Policy

How NYC bungled its monkeypox vaccine rollout, despite lessons learned during COVID

The failures raise questions about the due diligence undertaken by officials in awarding contracts.

A vial of the monkeypox vaccine

The tech failures are part of a broader mishandling of the monkeypox outbreak at all levels of government, which is causing public health experts to fear that the virus could already be out of hand.

Photo: Kobi Wolf/Bloomberg via Getty Images

In 2016, New York's state Attorney General Eric Schneiderman reached a settlement with a company known as MedRite Urgent Care, after Yelp caught the company paying for fake positive reviews. At the time, the attorney general's office accused MedRite of "misrepresentation and deceptive acts," for which the urgent care provider agreed to pay a $100,000 fine.

And yet, just six years later, in the midst of its fast-growing monkeypox outbreak, New York City chose MedRite to operate its monkeypox vaccine scheduler. The first day of the rollout, MedRite's system crashed, leaving New Yorkers scrambling to get access to a vaccine that is already in limited supply.

The U.S. is more than two years into a pandemic that forced health departments, including New York City's, to develop new technology to assist with vaccinations. But despite already having a system that was used to schedule millions of COVID-19 vaccinations, the MedRite debacle reveals the extent to which the city remained unprepared to apply those lessons and tools to a new crisis.

For weeks, New York City health officials pivoted between new scheduling systems from private providers — first MedRite, then another from a company called Affiliated Physicians. Affiliated Physicians' system also faced criticism because it crashed in minutes, too, and raised questions about why the city wasn’t using its existing COVID vaccine scheduler for the current health emergency.

“We commenced this effort quickly with the help of a vendor, MedRite. As the effort was expanded, it required the expertise of another vendor, AP,” said Michael Lanza, a spokesperson for the New York City Department of Health and Mental Hygiene. “We used the scheduling systems of the respective vendors before switching to the fixed city-run Vax4NYC portal. Retooling our existing system for monkeypox vaccine scheduling came with challenges and took some time, but it is now up and running.”

Lanza would not comment on why the city, in choosing a company to run its monkeypox vaccine scheduling system, had selected a provider that relatively recently had settled charges brought by the state for fake reviews.

MedRite officials also did not respond to requests for comment. But in a public statement posted to the company’s Twitter feed, they apologized to “fellow New Yorkers for any inconvenience we may have caused. We take full responsibility for the software error.” Affiliated Physicians declined to comment and referred questions to city officials.

The soup of websites and portals and the glitches that followed have made the city’s response to the outbreak “problematic,” said Dr. Bruce Y. Lee, executive director of the Center for Advanced Technology and Communication in Health and a professor of health policy and management at the School of Public Health at The City University of New York.

“There was significant potential for tech but it wasn't fulfilled because there didn't seem to be enough planning and strategy and also [there have been] different types of glitches.” he said. “One of the keys is you really want an organized and reliable system, so that anyone who wants the vaccine knows where to go, it has to be clearly advertised and it has to be consistent; there shouldn't be any changes.”

There have just been multiple failures, which I think are concerning because they are coming on the heels of COVID-19 and are reminiscent of some of the mistakes that happened early on in COVID-19.

The tech failures are part of a broader mishandling of the monkeypox outbreak at all levels of government, which is causing public health experts to fear that the virus could already be out of hand. Early this month, the White House declared the monkeypox outbreak a public health emergency, nearly two weeks after the World Health Organization did the same.

“[The response] feels like it’s been bungled because it has been,” said Dr. Amesh Adalja, senior scholar at the Center for Health Security at Johns Hopkins University. “There have just been multiple failures, which I think are concerning because they are coming on the heels of COVID-19 and are reminiscent of some of the mistakes that happened early on in COVID-19.”

The failures also point up possible issues with the due diligence undertaken by officials in awarding contracts, Adalja said. “Why a company that was recently cited for fraudulent behavior received such an important taxpayer contract during an infectious disease emergency — and to then perform inadequately— is something that raises questions about the process.”

The state attorney general found that MedRite paid an advertising agency $375 to write 15 positive reviews of its clinics on consumer sites including Yelp and CitySearch and posted job listings on Craigslist seeking freelance writers for reviews, promising to pay $10 to $15 per review. The reviewers were not required to have ever visited a MedRite clinic nor were they required to disclose to the public that they had been paid for the review, the attorney general said. Before the attorney general’s actions, Yelp in 2014 added a warning label on MedRite's profile for 90 days saying, “buying reviews not only hurts consumers, but also honest businesses who play by the rules.”

The clinic chain agreed to a $100,000 penalty settlement with the attorney general, half of which was suspended because of the company’s finances at the time. Since then MedRite has grown from three clinics in New York City to 26 locations in New York, New Jersey and Florida.

Lanza wouldn’t share the size of MedRite’s monkeypox contract, but according to the New York Post, the company’s contract for COVID-19 vaccinations has risen from $5 million to $36 million.

“Vaccine distribution can be complex so you need vendors and partners with demonstrated expertise and experience in the area,” said Lee.

The technical rollout may have been complicated by the fact that since the COVID crisis began, New York City has undergone an administration shift, from Mayor Bill de Blasio to Mayor Eric Adams. As part of that transition, both staff and leadership that had been responsible for product development in response to COVID have either left or moved to other departments.

The head of the Department of Information Technology and Telecommunications, Jessica Tisch, who “managed critical COVID-19 response and recovery efforts,” was named commissioner of the Department of Sanitation in mid-April just before the monkeypox outbreak began.

A former city official who worked on COVID response also told Protocol that teams handling product development at the Department of Health have shrunk substantially under the new administration. "Everything froze,” they said. “I don't know if there was that same political will" for monkeypox as for COVID, they added.

The Department of Health did not respond to questions about the shrinking of the product development team.

Whatever was going on at the city’s administrative level, though, Adalja said technological glitches “are not excusable in a public health emergency in which federal, state, and local governments exclusively control all access to the vaccine.”

“I think an important question to ask is why use a different system than COVID, which has been operating well for over a year?” he said.

Even the most efficient technology wouldn’t have solved New York’s monkeypox vaccine supply problem, which is dependent on the federal government, which has also been criticized for being slow to act.

But careful pre-planning for all scenarios and being pandemic ready for a major city like New York could have prevented many of the early mishaps that have occurred so far.

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