Ever since the vaccines began rolling out, we’ve heard far too many stories of large numbers of doses being discarded. Some cases have been from intentional spoilage by bad actors and conspiracy theory junkies. Others have been caused by refrigeration equipment failures or just simple human error. But it turns out that an even larger number of doses are going into the waste bin every week without any of those things happening. NBC News has a distressing report out this week revealing that healthcare workers are increasingly dismayed by the high number of doses that wind up being discarded while people are still waiting on line for a jab. The reason is that when they get down near the end of a vial, they are not allowed to use a process known as “pooling” to avoid wasting the precious liquid. The result is that for every shipment of 80 vials, forty full doses of the vaccine wind up in the trash. And they’re blaming the FDA.
Pharmacists at Inova Health, one of the largest hospital systems in the Washington, D.C., area, say they started noticing significant amounts of leftover vaccine in almost every vial, even after they used the additional sixth doses in Pfizer’s vials. But because of the FDA’s regulations, they are being forced to throw out any extra vaccine.
“It’s heartbreaking for us,” Massiah-White said. “We’ve had multiple team members that rotate through here, and at least daily somebody says, ‘Why can’t we pool the waste?’”
The Inova pharmacists did an experiment, taking 100 vials that had residual vaccine. Eighty of them had significant amounts left over. The pharmacists found that with the vaccine left in the 80 vials, they could make 40 additional full doses. That meant that on a typical vaccination day, when the hospital will typically give more than 4,000 shots, it could give an additional 400 vaccination shots with the same supply.
Healthcare workers claim that pooling is done all the time, including with flu vaccines. It’s also done with chemotherapy medication and antibiotics. When a vial doesn’t have enough medication left in it for a full dose, it’s combined with the remnants of one or more other vials until enough for a full dose is accumulated. Vials don’t all have the exact same amount in them and the pharmaceutical companies always put enough in a vial to ensure the listed number of doses is available, plus a bit more. Apparently it can add up quickly, and could result in pods being able to do 10% more patients per day than they can currently.
But the FDA claims that these coronavirus vaccines can’t be pooled because neither Moderna’s nor Pfizer’s products contain preservatives designed to inhibit microbial growth of germs or bacteria. Pooling, they say, would create a risk for unrelated infections as a result of the vaccination. But the pharmacy experts that NBC News spoke with argue that point, saying that the risk of contamination under clinical conditions is low. Also, the risk is outweighed by the benefit of increasing the number of doses by such a significant volume.
I’m no doctor, but I’m not sure which side to believe more on this question. I would be all in for a way to significantly increase the supply in a timely and economical fashion. But I’m a little shaken by the idea of going in for a vaccination and coming out with some sort of blood infection that could turn out to be worse than COVID. Or maybe I’m just overreacting. It’s hard to say. I suppose a better question that’s not addressed in the linked report would be why there is no preservative added to the 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 rapidly that there wasn’t time for it or is there something unique about these vaccines that wouldn’t allow for that to be done? If the former, perhaps the next generation of vaccines will be able to be pooled. But if not, then we’re back to balancing the risk of contamination against the value of a more robust supply.