How Not to Waste COVID Vaccines

 

What do you do when your COVID-19 vaccine clinic is 20 minutes from closing, only six people showed up for the day's last appointment, and you just opened a 10-dose Moderna vial?

Reports suggest that many clinics dump their leftover doses in the trash.

But some facilities have found solutions to minimize vaccine waste. Relying on constant communication, flexible planning, and a focused workforce including diligent volunteers, they said they have found takers for nearly all the thousands of doses they have prepared since vaccinations began last month.

"So far this has been not a hard problem to solve," said Dora Anne Mills, MD, who is coordinating the 11-hospital MaineHealth system's vaccination sites. "It's really about planning and keeping an eye on things."

Once a vial's seal is punctured, workers have only a few hours to administer them. Some fortunate bystanders have gotten vaccinated merely by being at the right grocery store at the right time. But that can be chancy, and can also draw criticism for giving precious doses to people not on the current priority list.

"There are vaccines that are being wasted and that is a travesty," Terry Fulmer, president of the John A. Hartford Foundation, told ABC News. "Even one dose wasted is too many."

Some facilities told MedPage Today they establish plans every morning and then adjust throughout the day. At Northern Light in Maine, for example, staff remove enough vaccine to cover the first three hours' worth of booked patients; then they prepare smaller batches every hour to ensure they do not take too much out, said James Jarvis, MD, a family medicine and obstetrics specialist who oversees the 11-site system's COVID response.

Ascension St Vincent's four sites in the Indianapolis area keep the vials they think they will need for the day in a fridge -- usually enough for 1,000-1,500 doses of the Moderna and Pfizer vaccines, said Cindy Adams, PhD, the system's chief nursing officer and COVID vaccine coordinator.

In New Jersey, Rowan School of Osteopathic Medicine staff assemble 100 doses to cover the first couple hours, then draw about 50, then 20. To cover the last two hours before the site shuts to the public at 4 p.m., they bring out one vial at a time as needed. Sometimes they don't know if the last 10 patients will all show up, said site coordinator Joshua Coren, DO, but they know they at least will not waste all 10 shots. "You're never going to be exactly right, but I'd rather open up only one vial as we need it," said Coren, chair of the family medicine program. The site gives 300-500 Moderna doses daily.

These sites also maintain lists of healthcare workers, first responders, and others currently prioritized by their states. When they find they have doses unaccounted for, they methodically call these people, working their way down the list until enough of them agree to come in. Sometimes they settle on whoever is willing and available -- including nonclinical staff and volunteer workers, even when they don't qualify under the current priority scheme.

MaineHealth's Mills said the system has vaccinated unbooked spouses who come with patients to appointments when extra doses are available.

"We always have somebody waiting in the wings," said Jarvis at Northern Light, where staff at one location with leftover doses called a nearby dental office to offer them.

Rowan assembles a list late in the day of who is around and unvaccinated, then offers them leftover doses.

"The vaccines are going to go bad anyway. You might as well give [such] individuals the vaccine," Erik Hefti, executive director and assistant professor of pharmaceutical sciences at Harrisburg University of Science and Technology in Pennsylvania, told a local TV station.

"We don't want any vaccine wasted, so if they're going to vaccinate someone in [group] 1B as opposed to wasting it that's absolutely fine," Pennsylvania Secretary of Health Rachel Levine said earlier this month when dosing was nominally restricted to group 1A.

Ascension St. Vincent's pharmacists have drawn on the first few weeks of vaccination to predict no-shows and expected patient flow, Adams said.

That is no cinch: "It is very hard to predict exactly how many vaccines you're going to use in a day," Julie Willems Van Dijk, acting secretary of Wisconsin's Department of Health Services, told the Racine Journal Times newspaper.

https://www.medpagetoday.com/special-reports/exclusives/90935