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Monkeypox Vaccine Rollout Is Marred by Glitches in New York

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

Thousands of New Yorkers spent hours refreshing a city government webpage on Wednesday, desperately seeking a monkeypox vaccine that, for now, is mostly going to the most 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 3,500 or so doses of the highly sought-after monkeypox vaccine via an online system, using Twitter as the main way to notify people. The appointments went within minutes.

On top of that, because of a glitch, about 600 appointments 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. 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 said, with 141 cases recorded so far, more than any other 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.

The health commissioner, Dr. Ashwin Vasan, apologized for the appointment glitch at a news conference Thursday and explained that the city would work harder to insure a more equitable approach as more appointments become available.

“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. And so we apologize to New Yorkers, and we pledge to do better going forward on this issue in the days ahead.”

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, despite limited testing. New York City’s public health lab, which was the only place running the test for the disease in the city until Wednesday, has only been able to test 10 people per day, city officials said. But testing will now be able to ramp up: Labcorp, the commercial testing company, also began offering the test on Wednesday.

Public health officials have decided not to put up billboards warning the wider public about the disease, which spreads primarily by prolonged close contact, because they see it for now as an outbreak almost completely among the community of men who have sex with men. Instead, they say they have been mostly relying on getting the word out through smaller efforts with community partners within the L.G.B.T.Q. community.

That began to change on Thursday, when officials held a news conference to announce the opening of a second clinic in New York City that will offer the vaccine by appointment only, in Harlem. The first clinic was in Chelsea, which advocates argued primarily reached a well-off patient population.

Dr. Vasan said that he picked Chelsea for the first site because 75 percent of the cases so far have been in Manhattan, and one-third of known cases are in the Chelsea and Hell’s Kitchen neighborhoods.

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.

New York City has so far received about 7,000 doses of the Jynneos vaccine, the preferred vaccine for the monkeypox. Of those 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. Another 144,000 doses will be released by the federal government 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 “robust protection.” Dr. Bassett, however, said that full protection from the vaccine would only come two weeks after the second dose.

What to Know About the Monkeypox Virus

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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.

Should I be worried? The likelihood of the virus being spread during sexual contact is high, but the risk of transmission in other ways is low. Most people have mild symptoms and recover within weeks, but the virus can be fatal in a small percentage of cases. Experts say that monkeypox is unlikely to create a pandemic scenario similar to that of the coronavirus.

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

Individuals with recent 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 experiencing monkeypox activity, 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. All 2,500 or so appointments went within minutes on Wednesday, health officials said.

Enormous frustration at access to the vaccine spilled over on Wednesday, as people spent hours not knowing if they had missed the rollout or if more doses were coming.

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 when a second set were released just before 7 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.”

Joesph Osmundson, a microbiologist and queer activist helping to increase access to the vaccine, said that the city did the right thing by opening a clinic in Harlem, in addition to the one in Chelsea, to give out the vaccine, 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.”

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