Monkeypox Vaccine Rollout Is Marred by Glitches in New York - The New York Times

The city has struggled to respond to a growing monkeypox outbreak, the first major public health crisis since the Covid pandemic began.

July 7, 2022

Thousands of New Yorkers spent hours refreshing a city government webpage this week, desperately seeking a monkeypox vaccine that, for now, is mostly going to the web-savvy and connected.

The rollout echoed the early days of New York City’s Covid-19 vaccine, when finding an appointment could feel like winning a radio contest. The city decided to assign appointments for the first doses of the highly sought-after monkeypox vaccine via an online system, using Twitter as the main way to notify people. The 2,500 appointments went within minutes.

On top of that, because of a glitch, the initial 600 appointments released Wednesday went only to those who happened to store an older appointment website on their browsers, because the slots appeared there before a link on the main Department of Health website went live.

“By following the Department of Health’s instructions, we had zero chance of getting the vaccine,” said Nicholas Diamond, who spent hours refreshing the city’s website in search of a shot. “I am really concerned that the city, state and federal government have learned nothing from the Covid response, and essentially the burden again has been left on us to figure out how to care for ourselves.”

New York City is the epicenter of the nation’s monkeypox outbreak, its health commissioner, Dr. Ashwin Vasan, said at a news conference on Thursday, with 141 cases recorded so far, more than any other American city. The disease is mostly spreading among men who have sex with men, and experts believe there may be many more cases than have so far been detected.

The spreading outbreak has not yet caused any deaths in the United States, but it can cause very painful lesions that take weeks to resolve.

With yet another frightening virus spreading in their community, many gay New Yorkers have pinned their hopes on getting the Jynneos vaccine, the safer of two available vaccines that can prevent monkeypox. But distribution missteps have caused anger and frustration. The first 1,000 doses of Jynneos, which arrived two weeks ago, were given out at a single clinic, in Chelsea, with almost no public notice.

As a result, they went primarily to people who saw a Twitter post or knew about the release ahead of time through public health connections.

Then on Wednesday, the city Department of Health said on Twitter at 10:45 a.m. that a second round of appointments would be coming soon. There was no further update until 1 p.m., when the department posted on Twitter that because of an “unfortunate glitch,” the appointments were already gone. People were told to keep checking back.

At 6:11 p.m., 1,900 more appointments were made available. They were gone in 10 minutes.

Dr. Vasan apologized for the mistakes at the news conference, at which he announced the opening of a second clinic in Harlem and explained that the city would work harder to insure a more equitable approach as more appointments become available.

What to Know About the Monkeypox Virus

What is monkeypox? Monkeypox is a virus endemic in parts of Central and West Africa. It is similar to smallpox, but less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research, according to the Centers for Disease Control and Prevention.

What are the symptoms? Monkeypox creates a rash that starts with flat red marks that become raised and filled with pus. Infected people may also have a fever and body aches. Symptoms typically appear in six to 13 days but can take as long as three weeks after exposure to show, and can last for two to four weeks. Health officials say smallpox vaccines and other treatments can be used to control an outbreak.

How infectious is it? The virus spreads mainly through body fluids, skin contact and respiratory droplets, though some experts suggest that it could occasionally be airborne. Typically it does not lead to major outbreaks, though it has spread in unusual ways this year, and among populations that have not been vulnerable in the past.

What’s the situation in the United States? Experts say that the rapid spread of monkeypox across the country and the government’s sluggish response raise questions about the nation’s preparedness for pandemic threats. Tests will not be readily available until later this month and vaccines will be in short supply for months. Official case counts, now in the hundreds, are likely a gross underestimate.

“Our vendor experienced technical glitches, and New Yorkers have had to wait much longer than they should have to get this vaccine,” Dr. Vasan said. “Ultimately, they work for us and the buck stops with us.”

He added: “Equity is an incredibly hard thing to preserve in an environment of scarce supply.”

Cases of monkeypox have been steadily increasing in the city, even though testing has been limited. New York City’s public health lab, which had been the sole city location running the test for the disease, has been able to test only 10 people per day, city officials said. But testing will now be able to ramp up: As of Wednesday, health providers can now order monkeypox tests through Labcorp, a commercial testing company.

Dr. Vasan said that he picked Chelsea, an upscale Manhattan area, as the location for the first clinic because 75 percent of the city’s known cases so far have been in Manhattan, and one-third of all cases have been in the Chelsea and Hell’s Kitchen neighborhoods, areas with large gay populations.

With the arrival of 6,000 additional doses this week, the city added the second vaccine clinic, which opened Thursday. It is planning a third clinic in Corona, Queens, once vaccine supply increases.

At the news conference on Thursday, officials acknowledged that there were high levels of anxiety among men who have sex with men and that there were still many unknowns about the disease’s spread. But they underscored that the risk to most New Yorkers remains low.

Shortly after the officials left, a line of men with appointments began to form. By noon, it stretched north on Fifth Avenue and west down 137th Street.

Irving Ruiz, who lives in Queens, said he was there because he had recently seen someone with a severe case of monkeypox, with rashes up and down his arms and legs. He said the experience made him fearful for his community.

“It’s not fair. I feel like we’ve gone back to H.I.V.-stigma,” he said.

Kevin de Wolf, who was also in the line, said his partner just came down with monkeypox, and that he was worried about his fatigue and fever.

“Seeing this up close and what it does to somebody at the height of good health is crazy,” said Mr. de Wolf, 35, who lives in Hell’s Kitchen.

Mr. de Wolf said he was desperate to find a vaccine and had considered traveling to Montreal because of the lack of availability in the United States. His partner found him the appointment on Wednesday. “It feels like being in a third world country,” he said.

New York City has so far received about 7,000 doses of the Jynneos vaccine. About 4,000 have already been given out or assigned to appointments. An additional several thousand are being held in reserve for distribution through community partners, Dr. Vasan said.

More doses are coming, said Dr. Raj Panjabi, the coordinator of the White House Pandemic Office, who also spoke at the news conference. The federal government will release another 144,000 doses within the next weeks, with some of those coming to New York. In total, four million doses have been ordered for use nationwide, with 1.5 million of those expected to go out to health departments later this summer and fall.

The Jynneos vaccine requires two doses to be fully protective, according to the Food and Drug Administration, but so far, all of the doses coming to the city are being considered as first doses. As more doses arrive, there will be more available for second doses, said Dr. Mary Bassett, the state health commissioner.

Paul Chaplin, the chief executive officer of Bavarian Nordic, which makes the vaccine, said Thursday that research shows that one dose offers “a very robust level of protection.” Dr. Bassett, however, said that full protection from the vaccine would only come two weeks after the second dose.

New York health officials said people who fall into one of several categories are eligible for the vaccine:

• Individuals with exposure to monkeypox within the past 14 days.

• Those at high risk of a recent exposure to monkeypox, including members of the gay, bisexual, transgender and other communities of men who have sex with men and who have engaged in intimate or skin-to-skin contact with others in the past 14 days in areas where monkeypox is spreading.

• Individuals who have had skin-to-skin contact with someone in a social network where monkeypox is spreading, including men who have sex with men and who meet partners through an online website, digital app or social event, such as a bar or party.

In part because the categories are broad, demand for the vaccine is extremely high.

Eugene Resnick, who works as a spokesman for the Metropolitan Transportation Authority, said he spent nine hours refreshing the city’s webpage before being able to finally snag an appointment after 6 p.m.

“I’m frustrated, angry, disappointed with the Health Department,” he said. “I’m an insider working in the government. I can’t imagine it’s at all accessible to the regular person not on Twitter.”

At a news conference on Thursday, Mayor Eric Adams said the city was giving out vaccine doses as soon as it received them. “We are not just ignoring it,” he said. “There was a glitch by the third-party vendor that created the website, but we pivot and shifted and we’re getting the vaccines out the door.”

Joseph Osmundson, a microbiologist and queer activist helping to increase access to the vaccine, said that the city did the right thing by opening the Harlem clinic, but that there had to be a more urgent effort to get more vaccine supply to the city soon.

“At every level, there is such frustration in the community,” Mr. Osmundson said. He said people he knows are trying to be careful but are increasingly angry at what they feel is a lack of urgency to protect the gay community in particular: “We feel like we’re being left behind and then blamed for the spread.”

Nate Schweber contributed reporting.