Thousands of Covid doses are going to waste, but some states won’t record how many

New York opened up its eligibility requirements after hospital systems reported throwing out doses

Americans long waited for a coronavirus vaccine to receive emergency use authorisation so the country could tackle the pandemic through immunity.

But the vaccination rollout has not gone as smoothly as anticipated.

Strict federal and state guidelines for who should first receive the limited vaccine available has caused thousands of doses to end up in the trash.

How many doses have gone to waste? That number remains unknown because some state governments have failed to report the waste to the public, which is required by the Centres for Disease Control and Prevention, ProPublica reports. Experts have estimated vaccine dose waste was in the thousands. 

Medical providers across New York state reported throwing out vaccine doses after they were unable to find people to administer them to that fit the state’s strict guidelines. Facing a backlash, Governor Andrew Cuomo loosened the guidelines following those reports to include a larger population group of New Yorkers.

But this problem wasn’t happening in just New York.

In Washington, the Washington State Health Association said that some doses have been thrown out due to the eligibility problems. “If you’re doing 500 [to] 700 doses a day, to end up at the end of the day with three leftovers, you know, we’d like there to be zero but that’s a hard ratio to hit,” Washington State Health Association CEO Cassie Sauer told NBC affiliate KING 5.

In Indiana, hospital systems also reported that doses were being tossed out. The Health Department told ProPublica that it reports the wastage, but it could not give the publication a number of how many doses became waste.

Dr Ashish Jha, Brown University School of Public Health dean, shared on Twitter about what he’s been hearing from colleagues regarding vaccine doses getting thrown out.

An ER doctor working in a hotspot location, who asked to remain anonymous, told Dr Jha that their hospital received extra Moderna doses earlier in January. But most of the healthcare staff who could and wanted to receive the vaccine already had it, causing a problem for where the extra doses would go.

“He tried to persuade vaccine team [to open eligibility] but they wouldn't override hospital policy. He called ER leadership. They wouldn't override. Next, hospital leadership. They initially said no, claiming state mandate. He is persuasive and persistent … so they eventually relented,” Dr Jha wrote.

But by the time the ER doctor got back to the vaccinators about more people fitting the eligibility, the vaccine doses had already been tossed.

“This kind of thing is pretty rampant,” Dr Jha told NBC News. “I have personally heard stories like this from dozens of physician friends in a variety of different states. Hundreds, if not thousands, of doses are getting tossed across the country every day. It’s unbelievable.”

Under the CDC, states are required to report the number of vaccine doses “that were unused, spoiled, expired, or wasted as required by the relevant jurisdiction.” When contacted by ProPublica, the state health departments of Maryland, Michigan, and Washington state all said the wastage was not being “systematically collected” or they haven’t asked their vaccine providers to report the data.

Pennsylvania, in comparison, reported that 0.1 per cent of its vaccine doses had been disposed of as of 11 January. 

Why are these doses being thrown out instead of getting held onto by hospitals systems and other vaccination centres? Covid-19 vaccines have a specific shelf-life.

Dr Paul Offit, a pediatrician with Children’s Hospital of Philadelphia who  specialises in infectious diseases, vaccines, immunology, and virology, told The Independent that the Pfizer’s vaccine storage is more complicated than Moderna’s.

“It has to be shipped and stored at minus 70 to minus 80 degrees, which means dry ice, which is not something we've ever done in this country before,” he said.

Then the vials can be stored in a refrigerator for about five days, and each vial contains five doses of the vaccine. Once that vial is reconstituted because “it’s concentrated”, Dr Offit said, that vial only has a six-hour life before it needs to be tossed. “So you have five doses that have to be given in six hours,” he said.

Moderna’s vaccine was more simplistic because it’s shipped and stored at minus 20 degrees, similar to most food shipments in US. Then the vials are stored in a refrigerator for up to one month and do not need to be reconstituted.

“Once you violate the stopper though, once you start to give it, you don't have much time either,” he said.

Waste was to be expected with any vaccination campaign, but health experts were working to eliminate waste due to narrow eligibility requirements put in place by state and federal agencies. 

Prior to leaving office, the Trump administration asked for states to open up their eligibility for the vaccine to those ages 65 years and older and those with comorbidities to prevent doses from expiring. These guidelines could change under the Biden administration, but Joe Biden has indicated he wanted to prioritise vaccinations so 100 million Americans could receive the vaccine within his first 100 days of office.

Besides opening up eligibility, the federal government also planned to open several vaccination centres across the country and ramp up manufacturing of the vaccine. In the past administration, it was largely left up to the state and local governments to administer the vaccine, which Mr Biden vowed to change.

All of this comes as the country reached the grim milestone of 400,000 deaths from Covid-19 and more than 24 million confirmed cases this week, according to Johns Hopkins University.