As a number of federal policies impact availability of COVID-19 vaccines, Rhode Island is looking to preserve access through protective measures. The moves followed a recent U.S. Food and Drug Administration green-light of three new COVID-19 vaccines.
But in approving these vaccines, the FDA also restricted their use to people who are 65 years or older or have underlying health conditions. Those who are not eligible to receive the vaccine can get a prescription from a health care professional, but they must pay out of pocket prices.
On Sept. 12, the Rhode Island Department of Health issued an “off-label” standing order — allowing pharmacists to provide medications outside of FDA-approved uses. Per the order, pharmacies are now authorized to administer the new COVID-19 shots to all state residents aged three and above, without a prescription. RIDOH and the Office of the Health Insurance Commissioner also mandated health insurance companies to provide coverage for all COVID-19 vaccines administered in the state.
As of Wednesday, 25 states have issued “off-label” standing orders.
On Sept. 19, the Advisory Committee on Immunization Practices — the main body responsible for vaccines within the Centers for Disease Control and Prevention — recommended everyone six months or older get vaccinated against COVID-19 based on individual choice. This recommendation differs from the latest FDA license and ACIP’s own guidance of universal vaccination the previous year.
“Focusing on the benefits to people who are at higher risk for severe illness (is) not by itself controversial,” said Jennifer Nuzzo, professor of epidemiology and director of Brown’s Pandemic Center. “What is controversial in both ACIP’s recommendations and what the FDA has said is that they arbitrarily drop off the list of patient groups known to be at high risk, (including) pregnant women, infants and toddlers.”
As separate federal entities, ACIP’s recommendations do not have to comply with FDA licensing. Instead, they inform the CDC’s adult and child immunization schedules, which are used by some states and private insurers to determine vaccine policy, Nuzzo said.
ACIP’s more lenient recommendations would still include COVID-19 vaccines in the CDC’s immunization schedule, but they currently await approval by the director of the CDC.
In reaction to federal uncertainties, RIDOH recommended in a press release that adults aged 19 or older — including pregnant women — and children between six months and two years old should be vaccinated. For healthy children between two and 18 years old, parents should consult a health care professional, RIDOH said.
RIDOH’s advisories can disagree with federal policies because, per state law, the department has sole authority in making vaccine recommendations for Rhode Islanders.
“Statutory and regulatory acts in general rest with states,” RIDOH Director Jerome Larkin said in an interview with The Herald. “The Department of Health could refer to ACIP and the CDC to make (vaccine) recommendations, but the authority has never been predicated on what (they) might say.”
Rhode Island has made COVID-19 vaccines accessible in the past. By May 2023 — when COVID-19 ceased to be a public health emergency per the CDC — about 88% of R.I.’s population was already fully vaccinated, ranking first among all states.
Despite this metric, in Rhode Island, “COVID-19 has really disproportionately impacted communities of color (and) older adults of all backgrounds,” William Goedel PhD’20, an associate professor of epidemiology, said in an interview with The Herald.
Every year since the pandemic, most in-state COVID-19 hospitalizations and deaths have been people in the 65-plus age group, according to RIDOH. Black and Latino Rhode Islanders have also suffered more COVID-19 hospitalizations and deaths than white Rhode Islanders per capita.
The Ocean State has embraced other vaccine measures on a regional level. On Sept. 18, Rhode Island — along with Massachusetts, Connecticut, Maine, New Jersey, New York and Pennsylvania — founded the Northeast Public Health Collaborative. The group aims to coordinate data collection, vaccine recommendations and procurement.
Regional collaboratives such as the NEPHC and the West Coast Health Alliance “are a double-edged sword,” Goedel said. While residents of the member states reap the benefits, people living in states that refuse to participate lose access to medical resources.
As states strive to preserve vaccine access through state orders and regional coalitions, they remain vulnerable to federal directives including recent budget cuts.
“Our overall goal … is to preserve vaccine access for Rhode Islanders, as is informed and indicated by sound medical science,” Larkin said.
