As millions of people across the country queue to receive their coronavirus vaccines, health officials struggle to meet the growing demand resulting from shortages of supplies.
“It’s more valuable than liquid gold, to tell the truth,” said Melanie Massiah-White, director of pharmacy for Inova Health System, a network of nonprofit hospitals based in Northern Virginia.
Some pharmacists say a simple solution could get thousands more people vaccinated each week, but the Food and Drug Administration stands in the way.
It’s called “bundling” and it’s not a new concept. Pharmacists have been doing it for years with everything from flu shots to some chemotherapy drugs and antibiotics. It involves taking what’s left in one bottle of medicine and combining it with what’s left in another bottle to create a full dose.
“It doesn’t seem like much at the bottom of the bottle,” said Dr. Stephen Jones, CEO of Inova Health System, based in Falls Church, Virginia. “But ultimately, put together, that adds up to a lot of doses that end up going to waste, and we’re not allowed to use that extra vaccine. But there are times when there’s almost a full dose at the end of the vial. which is heartbreaking to let that go to waste. “
Pharmacists at Inova Health, one of the largest hospital systems in the Washington, DC area, say they began to notice significant amounts of leftover vaccine in almost all of the vials, even after using the additional sixth dose in the Pfizer vials. But due to FDA regulations, they are forced to scrap any additional vaccines.
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“It’s heartbreaking for us,” Massiah-White said. “We’ve had several team members rotate around here, and at least on a daily basis someone says, ‘Why can’t we collect the waste?'”
Inova pharmacists did an experiment, taking 100 vials that had residual vaccine. Eighty of them had significant amounts left over. Pharmacists found that with the vaccine left in the 80 vials, they could produce an additional 40 full doses. That meant that on a typical vaccination day, when the hospital will typically administer more than 4,000 injections, it could administer an additional 400 injections with the same supply.
“If we can just start putting them together, using them right away, we will increase the number of vaccines available for free,” Jones said.
Experts say it’s a simple process that pharmacists have been doing for years.
“That’s a common practice seen in vaccines,” said Stefanie Ferreri, president of the Advancement of Clinical Practice and Education division at the Eshelman College of Pharmacy at the University of North Carolina. He said that only vaccines from the same batch number should be combined so that doctors can track where they came from if there are any problems, such as unusual side effects.
Although the combination is common, the FDA says pharmacists and other doctors cannot combine the leftover Covid-19 vaccine because neither Moderna’s nor Pfizer’s products contain preservatives, which help stop microbial growth in the event that the vaccine is contaminated with bacteria or other germs.
“This is an infection control measure,” an FDA spokeswoman said in a statement. “Cross-contamination of multidose medications using the same needle and syringe has occurred with other medications when this practice was used, leading to serious bacterial infections. If one vial becomes contaminated, this practice can spread contamination to others. , prolonging the presence of the pathogen and increasing the potential for disease transmission “.
But pharmacy experts say the danger of cross contamination is low and the benefits of having more doses far outweigh any risks.
“If that bottle is not used right away, then the risk of contamination is higher, because the bottle does not contain any preservatives,” Ferreri said. “If the vial is used immediately, with a new vial with the same lot number, the risk of contamination is extremely low.”
Inova health officials say that all doses are used almost immediately in large vaccination clinics like yours and that they already have protocols in place to protect against any kind of cross contamination.
“We would use those doses in 60 minutes,” Massiah-White said. “They are not going to sit down. They are not going to reach room temperature. We could get those injections very quickly right here in our clinic.”
But for now, the vaccination process remains a waiting game as Americans wait for injections and vaccine manufacturers ramp up production to meet growing demand.
“Ultimately, when there are enough vaccines, wasting some at the bottom will not matter,” Jones said. “But right now, we are millions of doses short. So a few extra doses from each set of vials will make a difference for literally hundreds of people a day.”