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

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 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.