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On May 28, 2015, the Rhode Island Senate approved the appointment of a new state health director with a background in infection diseases, but no experience in overseeing a large agency responding to a global public health crisis.

Five years later, Dr. Nicole Alexander-Scott has been heralded for her role, with Gov. Gina Raimondo, in leading Rhode Island as the state grapples with the worst pandemic to hit the U.S. in more than a century.

Rhode Island has emerged as a national leader in per-capita testing for the virus, paving the way for the state to move ahead with plans for phase 2 of its reopening next Monday.

With Raimondo, Alexander-Scott has been a mainstay during months of daily televised briefings.

Thousands of Rhode Islanders have tuned in regularly to see the image of two mothers, one Italian-American, and the other African-American, leading the state during a period of remarkable challenge.

In some ways, this was the role for which Alexander-Scott was made. Yet in other ways, the New York City native seemed a questionable fit for the role of communicating searing issues of life and death. (More about that later in this story.)

The state Health director gets a five-year term in Rhode Island, an attempt to insulate the office to some degree from politics.

Now, in response to an inquiry by The Public’s Radio, the governor’s office said that Alexander-Scott will be reappointed as state Health director in the weeks ahead.

“The governor is incredibly grateful for Dr. Alexander-Scott's extraordinary leadership throughout this crisis and looks forward to submitting her for reappointment as soon as possible,” spokeswoman Audrey Lucas said in a statement.


Under even normal circumstances, the job of state Health director is taxing.

Dr. Michael Fine, who preceded Alexander-Scott in the role, said a big part of the work is “trying to keep everybody happy, trying to keep everyone focused and organized [amid] different approaches to the world.”

“Clearly, there is the governor’s office and what the governor’s office wants,” Fine said in an interview earlier this year. “That usually has more of a political character. There’s what the legislature wants – that has an intensely political character and often [is] not that connected to what we’re trying to accomplish in terms of addressing the health and safety of Rhode Islanders.”

Fine said additional pressure comes from the professional medical community, the CDC, which provides most of the Health Department’s funding, and the folks in the department itself, who are trying to survive in state government, do good work and advance their own careers.”


The Health Department has 504 employees and an annual budget of $169.9 million.

Following Fine’s departure, she was appointed by Raimondo as Health director on April 16, 2015.

Alexander-Scott grew up in Brooklyn. Her father, who died when she was 11, had suggested she would become a doctor.

“Medicine was something that was always important,” Alexander-Scott said in an interview in March, in the early days of the state’s response to COVID-19.

Her mother worked as a director of nursing, “so it was something that was a normal part of my upbringing. It was a place where I knew I could make a difference, and I was blessed to have the opportunity.”

Prior to her appointment as Health director, Alexander-Scott completed a combined four-year fellowship at Brown University, in adult and pediatric infectious, and obtained a master’s in public health at Brown in 2011.

In the years before the emergence of COVID-19, Alexander-Scott was a somewhat uncomfortable interview subject during occasional appearances on televised Sunday public affairs shows, like Newsmakers on WPRI-TV.

The launch in March of daily news briefings, with Raimondo, marked a baptism by fire.

Rooted in her medical training, Alexander-Scott emerged as a skilled communicator and one of the top rock stars in state government. Some observers believe she may be more popular than the governor, whose own approval rating has soared past 80 percent in two recent surveys.


Since becoming director of Health in 2015, Alexander-Scott has also championed the need to erase healthcare disparities across racial, ethnic and socioeconomic lines.

Doing that remains a big challenge, particularly with COVID-19 having a disproportionate impact on Latinos and African-Americans in Rhode Island. Alexander-Scott has nonetheless amplified her message during regular briefings, with her oft-stated belief that someone’s zip code shouldn’t be a predictor of their health and well-being.

While the coronavirus came as a surprise for most people, Alexander-Scott said students of illness knew that viruses remain a threat.

“This is part of what we prepare for – crisis communications, with pandemics and with our emergency preparedness and response teams,” she said.

Alexander-Scott said she trained in infectious diseases since it “is one of the most exciting sub-specialties -- because something new emerges and it changes the entire world. And so that constantly keeps you on your toes and engaged and on the frontlines.”

Ian Donnis covers politics for The Public’s Radio. He can be reached at idonnis (at) ripr (dot) org