What’s Cooking?: Vaccination goals in RI are a recipe for failure

At the weekly COVID-19 press conference on Thursday, April 8, Gov. Daniel McKee and RI Department of Health (DoH) Director Nicole Alexander-Scott made clear that economic reopening plans were conditioned upon a goal of vaccinating 70% of everyone in the state to approach herd immunity. While a laudable aspirational goal, it is in my opinion unrealistic and unlikely. The RI vaccination effort is doing well by any measure, consistently in the top 10 among the states, but it may soon hit a wall.

“The two key dates that we’re watching right now are May 15 and June 5,” Alexander-Scott said. “By May 15, we expect that 70% of Rhode Islanders 16 and older will have had at least one dose of vaccine and have had two weeks pass since that point so that they can experience the partial vaccination coverage that’s important. Getting 70% of our population to that mark of being two weeks after their first dose is a milestone for us. And that’s that May 15 target, being able to reach that allows us to have the confidence as we continue to make the changes and expansion in reopening our economy.”

As of April 8 according to the US Centers for Disease Control and Prevention (CDC), 399,063 people in RI received at least one COVID-19 vaccine dose out of a total population of 1,059,361, or 37.7%.

“And by June 5, we expect that 70% of all Rhode Islanders who could get a dose – out of all Rhode Islanders: children, adults, and all – that, it will be two weeks after all of those individuals have had at least one dose,” Alexander-Scott continued. “Let’s work with everyone around you to get us to that May 15 point so that anyone who is eligible, 16 and older, is able to have at least one vaccine administered to them and receive the protection from that two weeks from there. That’s our May 15 date. And by June 5, it’s out of all Rhode Islanders, it’s 70% of all Rhode Islanders that we’re aiming for. With those dates in mind, and everyone centered on getting as many people around you that you know to get vaccinated, that’s the confidence we can have to move forward in reopening our economy incrementally, safely and effectively.”

At present, no vaccine is authorized for administration to anyone younger than age 16, and only one (Pfizer) of the three vaccines authorized by the US Food and Drug Administration (FDA) for emergency use in the US can be administered to anyone younger than age 18. There are currently no applications in the FDA pipeline for expansion of age criteria, although Pfizer is known to have compiled trial data for age 12 to 15 and is expected to file for authorization within the next few weeks. The most optimistic scenario is for an emergency use authorization for age 12 and older before school reopening in September, but authorization for younger children is unlikely before 2022. Practical as well as ethical considerations limit the speed at which clinical trials can be conducted and reviewed.

As of the most recent US Census data from 2019, there are 179,661 people younger than age 16 in RI out of a total population of 1,059,361, leaving 879,700 age 16 or older eligible to be vaccinated. To vaccinate 70% of the entire population of 1,059,361, it would be necessary to vaccinate 741,553 people, which is 84.3% of those age 16 and older eligible to be vaccinated.

Vaccine administration has for months been limited by supply far short of demand, but everyone knows that will reverse soon. I asked RI COVID-19 planning czar Tom McCarthy on March 30 when he expected that to happen, and he predicted the last week of June or the first week of July. Nationally, however, leading non-profit think tank Surgo Ventures predicts vaccine demand will plateau by the end of April, forcing a shift in strategy by public health agencies to convince people to want to be vaccinated rather than struggle to deliver enough physical doses.

Surgo previously warned in February that vaccine hesitancy would present a significant obstacle with only 40% eager to be vaccinated, 17% unwilling to be vaccinated under any circumstances, and 43% “persuadable.” Surgo divided this last group into three sub-groups labeled the “Watchful” 20% of people waiting to see what others they knew did, the “Cost-Anxious” 14% who worried about access issues such as appointment scheduling, transportation, or lost time at work, and the “System Distrusters” 9% consisting of those, often people of color, concerned they would not be treated fairly by the healthcare system. Hesitancy can and likely will decline over time, but how much and how soon are hard to forecast. Of the 17% not persuadable, 84% falsely believe that COVID-19 is exploited by government to control people, 65% falsely believe COVID-19 was caused by a ring of people who secretly manipulate world events, and 36% falsely believe microchips are implanted with the COVID-19 vaccine.

What disturbed me most about the April 8 press conference was that everyone except Alexander-Scott, including McCarthy, McKee, and Commerce Secretary Stefan Pryor, talked about the goal of 70% by June 5 as if they not only expect it to happen, but are depending upon it to justify a substantial reopening of the economy, allowing large gatherings for proms, commencements, weddings, concerts and festivals. By contrast, Alexander-Scott, a highly competent and respected medical professional and scientist, chose her words carefully, making no promises amidst all of the happy talk from her state government colleagues. She opened her remarks by conceding the data were not good: RI has seen increasing cases for weeks, with hospitalizations increasing as a lagging indicator following cases, and community spread in municipalities not previously hard hit, naming Bristol, Middletown and West Warwick, attributing the increasing incidence in part to the inference that more transmissible mutated variants of the virus were infecting younger people under age 40 who have not yet been vaccinated – precisely the vulnerable demographic most likely to attend those large events. Reading between the lines, Alexander-Scott may be laying down markers for where the numbers need to be with vaccination in order to allow reopening, preparing to test those markers against actual results. The problem with this approach is it will be hard to backpedal from promised reopening, with everything from weddings to parades and major music festivals already given the go-ahead signal.

To emphasize, the June 5 goal of vaccinating 70% of the total population of the state, which mathematically implies vaccinating 84.3% of those eligible to be vaccinated, will be effectively impossible: there simply will not be enough people willing to be vaccinated. Remember, we’re now only at 37.7%, a long way from 70%. If meeting that goal is prerequisite for reopening the economy, it is a recipe for failure.