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NYC health commissioner on the city's response to the monkeypox outbreak

ARI SHAPIRO, HOST:

The CDC says more than a thousand people in the U.S. are known to have monkeypox. The disease rarely leads to hospitalization or death, but the CDC's numbers are likely an undercount since there isn't much testing. New York is one of the country's biggest hot spots for the disease, and the vaccine rollout there has been glitchy and crashy. The city health commissioner, Dr. Ashwin Vasan, apologized yesterday for the mistakes, and he joins us now. Welcome.

ASHWIN VASAN: Great to be here, Ari. Thank you for having me.

SHAPIRO: New York confirmed its first monkeypox case in late May. How would you rate the city's response since then?

VASAN: I think we have tried to attack this with urgency, which is why we launched the first monkeypox clinic in the country in late June. And I think as a direct result of that clinic and the attention it garnered, we really pushed the national conversation forward. I don't think we'd be here as quickly as we are with a national vaccine strategy and the attention we're getting on monkeypox now if it wasn't for New York City leading the way. That said - and as I said yesterday - obviously there's been some technical and logistical glitches that we're working to iron out now. We just launched an announcement announcing how we're going to use the 14,500 doses that we received this week from the federal government and how we're doing that on a more stable vaccine appointment infrastructure.

SHAPIRO: Yeah, I kind of want to parse the response here because getting more attention paid to the problem means getting demand for tests and vaccines. And when that demand can't be met, you find a lot of anger. We heard yesterday from a New Yorker named Cody Dean who was trying to make an appointment for a vaccine. And as you know, the website just crashed. Here's what he said.

(SOUNDBITE OF ARCHIVED NPR BROADCAST)

CODY DEAN: I own a technology consulting business. I have the privilege of sitting here for 90 minutes to get through every step here. And I was still unsuccessful. I seriously doubt that someone working in a retail job in another borough could do that.

SHAPIRO: Why was the runway that the city has had not enough to get the infrastructure ready for what you knew would be an onslaught of demand for a limited number of vaccines?

VASAN: You know, we have a vaccine appointment infrastructure that we built for COVID, and it's being used basically to its maximum bandwidth. And we had to create a new build, and that wasn't available fast enough to meet the supply that we were getting in. And so we relied on vendors to use their technology, and it wasn't sufficient. And so we own that, and we apologize to New Yorkers who had a bad experience here. I will say this, though, we are trying to balance the public-facing appointments with pretty strong partnerships with community-based organizations and providers with whom we're giving direct access so that we are ensuring that we're centering equity as well in the process. So while there are a lot of glitches or there have been glitches with the public-facing side of things, we are partnering with community organizations to ensure that this is being rolled out in a more equitable way.

SHAPIRO: You've said the federal government is providing about 14,500 doses. Do you know what the demand is? How wide is the gap there?

VASAN: I think the gap is significant. I think what you're seeing just anecdotally is that the thousands of appointments we've put online have been snapped up in minutes. There are multiple ways of estimating a population in need, but I think we're talking on the order of tens, if not over 100 thousands of people in New York City alone that could be eligible for this vaccine. And so, as you can see, we've had about in total 20,000 doses delivered to New York City from the beginning of this response. And we have a long ways to go.

SHAPIRO: We've been talking about vaccination, but part of the challenge of getting a disease like this under control is understanding the scale of it. And tests, as we've said, are also scarce. When do you think widespread testing will be available?

VASAN: Absolutely, Ari. I'm an epidemiologist, and it's so challenging to try to fight a pandemic in an environment of low testing when you don't really know the denominator. We're encouraged by the fact that we've seen at least two commercial labs come online in recent days, and I think there are about five that are partnering with the federal government to come online to give clinicians much more access to testing. But that needs to happen fast to get our arms around what's actually going on.

SHAPIRO: A lot of public health experts have looked at the response to the monkeypox outbreak in the early months and said these are the same mistakes that were made in the early days of COVID. Why weren't those lessons learned? Do you think that's a fair assessment?

VASAN: I think the frustration of the public, the frustration of in particularly the affected community in this outbreak and epidemic is totally appropriate. People demand better from government, and government should be a force for good in people's lives, and it is. And when it doesn't perform, we need to hold ourselves accountable and stand up and say we didn't do what we needed to do. But we also have to diagnose the problem accurately, which is to say, did we have the resources to do what we needed to do? Did we have the time to do what we needed to do? And I think in this case, with monkeypox and while we're continuing to fight COVID, I think that what you found was a public health system that has been shorn of workforce with incredible rates of burnout and mental health issues amongst health care workers and public health workers. And I think that what we need to do is support that infrastructure, support those workers so that we can manage multiple crises at once, which is what we're in the midst of doing.

SHAPIRO: That's New York City Health Commissioner Dr. Ashwin Vasan. Thank you very much.

VASAN: Thanks, Ari - appreciate you. Transcript provided by NPR, Copyright NPR.

Ari Shapiro has been one of the hosts of All Things Considered, NPR's award-winning afternoon newsmagazine, since 2015. During his first two years on the program, listenership to All Things Considered grew at an unprecedented rate, with more people tuning in during a typical quarter-hour than any other program on the radio.
Elena Burnett
Christopher Intagliata is an editor at All Things Considered, where he writes news and edits interviews with politicians, musicians, restaurant owners, scientists and many of the other voices heard on the air.