Since the vaccines began to be distributed, we have heard too many stories about discarding a large number of doses. Some cases have been for intentional spoilage on the part of bad actors and conspiracy theory junkies. Others have been caused by failure of refrigeration equipment or simply simple human error. But it turns out that an even larger number of doses go to the bin each week without any of those things happening. NBC News has a harrowing report this week that reveals healthcare workers are increasingly dismayed by the high number of doses that end up being discarded while people are still waiting in line to get a puncture. The reason is that when they go down near the end of a jar, they are not allowed to use a process known as “clumping” to avoid wasting the precious liquid. The result is that for every shipment of 80 vials, forty full doses of the vaccine end up in the trash. And they are blaming the FDA.
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.
“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.
Health workers say the combination is done all the time, even with flu vaccines. It is also done with chemotherapy drugs and antibiotics. When a vial does not have enough medicine left for a full dose, it is combined with the remains of one or more vials until enough for a full dose accumulates. Not all vials contain the exact same amount, and pharmaceutical companies always put enough in a vial to ensure the indicated dosage amount is available, plus a little more. Apparently it can add up quickly and could result in the capsules being able to serve 10% more patients per day than they currently can.
But the FDA states that these coronavirus vaccines cannot be combined because neither Moderna’s nor Pfizer’s products contain preservatives designed to inhibit the microbial growth of germs or bacteria. The cluster, they say, would create a risk of unrelated infections as a result of vaccination. But the pharmacy experts NBC News spoke to argue that point, saying the risk of contamination under clinical conditions is low. Furthermore, the risk is outweighed by the benefit of increasing the number of doses by such a significant volume.
I’m not a doctor, but I’m not sure which side to believe more on this question. I would be willing to significantly increase the supply in a timely and economical manner. But I am a little touched by the idea of going to get vaccinated and come out with some kind of blood infection that could be worse than COVID. Or maybe I’m exaggerating. It is difficult to say. I guess a better question not addressed in the linked report would be why aren’t preservatives added to Pfizer and Moderna vaccines if it’s possible to put it in a flu vaccine. Is it because they developed and tested the vaccines so quickly that there was no time to do so or is there something unique about these vaccines that would not allow that to be done? If it is the former, perhaps the next generation of vaccines can be bundled. But if not, we re-balance the risk of contamination with the value of a more robust supply.