Avoiding Waste in the Vaccines

Terry H. Schwadron

Nov. 25, 2020

Any minute now — the actual process seems likely in a few short weeks — the first companies are going to get the go-ahead to distribute a coronavirus vaccine.

As we keep hearing, there may be enough between Pfizer and Moderna to provide 20 million with doses in two shots three weeks apart — if we know who and where they are. This week, we added British-Swedish owned AstraZeneca as a third producer, though their offering, while also requiring two injections, reflects a different medical approach.

As usual, Donald Trump is leaving the details as uncritical, the military and the White House group are leaving it to the states, and the states are waiting for guidance from the feds about setting the guidelines.

We’re glossing over the fact that half the country is resisting the idea of a vaccine altogether, and that there are logistical problems galore here. Add in the stupid effects of Trump’s recalcitrance in giving the incoming Joe Biden team access to any current planning, and you can easily imagine the extent of problems.

But one thought just emerging from the messiness is that the very fragility of the vaccines themselves could prove problematic — that a “short shelf life of Pfizer’s shots and uncertainty over how to get them to enough health care workers, frail seniors and other priority patients once vials with vaccines are taken out of cold storage and cracked open could mean thousands of doses go to waste,” warns Politico.

Apparently, all parties are overlooking the obvious — to serve up vaccines at bars.

Making Lists

Clearly, the states do have lists of both hospitals and nursing homes likely to be targeted for the very first deliveries. But even that does not guarantee the intended outcome.

Who exactly is being targeted — all doctors, nurses, orderlies at a hospital but not, say, cafeteria workers? The doctors and nurses whose out-of-hospital patients come into the hospital for non-Covid surgeries? EMT, police, fire and other emergency workers? Funeral home employees? Those pharmacy interns who will be dispatched in mobile units to administer the injections?

To date, the list of how we determine such priorities is being kept quiet, even if hidden, as if it is a state secret. Or they don’t exist, with each agency involved merely pointing at the next agency in line to make such a determination.

Meanwhile, with Congress having bottled up the discussion of coronavirus aid in polemics, there is no extra money hanging around for state distribution plans. The idea is that the CVS pharmacies and equivalent will figure it out. The head of CVS was on one of the talk shows saying, naturally, that his chain of thousands of stores is awaiting direction.

Meanwhile, we also have been told at great length about the super-low temperatures required for the Pfizer vaccine. One delivered, that drug chain or state health official or National Guard unit who receives it will be on the clock before the limited supplies lose their juice.

“Pharmacies set to administer many of the shots are worried about waste, and cash-strapped state and local health departments say they need more money and direction from the federal government. The federal health department says states have what they need and that the government will backstop any shortages that occur,” Politico noted.

Practical Details

The Pfizer injections are under ultra-cold conditions in boxes holding 975 doses in 195 glass vials, meaning about five shots an hour. “Once a vial is thawed and diluted to make five shots, health workers will be in a true ‘use it or lose it’ situation: If there aren’t enough people ready for the shots within six hours, the vaccine spoils, slowing efforts to stamp out hot spots and save lives,” said Politico.

We can all foresee that as mobile units, presumably with super-refrigerators, deploy to neighborhoods and more rural areas, the time factor will kick in.

Maryland health officials told the Centers for Disease Control and Prevention that as much as 5 percent of the vaccine the state is allocated could spoil and go unused, Politico noted. Some rural counties may not be able to use up 975 doses by themselves.

It could be that Moderna’s vaccine or AstraZeneca’s, which require only normal refrigeration, could be deployed to more rural areas.

Gen. Gustave Perna, who leads Operation Warp Speed, the Trump administration initiative charged with bringing a vaccine to market, said CVS and Walgreens know how to do this and that his team has worked with states to “make sure that no vaccine is wasted.”

Oregon is contracting with medical providers to drive around and divide the vaccine among remote areas to avoid having leftover shots. North Dakota wants to repackage the vaccine into boxes with smaller quantities. Some states want people who want a vaccine to pre-apply to have specific lists.

This sounds we’re depending a lot on messy government trains coming down the line efficiently.

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