‘Frustration and Stress’: State Officials Fault Rollout of Monkeypox Vaccine

Federal officials are not relying on an established system to distribute the vaccine, slowing immunizations and burdening local health departments, critics say.

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By Apoorva Mandavilli

Roughly 5,000 doses of monkeypox vaccine intended for Fort Lauderdale, Fla., left the national stockpile’s warehouse in Olive Branch, Miss., on July 19. They somehow ended up in Oklahoma.

Then Tennessee. Then Mississippi again. Then, finally, Florida.

In Idaho, a shipment of 60 vaccine doses disappeared and showed up six days later, refrigerated rather than frozen, as needed. Another 800 doses sent to Minnesota — a significant portion of the state’s total allotment — were unusable because the shipment was lost in transit for longer than the 96-hour “viability window.”

The federal government’s distribution of monkeypox vaccine has been blemished by missteps and confusion, burdening local officials and slowing the pace of immunizations even as the virus spreads, according to interviews with state health officials and documents obtained by The New York Times.

Officials in at least 20 states and jurisdictions have complained about the delivery of the vaccine, called Jynneos. (More than half are led by Democrats, including California, Washington, Connecticut and Michigan, suggesting that their grievances are not politically motivated.)

“This is happening everywhere,” said Claire Hannan, executive director of the Association of Immunization Managers, a nonprofit group that represents state, local and territorial officials.

“Our response is completely inefficient and breaking the back of state and local responders,” she added. Ms. Hannan said she had never “seen this level of frustration and stress.”

In previous emergencies, including the 2009 swine flu outbreak and the Covid-19 pandemic, vaccines were delivered directly from manufacturers to health care providers through a system run by the Centers for Disease Control and Prevention.

That system, called VTrckS (pronounced “vee-tracks”), routinely moves billions of vaccine doses for annual immunizations and, importantly, is integrated with state databases that track vaccinations and doses.

But Jynneos is being disbursed from the National Strategic Stockpile by a different government agency under the Department of Health and Human Services. That agency was never set up to take ongoing orders, arrange deliveries from the stockpile, track shipments or integrate with state systems.

Instead, the stockpile was designed to deliver massive amounts of vaccine to each state in response to a catastrophic event, according to a federal official with knowledge of the stockpile’s operations.

“If it was a smallpox response, they’re not going to be sitting in their offices ordering vaccine,” the official said of state health authorities. The stockpile is intended to be “pushing products out — it’s not an ordering-based system,” the official added.

As it stands now, the stockpile is shipping monkeypox vaccine to just five sites in each state, regardless of its size. State officials must distribute the doses, track them manually and enter the data into their databases, none of which would have been necessary under the C.D.C.’s system.

Until recently, orders for Jynneos had to be placed via email instead of an automated system, and state officials often did not know where their deliveries were or whether they had been sent at all.

What to Know About the Monkeypox Virus

What to Know About the Monkeypox Virus

What is monkeypox? Monkeypox is a virus similar to smallpox, but symptoms are less severe. It was discovered in 1958, after outbreaks occurred in monkeys kept for research. The virus was primarily found in parts of Central and West Africa, but recently it has spread to dozens of countries and infected tens of thousands of people, overwhelmingly men who have sex with men.

What to Know About the Monkeypox Virus

What are the symptoms? People who get sick commonly experience a fever, headache, back and muscle aches, swollen lymph nodes, and exhaustion. A few days after getting a fever, most people also develop a rash that starts with flat red marks that become raised and filled with pus. On average, symptoms appear within six to 13 days of exposure, but can take up to three weeks.

What to Know About the Monkeypox Virus

How does it spread? The monkeypox virus can spread from person to person through close physical contact with infectious lesions or pustules, by touching items — like clothing or bedding — that previously touched the rash, or via the respiratory droplets produced by coughing or sneezing. Monkeypox can also be transmitted from mother to fetus via the placenta or through close contact during and after birth.

What to Know About the Monkeypox Virus

I fear I might have monkeypox. What should I do? There is no way to test for monkeypox if you have only flulike symptoms. But if you start to notice red lesions, you should contact an urgent care center or your primary care physician, who can order a monkeypox test. Isolate at home as soon as you develop symptoms, and wear high-quality masks if you must come in contact with others for medical care.

What to Know About the Monkeypox Virus

What is the treatment for monkeypox? If you get sick, the treatment for monkeypox generally involves symptom management. Tecovirimat, a hard-to-obtain antiviral drug also known as TPOXX, occasionally can be used for severe cases. The Jynneos vaccine, which protects against smallpox and monkeypox, can also help reduce symptoms, even if taken after exposure.

What to Know About the Monkeypox Virus

Who can get the vaccine? Jynneos vaccine is most commonly used to prevent monkeypox infections, and consists of two doses given four weeks apart. It has mostly been offered to health care workers and people who have had a confirmed or suspected exposure due to limited supplies, though new doses should become available in the coming months. A few states, including New York, have also made vaccines available among higher-risk populations.

What to Know About the Monkeypox Virus

I live in New York. Can I get the vaccine? Adult men who have sex with men and who have had multiple sexual partners in the past 14 days are eligible for a vaccine in New York City, as well as close contacts of infected people. Eligible people who have conditions that weaken the immune system or who have a history of dermatitis or eczema are also strongly encouraged to get vaccinated. People can book an appointment through this website.

Some containers arrived without labels saying they contained vaccines or needed cold storage. Some were tracked down only after multiple emails and phone calls. Doses of Jynneos have arrived in the dead of night.

“We had no way to track vaccine shipments, when they actually shipped or when they were going to arrive,” Chris Van Deusen, director of media relations at the Texas Department of State Health Services, said in an email. “They just showed up with no notice.”

H.H.S. officials two weeks ago switched to a different ordering system, which has been used to deliver antiviral drugs from the stockpile. But that system is also not linked to state immunization databases, and it is not well suited to monitoring the special conditions needed for transporting vaccines, several state officials said in interviews.

In a statement, the H.H.S. said that of more than 1,100 deliveries of Jynneos, “only a minuscule number of shipments have experienced issues.” The stockpile “has not experienced any loss of Jynneos vaccine in transit for any reason, including temperature excursions,” the statement said.

The delivery flaws threaten to aggravate tensions between federal health officials and their state counterparts. Xavier Becerra, the H.H.S. secretary, recently suggested that states and localities should be doing more to help contain the monkeypox outbreak.

But allegations that states are not requesting all their available vaccine doses or are shirking their responsibilities don’t tell the whole story, some officials said.

“We don’t want to point fingers at any of our partners on any level of government,” said Dr. Umair Shah, secretary of health for Washington State. But “the system that the federal government put in place was, in essence, clunky.”

The traditional system for delivering vaccines, VTrckS, has been operated for years by McKesson, a drug and medical supply distributor, under contract with the C.D.C.

VTrckS processes orders, tracks shipments, offers delivery estimates and notifications, and is integrated with state registries so that each package of vaccines can be tracked and easily redistributed from one provider to another when necessary.

In the past, “we have literally done nothing except basically hit an approve button,” said Kathryn Turner, the deputy state epidemiologist of Idaho and secretary and treasurer for the Council of State and Territorial Epidemiologists. “It’s a very slick system, and it’s worked for years and years and years.”

Other state officials said they were baffled by the decision to use a new ordering process that required emailing and manual data entry during a rapidly escalating outbreak.

“We have the systems in place,” said Jeremy Redfern, a spokesman for the Florida Department of Health. “Why they’re not using them, I don’t really know.”

H.H.S. considered several options for delivering the vaccine from the national stockpile, but other systems “could not be implemented on the timeline needed for distribution of Jynneos,” the department said in its statement.

It would take several months to integrate VTrckS with the stockpile, the statement said. The department is seeking a commercial partner to improve delivery.

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