New York City is set to run out of COVID-19 vaccines today.
In announcing the city has exceeded its own goal of vaccinations, Mayor Bill De Blasio notes 220,000 doses were distributed last week of an expected 175,000, and all pre-existing appointments will have to be cancelled until new shipments come in next Tuesday.
The news is curious in that it comes just a few weeks after medical providers reported they had been forced to throw out expired doses because of a) people matching incredibly strict guidelines and b) steep penalties imposed for breaking said guidelines.
As Snopes explains, some vaccines may have to be thrown out because a vial contained more doses than was originally thought and mRNA-based vials such as Moderna have a six hour shelf-life; health care workers may not be able to find enough people to use excess doses, or may not have been given regulatory guidance on how extra fluid should be administered.
Still, that a city suffering one of America’s worst outbreaks could, in early January, have any reports of expired doses and, weeks later, claim a shortfall is surprising considering a vaccine distribution plan was issued last September along with a requirement that states submit their own plans to the Centers for Disease Control and Prevention by October 16.
Some of this blame can be traced to an early push for simultaneous and stringent means-testing and penalties under Governor Andrew Cuomo, one that had some arguable justification but, oddly, has not let up even in the face of the current shortfall.
How vaccines ended up in the bin
Ahead of the mid-December rollout, the Cuomo administration set state guidelines limiting vaccines to two priority groups: specific health care workers, namely, high-risk health care workers in hospitals, federally qualified health centre employees, EMS workers, coroners, medical examiners, certain funeral workers, and staff in addiction treatment centres; and residents and staff in nursing homes and group homes.
As Newsday reports, Cuomo then signed an executive order on December 28 threatening health care providers who fraudulently obtain or use the vaccine with up to US$1 million in fines and the loss of their state licenses. This came after Attorney General Letitia James was referred to in allegations that ParCare Community Health Network received and administered vaccines to some members of the public in violation of the state guidelines.
This announcement came with news that urgent care centre employees, people administering COVID-19 vaccines, and residents of facilities for addiction treatment would be added to the priority list, which would grow the next week to include ambulatory care health care workers and select public health workers, including those who administer COVID-19 tests.
On January 1, some 17 days after the program launched, the New York Times reports about 88,140 people had received the first of two doses (about 1% of New York City’s population) despite roughly more than 340,000 doses being delivered to the city. The city was also yet to open any large vaccination sites, with hospitals instead administering many the first vaccinations to their employees.
It was at this point some of the earliest cracks between Cuomo and de Balsio appeared, with the latter pledging to administer doses to one million people by the end of January while suggesting the state was acting as a bottleneck by refusing to open up eligibility to more people.
Nonetheless, days later, on January 4, Cuomo went a step further in his efforts to punish rule-breaking with a proposal to criminalise the fraudulent administration or sale of the vaccine. He also announced that, to supposedly expedite the vaccination process, providers that don’t use their allocated doses within seven days of receipt could be disqualified for future distributions; at this point, the only largely-approved sites remain hospitals, with pharmacies and large-scale sites such as the Javits Center only granted permission in mid-January.
Criticisms from de Blasio and others claiming vaccines were starting to go to waste quickly caught up with Cuomo, however, and he announced on January 8 that three million people would be added to the list of eligible groups, including those aged 75 and older and essential workers such as first responders and teachers, with health care workers to remain a priority where possible.
New York City has heard enough. We will begin administering shots to City Workers and the elderly in 1B starting on Monday.
— Mayor Bill de Blasio (@NYCMayor) January 8, 2021
Stories had begun to be circulate of doses being thrown out because of tight eligibility — i.e., the Family Health Center of Harlem being told by the health department not to use excess doses on people not deemed eligible — and two days later on January 10 Cuomo expanded the rules again to employees interacting with the public — namely pharmacy cashiers.
Notably, New York was not the only state to experience this learning curve. California issued guidance on January 7 that vaccines could go to lower priority groups if they are able to expire, Walgreens admitted on January 6 to having to throw out a vial in an Ohio store, see Massachusetts, Wisconsin, etc.
Mayor de Blasio also appears to hold some responsibility for a city council website that, on January 11, required of senior citizens the filling out a 51 step online questionnaire with multiple attachments that, as city comptroller Scott M. Stringer outlined at the time, could be responsible for more than 200 vacant vaccine slots.
This very minute, there are more than 200 vaccination slots available on TUESDAY on the @nycHealthy website.
I am concerned this signals twin failures of outreach and technology by the City.
— Scott M. Stringer (@NYCComptroller) January 11, 2021
How NYC ran out of vaccines
While there are still significant gaps in the list of eligible recipients — as The City reports, Cuomo refuses to include incarcerated people despite CDC recommendations per their increased risk of disease — the current shortfall appears to be due to an increased roll-out.
According to the New York Times, since Wednesday January 13 the city had given out roughly 24,000 first doses per day, and inoculation sites are set to open at Yankee Stadium, Citi Field, and the Empire Outlets on Staten Island. de Blasio has since called on the state government to increase New York City’s supply.
Cuomo, who has targeted federal supplies of 300,000 doses a week as inadequate and called on Pfizer to deal with his government directly, has doubled-down on his propensity for micromanaging; as NY1 reports, the governor sharing a graphic at Monday’s press conference claiming that 10 NYC vaccination sites have distributed less than 80% of the vaccines they have received, while four such sites have distributed more than 80%, and announced the state would deliver fewer doses to the sites with a poor record.
de Blasio has again pushed back, claiming, “We are moving so quickly now, we have built up such a head of steam that we’re going to use up our supply. So, by definition, if he’s taking supply away from New York City, that makes no sense.”
Whatever the case — and there are surely untouched complications here, especially given the state is experiencing another wave of hospitalisations — it is a far from the city’s best effort. Which, as City and State New York explains, was vaccination of 5 million New Yorkers to smallpox in a two-week period in 1947, a program reportedly down to a much stronger reliance on public health systems and effective communication.