While the New York City’s health department said publicly that it wanted to vaccinate 10,000 gay and bisexual men to stop an outbreak of invasive meningitis, it purchased just 4,000 vaccine doses, according to health department documents obtained by Gay City News.
“The estimate of 10,000 was based on HIV-infected men who live in New York City and met the ‘high risk’ criteria included in our announcement,” a health department spokesperson wrote in an email. “HIV-infected men in New York City have access to HIV primary care, and primary care providers can be reimbursed for meningococcal vaccination. The Department’s vaccination purchase was meant to support non-Department facilities that needed a small supply of vaccine while they ordered their own vaccine and to supply Department-operated clinics for sexually transmitted diseases and immunizations.”
The health department first noted the meningitis outbreak on September 27 of last year in a media alert that reported four cases of “invasive meningococcal disease” among gay and bisexual men in the prior four weeks.
A separate alert that was sent to healthcare providers that day reported on 12 cases occurring since 2010. Four of those men had died. One case occurred in 2010, three occurred in 2011, and eight in 2012. Eight of the men were HIV-positive. The department recommended that any HIV-positive man who had had recent sex with another man get vaccinated.
At an October 16 presentation at the Physicians’ Research Network, an educational group, Dr. Marcelle Layton, the assistant commissioner at the agency’s Bureau of Communicable Disease, told attendees, “The estimate is about 10,000 that we’re aiming to vaccinate,” according to a video posted on the network’s website.
On September 27, the agency ordered 1,000 meningitis vaccine doses, according to documents obtained through a state Freedom of Information request. A federal program that funds vaccination efforts paid $68,000 for the doses. On October 2, the department ordered 3,000 doses, spending $204,000 in city tax levy funds for the vaccine.
The records released to Gay City News suggest the agency was struggling to pay for the vaccine, which was purchased under a contract the department has with the federal Centers for Disease Control and Prevention (CDC) that allows it to buy medication at a reduced cost. In emails exchanged between the department and the CDC, there was discussion about whether federal funds could be used to pay for the vaccine.
“[W]e have an increase in meningococcal cases and are considering conducting a vaccine clinic,” wrote Dr. Jane Zucker, the assistant commissioner at the department’s Bureau of Immunization, in a September 26 email to three CDC staffers. “We no longer use 317 $ for purchase of meningococcal vaccine for adults, and as you appreciate with the recent cut in 317 funding, do not have extra money for this... We are looking into available City money.”
“317” is a reference to the section of the federal law that authorizes the vaccination funding program. The discussion about using 317 dollars continued via email among three senior CDC staffers on September 26 and into the next day.
In a September 27 email to John M. Flynn, a project officer in the CDC’s Immunization Services Division, Igor Bulim, a staffer in CDC’s Vaccine Supply and Assurance Branch, wrote, “Since it appears 317 funding is off the table the only other funding source would be State/ Local funds.”
Flynn responded, “Is 317 off the table? Jane is stating that the data is complicated but they could make an argument for use of 317 funds that are in accordance with the new policy.”
In a later email, Flynn wrote, “Jane mentioned that they definitely don’t have access to state; she is asking for city funds. She’s wondering how fast she could get vaccine if she ordered today and if it would be possible to have it delivered for tomorrow?”
By October 6, the department had 4,000 doses and distributed all but 1,765 doses to a network of 34 healthcare providers across the city by November 8. As of January 28, the department estimated that 4,022 people had received a first dose of the two-dose vaccine.
“This is likely an under-estimate, because providers are not required by law to report adult vaccinations to the Department of Health and Mental Hygiene; we rely on voluntary reports from many, but not all, large volume outpatient clinics,” the spokesperson wrote.
On January 28, the department reported two new cases, bringing the total to 18, with two occurring since November 29 when the case total was at 16, with 11 occurring in the prior 12 months. On November 29, the agency recommended that all gay and bisexual men, regardless of HIV status, who had recent sex with another man get vaccinated.
Toronto and Chicago had smaller meningitis outbreaks among gay and bisexual men and responded faster with vaccine campaigns. Toronto’s campaign was comparable to New York City’s at 3,850 vaccinations that were done in 25 days. Chicago distributed 14,267 vaccinations in eight days. Both cities reported no new cases after their campaigns.
Among infections in New York City’s current outbreak that were analyzed, the health department, in its September 27 alert, noted that “6 of 7 infections are related to a strain of N. meningitidis that was responsible for the 2006 outbreak in New York City.”
That earlier outbreak was among injecting drug users in Central Brooklyn, with 23 reported cases and seven deaths. Between June 28 and September 30 of that year, DOHMH vaccinated 2,763 people. An additional three cases were seen after the campaign.