Federal, state and local governments share responsibility for the tumultuous expansion of COVID-19 vaccinations this week, experts say, and they worry that the bumpy start could endanger efforts to reach the level of mass inoculation needed to move New York toward normalcy.
Frustrated Long Islanders spent hours in vain trying to get vaccine appointments after the state expanded vaccinations on Monday to those 75 and older and some essential workers, and then, the next day, expanded it to anyone 65 and older — or from about 2.1 million New Yorkers to more than 7 million.
"It’s just complete and utter chaos," said Gary Ostrager of Woodbury, who said he is over 65 and spent three unsuccessful hours trying to get an appointment.
He described wading through a wave of error messages, a screen that sometimes displayed computer code rather than a calendar, hopeful attempts to click on a time and date that yielded nothing, and months and months of no appointments.
"Getting this vaccine is of the most critical importance," he said. "And to have the rinky-dink, amateurish system they slapped together makes absolutely no sense."
The state's registration website repeatedly crashed and, on Thursday, as many as 20,000 people signed up for an appointment for a Stony Brook University vaccination site set to open next week — and later saw those appointments voided. Melissa DeRosa, a top aide to Gov. Andrew M. Cuomo, said that state officials believe the unpublished link that was set to go live Friday may have been hacked or leaked.
Residents of other states reported similar problems with online sign-up systems after the federal government on Tuesday urged states to expand vaccine eligibility.
U.S. Health and Human Services Secretary Alex Azar on Tuesday said the expansion of eligibility would save lives, because "some states’ heavy-handed micromanagement of this process" meant that some vaccine doses were sitting in storage rather than going in the arms of vulnerable people.
Increase in demand, not in supply
Cuomo said he reluctantly followed federal guidance. The problems, he said, are rooted in demand for the vaccines far outstripping the roughly 300,000 weekly doses — 250,000 next week, state officials said — the federal government is allocating New York.
"The premise of the federal government is that they would increase the allocation …," he said Friday. "That hasn’t happened. They increased the eligibility. They did not increase the supply."
Part of the supply problem lies with the production capabilities of the companies authorized by the federal government to distribute vaccines for emergency use. The companies, Pfizer-BioNTech and Moderna, said they won’t finish distributing their combined 400 million doses ordered by the federal government — each person requires two doses — until the summer.
New York’s early rigidity on who could receive vaccines was problematic, said Rachael Piltch-Loeb, an associate research scientist at New York University’s School of Global Public Health and an expert on emergency preparedness. But the expansion was "too fast, too soon," especially because the federal government has not coordinated with states and municipalities, she said.
"The federal government is really doing a disservice to the states and localities because [it appears] they’re not providing resources, guidance and feedback on vaccination plans," she said, citing complaints from multiple states and localities about a lack of communication and support from the federal government.
President-elect Joe Biden on Thursday vowed a closer federal partnership with state and local governments and $20 billion more in vaccine spending. Biden on Friday said the federal government would set up its own mass vaccination sites and launch mobile vaccination clinics, and would use the Defense Production Act to increase the manufacturing of vaccines and related supplies such as vials and needles.
If the government authorizes two other vaccines now in clinical trials — from Johnson & Johnson and AstraZeneca and the University of Oxford — that would greatly increase availability and be "a huge step in the right direction," particularly the Johnson & Johnson vaccine, which requires only one dose, said Perry Halkitis, dean of the Rutgers School of Public Health.
The fractured U.S. health care system, with its patchwork of public and private services and inadequate public-health spending, makes vaccine coordination more difficult, said Dr. Wafaa El-Sadr, a professor of epidemiology and medicine at Columbia University.
In other countries, "It’s one system, so you can organize it as one system," she said. In the United States, El-Sadr said, "We have all these bits and pieces, and that hasn’t helped."
More sites coming online
On Long Island, new state and county vaccination centers have opened in the past week, and more will open in the coming weeks, state and county officials said. But Piltch-Loeb said they should have opened earlier, because venues like hospitals and pharmacies weren’t prepared for the surge in vaccination requests. One Long Island pharmacy pulled out of the vaccination program because its phone system crashed and it couldn’t fill prescriptions for regular customers.
Halkitis said the repeated crashing of the state registration system stemmed from lack of preparation. "They should have made sure the system could handle this," he said.
On Friday, Cuomo, citing the problems, said the state website would now only handle appointments for its own mass vaccination sites. By late Friday afternoon, the website included appointments for Stony Brook, as well as Jones Beach. DeRosa said appointment registrations for local health departments, pharmacies and hospitals were removed from the website. She said there would be 20 total state vaccination sites within the next two weeks.
State Sen. Phil Boyle (R-Bay Shore) said the state should have had a distribution plan and more coordination with local governments in place before vaccines arrived.
"We all knew the vaccines were coming," he said by phone after a Thursday news conference on the topic with other Republican officials. "We didn’t know exactly when. Day One, this should have been like a military operation."
Cuomo spokesman Jack Sterne said in a statement in response to the criticism that "every state had trouble in the beginning due to a lack of support and planning from an incompetent federal administration."
Asked whether the state should have worked more closely with counties earlier, Nassau County Executive Laura Curran said she is "not interested in playing the blame game." But, she said, "We certainly communicated with them in any way we could that we were ready to be helpful. … I think the state is now seeing how valuable we can be on the local level."
El-Sadr said planning at all levels of government was insufficient and not detailed enough.
"With something as complex as this, you need a plan that has been worked on and tested way before the vaccine is available," she said.
Cuomo said the state had planned a massive distribution process and is expanding it. But the federal government gave the states little notice before greatly expanding vaccine eligibility and didn't increase supply, he said.
Moderna vaccines travel from the company to two huge centers owned by Dallas-based McKesson, which handles distribution of that vaccine for the federal government, company spokesman David Matthews said. UPS and FedEx then transport them to vaccination sites, he said.
Pfizer's vaccine goes directly from the company to vaccination sites, said Onisis Stefas, chief pharmacy officer for Northwell Health, which is helping coordinate Long Island vaccinations. Pharmacies and doctors' offices typically don't have the ultracold storage capabilities needed for the Pfizer vaccine, so they are only administering the Moderna one, he said.
Nassau and Suffolk officials said there was planning for vaccinations in a potential pandemic — including drills — even before COVID-19, along with agreements with colleges, schools, community centers and other venues to house vaccination sites.
"The plan was always to do additional sites," said Lisa Black, Suffolk’s chief deputy county executive, but the county hasn’t had enough vaccine even for its single site at Suffolk County Community College in Brentwood.
The Meadows at Mitchel Field Homeowner Association, a senior community in East Meadow, wants to host vaccinations in its clubhouse, which would especially help residents who have limited mobility, said the association’s managing agent, Frances Miller. But no one has contacted the community.
Many of the residents can’t navigate a computer, and most who have tried to schedule an appointment online — or asked their children to — have failed, she said.
"I have 611 people and they’re all calling me on my cellphone: ‘What do I do? What do I do?'" she said. "Everyone wants to get vaccinated."
'We need the vaccine'
Nassau and Suffolk officials said they have identified some mobile vaccination sites, like senior communities, but haven’t contacted all of them because it’s unclear when vaccinations can occur.
"Obviously we need product," Curran said. "We need the vaccine."
Nassau’s first pop-up site will be a church in Hempstead, on Monday, and those who will receive the shot already have been selected.
Nassau Health Commissioner Dr. Lawrence Eisenstein said despite registration problems, the county’s two vaccination sites — at Nassau Community College and the Yes We Can Community Center in New Cassel — are running smoothly.
"From a local perspective, I think we have done fantastic," he said.
Although the problem now is demand far exceeding supply, in a few months, the challenge may be not enough people taking the vaccine to reach the 70% to 90% vaccination level needed for herd immunity, when virus transmission is so low that society can return to a level of normalcy.
The chaos of the past several days could increase vaccine hesitancy, Halkitis said.
"If you make it difficult for people, people who already are anxious about getting a vaccine are going to have an excuse not to get it," he said.
The counties and Northwell Health are working to identify trusted community leaders to help boost vaccination rates, especially in minority communities. Officials said some of that outreach began months ago, when searching for testing sites.
El-Sadr said outreach should have been completed before vaccines arrived, because it is critical to counter myths and misinformation about vaccines early.
"This is not something you can do overnight," El-Sadr said. "It takes time. We had the time to engage the communities, engage the leaders, educate them. We lost that opportunity."