Age will be the top consideration in the next phase of Rhode Island’s coronavirus immunization campaign, health officials said during a presentation to an advisory committee Friday morning.

The state’s draft plan for the second phase of vaccine delivery would start by offering COVID-19 vaccines to adults age 65 and older. 

“We feel this really aligns with the data of who has been most impacted by COVID-19 in Rhode Island, and also that this would be the quickest way to really minimize morbidity and hospitalizations across the state,” explained McKenzie Morton, who facilitated the meeting for the Department of Health. 

Rhode Islanders over age 60 account for nearly two thirds of coronavirus-related hospitalizations in the state, and the risk of death rises steeply with age. 

Once those over age 64 have been vaccinated, the health department would then prioritize those with health conditions that put them at higher risk from the virus, and begin offering vaccines to residents based on their age. 

Equity has also been a key consideration in the state’s vaccine distribution, as Black and Latino Rhode Islanders have contracted the virus at higher rates, and have a higher risk of hospitalization and death. 

The health department currently plans to use geography as a proxy to address these disparities, by prioritizing vaccination in areas that score highly on the Centers for Disease Control and Prevention’s Social Vulnerability Index. Community-wide vaccination is already underway in Central Falls, where 19% of residents have tested positive for COVID-19, and health officials have said they plan to target other hard-hit zip codes. 

“As we looked at the Social Vulnerability Index,” said Alysia Mihalakos, who co-leads the health department’s COVID-19 vaccination effort, “it really is condensed inside the core communities. And so the high density community initiative will continue throughout, while we’re also simultaneously achieving the age-based strategy, so that we’re able to balance both.”

The state currently does not plan to prioritize vaccination by occupation, despite pressure from educators to move teachers to the front of the line. The CDC’s Advisory Committee on Immunization Practices has also recommended vaccinating frontline workers, including those who work in manufacturing, grocery stores, public transit, and education, ahead of adults age 65-74. 

Health department director Dr. Nicole Alexander-Scott said she recognized the importance of teachers in educating children and allowing parents to return to work.  

“When you look at just high risk conditions alone and age, we cover almost 50% of teachers,” Alexander-Scott said. But she described prioritizing vaccination for younger teachers as a “dilemma,” given that schools will still have to follow the same quarantine and remote learning procedures regardless of whether teachers are vaccinated. 

Members of the advisory committee suggested prioritizing teachers in communities with high rates of infection, and elementary school teachers and those who work with students with special needs, who may have more difficulty social distancing with their students. 

Courtney Hawkins, director of the state Department of Human Services, added that teachers are among many public-facing workers who would like to be prioritized. “What this would allow us to do is target those individuals who are at highest risk in those jobs, which is also important given the limited supply,” she said. 

Hawkins suggested that if Rhode Island begins to receive more doses, the state may consider adding occupation to the list of considerations. But overall, she said the age-based distribution plan would be more efficient. 

“The team really worked hard to think about how do we achieve our broader public health goals, how do we develop a strategy that can be operationalized quickly, and how do we develop something that can be communicated to the public, so that the question, ‘When will I be vaccinated?’ can be easily answered,” Hawkins said.  

“We’re hearing from a lot of people that our current framework doesn’t allow for that, and there’s a lot of frustration.”

Much of the draft plan is still subject to change or clarification. The state’s COVID-19 Vaccine Subcommittee spent much of it’s meeting Friday morning discussing which pre-existing medical conditions should bump someone up on the vaccination timeline. And officials noted that federal guidelines may change as the Biden administration takes charge of vaccine delivery. 

Health officials said they would use the committee’s input to finalize the prioritization plan for Phase 2, which they are set to present to the committee on Feb. 5. Based on the current vaccine supply allocated to Rhode Island, state health officials said that Phase 2 would likely begin in April.

The health department has consolidated its previous 4 phase plan into just 3 phases. Rhode Island is still working through the first phase, which includes health case workers, nursing home residents and staff, first responders, people who are incarcerated, and residents of Central Falls. Adults age 75 and older are also included in Phase 1, and are expected to begin receiving the vaccine next month. 

Phase 3 is set to include children, pending approval from the Food and Drug Administration and the Centers for Disease Control and Prevention to administer the shots to children. Anyone who did not get vaccinated during the first two phases will also have the option to get the vaccine. 

Reporter Sofia Rudin can be reached at and 401-302-1057.