“It was like the checkout at the supermarket,” said Tonya Warden, 51, who went to get her shot with a co-worker. “Really fast.”
But after Philadelphia’s health department learned that Philly Fighting Covid, established in April as a nonprofit, had launched a for-profit company in December, the city abruptly shuttered the vaccination clinics. Officials said they had lost trust in the group, citing concerns that changes in its data policy might allow personal information to be sold.
Residents were beset with confusion about where to get their shots as an automated system sent out reminders for appointments that have since been canceled. One senior health official from the city resigned. Allegations of incompetence and angry calls for racial equity erupted, aimed not only at the start-up but at the health department and the mayor, who had implicitly endorsed the operation by showing up on the first day shots were administered in early January.
“It was botched, completely botched,” said City Council member Cindy Bass (D), who chaired a Feb. 5 hearing questioning the health department’s decision to entrust 6 percent of its vaccine supply to an organization run by recent college graduates who had little medical training.Read:Clinical study aims to better understand COVID-19 immunity
The evolving crisis highlights the challenges facing cities and states, each charged with creating its own vaccine delivery system and facing criticism for confusing registration requirements, hours-long waits and failure to administer vaccine doses in high enough numbers to communities of color.
Philadelphia has stood out as one of a handful of cities receiving doses directly from the Centers for Disease Control and Prevention and for its willingness to create unconventional partnerships — in this case, pairing Silicon Valley-style strategies with its public health program.
Days before the relationship collapsed, James Garrow, the public health department’s communications director, described the leeway the health department had given Philly Fighting Covid: “It’s their clinic. They run it as they see fit. We are there to keep an eye on our vaccine to make sure it’s used properly.”
In an email to The Washington Post two days before the arrangement fractured, Philly Fighting Covid’s founder and CEO, Andrei Doroshin, 22, pledged that preregistration data collected on 100,000 Philadelphia residents would not be sold.
“Anyone who pre-commits on our platforms and had entered their personal information into our systems can feel confident that their data is private, safe and will not be sold to a third-party company,” Doroshin wrote.Read:Women have a lower range of ‘normal’ blood pressure than men
Becoming a for-profit entity was necessary to expand, Doroshin told The Post, explaining that he took advice from health-care lawyers.
“Creating new sites is very expensive,” he said. “It cannot just be funded by donations.”
In a statement that has since been removed from the start-up’s website, Doroshin says that instead of defending against “Philly’s dirty power politics,” his organization should be busy “vaccinating thousands of people.”
But soon after ties were severed, another controversy erupted. While some providers nationally were winning praise for finding inventive ways to administer soon-to-expire doses, Doroshin took things a step further: After a participating nurse tweeted that Doroshin “took home a ziplock bag-full of vaccines,” the CEO acknowledged on air that he had administered leftover doses to four friends.
The fallout has been rapid. The acting deputy health commissioner, Caroline C. Johnson, an infectious-disease expert with extensive immunization experience, resigned over communications with Philly Fighting Covid and another testing partner, the Black Doctors Covid-19 Consortium. Those communications appeared to give the groups a head start in winning the city’s burgeoning vaccine business. The city’s inspector general launched an investigation, promising a public report. And some state legislators called for the city’s health commissioner, Thomas A. Farley, to step down.Read:German chemicals giant Bayer says to produce Curevac vaccine
Farley declined to comment, citing the inspector general’s ongoing investigation.
On Feb. 5, the city council grilled Farley for three hours, calling on him to explain the relationship with Philly Fighting Covid. Farley, who described the partnership as a “mistake,” faced broader questions about why Black residents have been underrepresented among the rolls of vaccine recipients — especially in a city in which people of color are the majority.
Farley acknowledged that “the people who force their way to the front of the line . . . often are people who are White.” While Farley did not have data to show that was the case at the Philly Fighting Covid clinics, sign-up links had been shared, allowing some people to jump ahead of their priority status.
Witnesses at the city council hearing evoked the Tuskegee Study, in which Black men with syphilis were deprived of treatment without their knowledge, and the response to Hurricane Katrina. The meeting vaulted into the charged territory of race, laying bare the historical and contemporary grievances that plague public health nationwide — and now the coronavirus vaccine rollout.
“When you look at those past government failures, when you’re African American, you see a pattern,” Bass said in an interview. “It’s a form of disenfranchisement, and it’s not just from guys that stormed the Capitol. It’s from the government itself.”
Early in the pandemic, the health department sought to ensure coronavirus testing reached underserved and hard-hit populations by forging relationships with organizations presenting innovative approaches and with roots in communities of color and neighborhoods where many residents do not speak English. Once the vaccine became available, the department built on those relationships to administer shots.
Philly Fighting Covid, which Doroshin launched as a nonprofit last spring to make face shields using 3-D printing, had already evolved once to provide free testing centers, which were used by more than 15,000 people. The group won a $194,000 contract with the city for testing.
Well before vaccines were available, Doroshin said he and his team started figuring out how to get shots to recipients with as little human contact as possible.
“We had six months’ lead time,” said Doroshin, who said he and two friends plowed about $300,000 of their own money into Philly Fighting Covid. He declined to describe how he acquired the funds, apart from saying on different occasions that he has worked since he was 14 and that he has profited from “cryptocurrency.”
“It wasn’t that [the health department was] partnering with us to build a solution,” said Karol Osipowicz, a cognitive neuroscientist and Doroshin’s mentor first at Drexel University and then at Philly Fighting Covid, where he served as chief science officer. “We gave it to them.”
“They trusted us,” said Victoria Milano, 23, site manager at the vaccination clinic.
Just before Christmas, as coronavirus cases surged and hospitals were tied up vaccinating their front-line workers, Philly Fighting Covid and health department officials had a meeting.
In mid-January, as Philly Fighting Covid was winning accolades for its first clinics, Johnson, then acting deputy health commissioner, recalled her reaction to the group’s the-sky’s-the-limit proposals.
“We are always suspicious, but we didn’t have much to lose,” she said, describing how she was providing some medical oversight and committed a staff member to watch over the vaccine. “It wasn’t our good name that would go up in flames.”
By lowering barriers to access, Philly Fighting Covid would allow the health department to focus resources on members of high-risk groups who may not have cars or proper documentation, said Johnson, who was also collaborating with the Black Doctors Consortium.
Johnson said she had seen the benefits of working with outside groups. Philly Fighting Covid and other grass-roots partnerships reminded her of the early days of the HIV/AIDS crisis, when citizens founded their own response organizations, many of which gained national prominence.
If Philly Fighting Covid expanded, Johnson said, the health department would probably “go along for the ride.”
Johnson said she believed the group would apply for city funding and start billing insurers.
“We are silent on that,” she said, referring to billing.
Following her resignation, Johnson did not respond to requests for comment.
The health department did not sign a contract for vaccinations with Philly Fighting Covid as it had done for testing. Instead, as is the case with more than 100 nonprofit and for-profit vaccine providers in the city, the group had to meet requirements set out by the CDC.
On five days in January, Philly Fighting Covid transformed the yawning hall of the Pennsylvania Convention Center — better known as the backdrop for the city’s famous flower show — into an immunization assembly line, delivering about 140 shots an hour, almost 1,500 a day.
“We’re treating it like a factory, with quality control and safety checks,” Doroshin said after the first two days of vaccinations, explaining that he had his eyes on a stadium where he believed they could vaccinate “20,000 a day without breaking a sweat.”
Buoyed by their early success, Doroshin said he was looking into taking the show on the road — perhaps to another major city, such as Los Angeles or D.C., or to a purpose-built site, possibly with the help of out-of-work concert roadies.
The opportunity to innovate — and far faster than government — had appealed to City Council member Mark F. Squilla (D) from the moment he met the team of young entrepreneurs with degrees in engineering and neuroscience and expertise in data management. Now, he was excited to see what was happening at the Convention Center, which sits in his district.
“You go in. Boom! Boom! Boom! And you’re done,” he said, even as he anticipated some criticism of the swashbuckling approach. “Are people going to push back? Say there’s something we didn’t do right?” he said before the controversy blew up. “I’m sure that’s going to be the case. But we can’t wait until it’s perfect.”
Things didn’t go perfectly. Internet connectivity wasn’t reliable at the start, resulting in the loss of data on the race and ethnicity of some vaccine recipients. The sign-up link intended largely for health-care workers who don’t work in hospitals — many of whom are people of color — was shared more widely so that real estate developers and financiers were among the people speeding through, some apparently unaware they had skipped ahead.
Doroshin said at the time that Philly Fighting Covid was tightening access and remained “committed to making this process as equitable and accessible as possible.”
Garrow acknowledged that officials were concerned but said that the problem also exists in pharmacies and that sticking too rigidly to priority groups can slow the process or leave vaccine doses unused.
“We know that if someone is hellbent on jumping the line and don’t care that they are, there’s not much we can do about it,” Garrow said.
What’s more, the “boom, boom, boom” approach wasn’t for everybody in this multiracial city, according to Ala Stanford, a surgeon who founded the Black Doctors Consortium, which is increasing the number of vaccinations it provides in partnership with the health department. The community-based campaign draws on principles Stanford developed driving door to door and church to church to deliver coronavirus tests to underserved neighborhoods.
“We don’t rush them,” Stanford said in a January interview.
Stanford, who has a private practice in the Philadelphia suburbs, said clinicians make themselves available to answer questions, especially in communities with a historic distrust of public health measures.
“Grandma needs you to take time,” she said. “Someone needs to look after kids while we take care of mom.”
Across the country, public health departments are struggling to overcome vaccine hesitancy and increase access to clinics in communities of color. Recently released CDC data shows that in the first month of vaccinations, just 5.4 percent of the 13 million people vaccinated were Black, although Black people account for about 16 percent of health-care workers. But the data is limited, with information on race and ethnicity missing in about half of the cases.
In Philadelphia, which is more than 40 percent Black, African Americans account for about 18 percent of the people vaccinated so far, according to health department data.
Stanford said that to reach hesitant people, she relies heavily on word of mouth and trust born out of personal connections, rather than what she referred to as Philly Fighting Covid’s “tech aspect.”
For the men and women who came to the convention center, getting a vaccine required an electronic appointment and about half an hour of free time. After they passed through security and checked in, it took a matter of minutes to be waved through to one of eight private vaccination pods, where nurses, each with an assistant, asked brief screening questions and used pre-filled syringes to give the injections.
People moved in a clockwise direction — by design, according to Osipowicz, the group’s chief science officer. The circular movement reflects what behavioral scientists have identified as the natural herding behavior of human beings, he said.
Each step had been mapped out to the second, said chief operating officer Jesse McGrath, who designed the system and believes it remains superior to almost any in the country.
Once vaccinated, for example, dozens of people waited on chairs several feet apart to be monitored for side effects, with emergency medical staff on hand in case anyone needed to go to a hospital. That allowed a far more efficient flow of people than in pharmacies and small clinics, where limited space for observation restricts the number of shots that can be given.
And if there was any doubt this was set up by millennials, the newly vaccinated left by way of a selfie station. (“My first!” exclaimed one judge, as he snapped a celebratory shot.)
The clinics attracted immediate attention.
Milano, the site manager, received an email from a member of a professional organization for roadies, who erect and dismantle small cities every day to put on festivals around the world.
“We are logistics geniuses,” read the email, from a representative for the bands Mumford & Sons and the 1975. “The work you are doing mirrors what we do on the road, and the arenas and stadiums across the country are our offices. It just seems like the perfect match to get out-of-work roadies involved somehow.”
The nine-month-old start-up was also coming under scrutiny.
Asked about the business model in the days before the breakup, Doroshin described Philly Fighting Covid as a “company,” then as a “501” or nonprofit.
In a Jan. 23 email, Doroshin wrote that “Philly Fighting Covid switched to for-profit LLC status in early December.” The new company, Vax Populi, would eventually bill insurance companies for vaccine administration, Doroshin said, although recipients would not incur out-of-pocket costs.
At the time, the Philly Fighting Covid website described it as “a 501(c) 4 not-for-profit organization.”
A day later, Doroshin wrote again, this time offering “an explanation and an apology” and saying the company was “transitioning” to for-profit status and would update the public once the process was complete.
“The reality is that I, like many of us, am learning as I go,” he wrote. “The learning curve is maybe a bit steeper for a young guy like me.”
On Jan. 25, after the Philadelphia Inquirer raised concerns with Farley, the health department sent out a statement, terminating the partnership with Philly Fighting Covid “effective immediately.” While the department works with many for-profits — including pharmacies and hospitals — to provide doses of the vaccine, Garrow wrote that Philly Fighting Covid had altered its status without telling city authorities.
“As part of this change, PFC updated its data policy in a way that could allow the organization to sell data collected through PFC’s preregistration site,” the statement said, also criticizing the group for abruptly stopping its testing program.
Doroshin said in a statement that the data policy contained “problematic” language, and “as soon as we became aware of it, we removed it.”
The bigger problem was that the partnership with Philly Fighting Covid had been based on trust, Garrow said, faulting the group for its lack of transparency.
Doroshin remained bullish on the methodology, even on the day the health department cut ties.
“This is what other efforts look like if you need a comparison to our operation,” he wrote in a text to The Post, attaching an article about a state-run vaccine rollout in neighboring Delaware where residents complained of “nightmarish” waits.
On that point, the health department agrees.
“Philly Fighting Covid demonstrated they can get people through a site and get them vaccine,” Garrow said. “Most people who came through came away super impressed.”
Now, Philadelphia Mayor Jim Kenney (D) is seeking to regain residents’ trust by overseeing the opening of a new mass vaccination clinic at the same site. This time, it’s run by the health department.
Julie Tate contributed to this report.