The Maddening Red Tape Facing Older People Who Want the Vaccine

Laura Engle, 78, lives alone in an apartment in Midtown Manhattan. She uses a walker and has a chronic lung disease. She is exactly the kind of person who most needs a coronavirus vaccine.

And yet, she has found it impossible to make an appointment and has become lost in the confusing system set up by the city and the state.

Computer-literate, she navigated New York City’s vaccine finder page on Monday, found the closest provider and sent an email with her name and number to set up an appointment. When no one called, she reached out to the urgent care’s corporate office, which told her to wait.

She wanted to register at the new Javits Convention Center megasite, which she heard about on the news, but could not figure out how. Since it is a state-run site, it does not show up on the city’s map.

“I’m willing to wait my turn,” she said, frustrated, “but I would like to have some feeling that I have a turn.”

In the city, over a million older New Yorkers started the week with optimism that they would finally gain access to the vaccine after months of fearing they would fall victim to the coronavirus. But the reality of actually getting the shots has proved to be far more maddening.

Buggy websites, multiple sign-up systems that act in parallel but do not link together and a lack of outreach are causing exasperation and exhaustion among older New Yorkers and others trying to set up vaccination appointments. It is also stymying New York’s early efforts to get the vaccine to many of the city’s most vulnerable, creating a situation that elected officials say risks exacerbating the inequalities that Covid-19 has already laid painfully bare.

The race to vaccinate millions of New Yorkers has reached a critical point, as officials on Wednesday announced that two cases of a more contagious British variant of the virus had been detected in New York City, one in Manhattan and one in Queens.

The state has used 35 percent of its available vaccine, in line with the national average in a rollout that has gone far slower than expected nationwide. New York City has distributed 34 percent of its shots, with 526,000 available doses as of Wednesday.

But in the race to get shots in arms, some say the bigger picture about exactly whose arms should be prioritized has been lost.

“Here we are, facing a global pandemic, with thousands of New Yorkers who have lost their lives, and who is again the forgotten group of people? The very people who need help the most,” said Mark Treyger, a city councilman from Brooklyn who said his office had been inundated with calls from family members trying to get appointments for their parents.

In New York City, more than two million residents now qualify for the vaccine, including over one million people over age 65 who became eligible this week. The city’s vaccine supply varies, with about 100,000 doses coming this week from the federal government, though some weeks it has received double that amount.

Even as the city and state rush to stand up a huge distribution network, there are increasing worries about supply, with essential workers — including teachers, police officers, transit workers and grocery store clerks — and people over 65 racing to make appointments. About 25,000 shots per day are now being administered in the city.

“Right now, if we don’t get more vaccine, there literally will not be appointments available after the next couple of weeks,” Mayor Bill de Blasio said at a Wednesday news conference. He called the frustrating sign-up system a smaller problem by comparison.

Covid-19 Vaccines ›

Answers to Your Vaccine Questions

While the exact order of vaccine recipients may vary by state, most will likely put medical workers and residents of long-term care facilities first. If you want to understand how this decision is getting made, this article will help.

Life will return to normal only when society as a whole gains enough protection against the coronavirus. Once countries authorize a vaccine, they’ll only be able to vaccinate a few percent of their citizens at most in the first couple months. The unvaccinated majority will still remain vulnerable to getting infected. A growing number of coronavirus vaccines are showing robust protection against becoming sick. But it’s also possible for people to spread the virus without even knowing they’re infected because they experience only mild symptoms or none at all. Scientists don’t yet know if the vaccines also block the transmission of the coronavirus. So for the time being, even vaccinated people will need to wear masks, avoid indoor crowds, and so on. Once enough people get vaccinated, it will become very difficult for the coronavirus to find vulnerable people to infect. Depending on how quickly we as a society achieve that goal, life might start approaching something like normal by the fall 2021.

Yes, but not forever. The two vaccines that will potentially get authorized this month clearly protect people from getting sick with Covid-19. But the clinical trials that delivered these results were not designed to determine whether vaccinated people could still spread the coronavirus without developing symptoms. That remains a possibility. We know that people who are naturally infected by the coronavirus can spread it while they’re not experiencing any cough or other symptoms. Researchers will be intensely studying this question as the vaccines roll out. In the meantime, even vaccinated people will need to think of themselves as possible spreaders.

The Pfizer and BioNTech vaccine is delivered as a shot in the arm, like other typical vaccines. The injection won’t be any different from ones you’ve gotten before. Tens of thousands of people have already received the vaccines, and none of them have reported any serious health problems. But some of them have felt short-lived discomfort, including aches and flu-like symptoms that typically last a day. It’s possible that people may need to plan to take a day off work or school after the second shot. While these experiences aren’t pleasant, they are a good sign: they are the result of your own immune system encountering the vaccine and mounting a potent response that will provide long-lasting immunity.

No. The vaccines from Moderna and Pfizer use a genetic molecule to prime the immune system. That molecule, known as mRNA, is eventually destroyed by the body. The mRNA is packaged in an oily bubble that can fuse to a cell, allowing the molecule to slip in. The cell uses the mRNA to make proteins from the coronavirus, which can stimulate the immune system. At any moment, each of our cells may contain hundreds of thousands of mRNA molecules, which they produce in order to make proteins of their own. Once those proteins are made, our cells then shred the mRNA with special enzymes. The mRNA molecules our cells make can only survive a matter of minutes. The mRNA in vaccines is engineered to withstand the cell’s enzymes a bit longer, so that the cells can make extra virus proteins and prompt a stronger immune response. But the mRNA can only last for a few days at most before they are destroyed.

Lorraine Cortés-Vázquez, commissioner for the Department for the Aging, said 290 participant organizations were making 60,000 calls per week to older adults to let them know about the vaccine and help them schedule visits.

The problem, people who work in senior services say, is that these systems were not sufficiently organized ahead of time. Allison Nickerson, executive director of LiveOn NY, an advocacy organization for older New Yorkers, said that she had been asked to participate in a task force on rolling out the vaccine to those over 75, but it had not met yet.

Several nonprofit social service organizations said that save for being given a script to read to people on a phone call, and a link to the same vaccine-finder map that Ms. Engle was struggling with, they had not been consulted.

“There is a big aging services network whose remit is to reach the poorest, oldest, least capacitated people,” said Ruth Finkelstein, executive director of the Brookdale Center for Healthy Aging at Hunter College. “But those agencies have not been central to the distribution strategy.”

In Jackson Heights, Roseline David, 80, a retired auditor, said that she had been trying to get vaccination appointments for herself and her husband since Monday. She sent repeated messages to her regular doctor. She spent hours on the city’s website on Tuesday night, painstakingly filling out forms, only to find out at the end that there was no availability and she had to cancel out of the system. She called 311 and is waiting for a call back.

“I’ve spent about 18 to 19 hours so far,” she said on Wednesday. “I call this harassment. It affects my mental ability to do other things. And this is only for the first shot, who knows when the second shot is coming?”

Along with older New Yorkers, people who speak languages other than English are also disadvantaged, as well as those who cannot use a computer, Mr. Treyger and others said. There is a phone hotline, but hold times can be long.

A key issue is the disconnect between the city and the state’s systems for setting up appointments, which is leading to confusion on the ground.

At Hillcrest High School in Queens on Wednesday, a vaccination hub run by the city, a handful of people who had signed up via the state’s website were told by health department staff that they were in the wrong place and would have to go to a community health center located in a former firehouse about a half-mile away.

Struggling with their phones, a few people failed to produce their appointment identification numbers for health workers, or a corresponding QR code that would confirm their appointments. Staff in blue vests helped sort out the confusion, and in some cases, scheduled appointments for people who thought they had already scheduled them.

“Some people don’t even have computers,” said Hilary Umans, who had brought her mother, Priscilla, for her vaccine. “What if you don’t have a smartphone? And what if you’re not a native English speaker?”

Dave Chokshi, the city’s health commissioner, said at a City Council oversight hearing on Tuesday that to some extent, the separate sign-up systems cannot be helped: Each major player in the effort has separate medical records systems that vaccination schedules must link to. Each participating urgent care also has its own scheduling system, as do Costco, Rite Aid and dozens of other providers.

The city is trying to streamline the sign-up system to make it simpler, he said. But it has not yet announced how it will tackle the other huge challenges of how to get frail adults without transportation safely to vaccine appointments, and how to reach the city’s tens of thousands of homebound older New Yorkers.

“We have to ensure that the experience, particularly for our elders, including frail elders, is as easy as possible,” Dr. Chokshi said.

For now, many older adults are getting help from friends and relatives, but even that is no guarantee of success. In Riverdale, in the Bronx, Annette Gaudino, who works as policy director for a health advocacy organization, had been trying to register her 95-year-old mother for two days, checking multiple locations. She was not sure if she would be allowed to accompany her to the appointment.

“My mom is increasingly confused, needs a walker and has a part-time home care aide who also needs vaccination,” she said. “There’s got to be a better way.”

Joan Jeffri, 76, who lives in Midwood, Brooklyn — and who was frustrated after being confirmed for an urgent care appointment only to be told later that they had no vaccine — sent a letter to Gov. Andrew M. Cuomo alerting him to the problems.

The lightest moment in her last few days, she said, was when she clicked on the link to her local Rite Aid through the city’s website, only to be told there were 11,624 people waiting to enter the website in front of her.

“I burst out laughing,” she said.

Her daughter-in-law finally got her an appointment at a city site after two hours of effort, and she goes for her shot in two weeks.

Everyone I speak to is insanely and completely frustrated,” Ms. Jeffri said, “and has spent between two and eight hours or more trying to get through.”

Sean Piccoli contributed reporting.

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