categorized as the “education sector,” including K-12 and postsecondary teachers, crossing guards, school bus drivers and monitors, library employees, childcare workers and custodial staff.

The debate over education during the pandemic has become one of the most contentious in Rhode Island, as teachers unions and school administrators have clashed publicly with Governor Raimondo over whether it’s safe to educate children in-person.

The groups are now lobbying state leaders both privately and publicly to prioritize educators in the vaccine rollout.

“To the extent it is not obvious, of course we believe that teachers and education support professionals (and principals and superintendents) should be in round one of the vaccine distribution,” National Education Association Rhode Island executive Robert Walsh Jr. tweeted on Jan. 3. “Hopefully this will be officially addressed before we need to say much more on the topic.”

Bristol-Warren Regional School District superintendent Jonathan Brice echoed the sentiment during a subcommittee meeting last week, pointing out that the coronavirus has made it challenging to effectively teach in-person, particularly due to widespread quarantining among staff and students.

“If want to do this, if we want to continue this, school staff need to be somewhere in Phase 2,” he said.

And educators are hardly the only group lobbying state leaders.

The Rhode Island Hospitality Association, representing more than 80,000 workers, has called on the governor to prioritize its workforce, and many others are jockeying behind the scenes for a spot in line.

Of course, vaccine prioritization is only one piece of the broader puzzle health officials are trying to solve. The state is still working on a public campaign strategy, seeing the task of convincing people that the vaccine is safe as paramount to its success.

Too much vaccine hesitancy could render the vaccines ineffective, and further erode the public’s trust.

Hospital workers have been accepting the vaccine at high rates, according to Chan and interviews with emergency care doctors. But there are already signs of high rejection rates in nursing homes.

Rhode Island Health Care Association President and CEO Scott Fraser told 12 News this week uptake among nursing home residents has been upward of 90%, but anecdotally he’s hearing rejection rates as high as 40% among staff in some places.

He’s hopeful that rate comes down after another round of vaccine offerings, saying the high rejection rate could be reflective of how many people have been out due to quarantines recently. Yet similar rejection rates have been reported in other parts of the country.

In Central Falls, Mayor Maria Rivera — along with former Mayor James Diossa and other city leaders — publicly received vaccines to try and convince residents that the process is safe. Rivera said having public figures get vaccines will be important because “there are some myths out there.”

“Every question is valid, right?” she told 12 News. “But when you listen to some things, like somebody is ‘going to grow another leg,’ it’s a myth.”

Rivera is hopeful the state will continue to prioritize her community, but said she understands that everything comes down to supply. Yet the newly elected mayor’s wish for her community is being echoed in various circles across the state.

“I wish we had a vaccine for every single one of our residents, but that’s just not the case,” she said.