A medical company contracted by New York City to bring thousands of migrants up to date on vaccines struggled to train staff on how to choose doses and interpret international vaccine records in the early weeks of its operation, according to internal documents reviewed by Gothamist and interviews with current and former staff members.

Contemporaneous email exchanges and interviews with two nurses who worked on the project in early 2023 show that staff hired by Affiliated Physicians mixed up vaccines with similar names, misunderstood vaccine records and incorrectly counted oral polio doses. Workers say that mistakes and near-misses occurred almost every shift they worked in January. And because Affiliated Physicians tracked each patient’s vaccines with disposable paper slips rather than an electronic medical record, workers said in interviews, it was difficult to trace those errors back to specific people.

Vaccines are an important part of health care for the more than 30,000 migrants living in city shelters as of March 7. Many families had fallen behind on medical care in their home countries or during their journeys, and the children needed certain shots on a precise schedule to stay enrolled in their new schools. Advocates and workers said in recent months shelters have seen outbreaks of vaccine-preventable viruses like chickenpox, which can increase the risk of birth defects if contracted by a pregnant person.

Affiliated Physicians, which typically offers onsite shot clinics and health screenings for companies, has been heavily involved in past vaccine rollouts, including COVID and mpox. But interviews with workers on the ground and internal correspondence about the asylum seeker vaccine clinics point to limited training and unclear guidance that led to errors and hiccups.

“Shit was going wrong every single day,” said one former staff member, who asked not to be identified due to fears of retribution and because they want to keep working in health care.

The workers interviewed by Gothamist said Affiliated Physicians has improved substantially since January, tweaking procedures in response to feedback from staff. Email bulletins shared with nurses include changes to record-keeping, constantly updated guidelines and repeated urgings to go slow and avoid mistakes.

And Health + Hospitals, which is managing health care for the migrants, has invested huge resources in delivering these shots, including the Affiliated Physicians clinics. Since last year, the city has given out more than 15,000 vaccines to asylum seekers, including 9,000 to children, according to data shared by NYC Health + Hospitals, the city's public hospital system.

Vaccines represent only one part of the health care provided to migrants. About 8,000 have been signed up for health insurance, and those staying in the city’s Humanitarian Emergency Response and Relief Centers (HERRCs) also have access to other onsite medical services. Asylum seekers themselves said they’re more than satisfied with the care they’ve received overall. Blanca Alarcón, who arrived in New York City in December, said her three children got vaccines both in Colombia and here in the United States.

“They are really attentive to us,” she said. “It’s been really easy and fast.”

When asked for comment, Affiliated Physicians referred Gothamist to New York City Health + Hospitals, which has run point on the city’s asylum seeker response. Health + Hospitals spokesperson Adam Shrier said the public hospital system has been working hard to care for migrants’ health since they first arrived.

WNYC host Michael Hill spoke with data reporter Jaclyn Jeffrey-Wilensky about the story. Click "listen" in the player to hear their conversation, and visit Gothamist for more details.