Vials have shattered. Vans transporting the vaccine in Oregon have gotten stuck in snow. Doses have been thawed from a deep freeze before their time. In one case, a Maryland hospital’s freezer malfunctioned and more than 1,500 immunizations were spoiled.
The national rollout of the coronavirus vaccines has not been without obstacles — or waste. As of Friday, at least 1,748 COVID-19 vaccines have gone unused in Maryland since doses first arrived in December, according to the state health department.
Though that’s just a sliver — less than 1% — of the roughly 1.26 million doses Maryland has obtained from the federal government, the number depicts the challenges of handling the delicate vaccine, for which there is a stubbornly short supply and overwhelming demand. It also underscores the need for more vaccine candidates to be approved, public health experts say.
The two vaccines authorized for use in the United States, made by Moderna and Pfizer/BioNTech, are difficult to transport and to store. They go bad if they’re kept at the wrong temperature, or if they’re not used quickly after thawing, according to the U.S. Centers for Disease Control and Prevention.
That means vaccinators have to be versed in dry ice and technologies used to track the temperature of the trays. They also must be vigilant of doses once they’ve been thawed. Every last detail, from the condition of the syringe to the time of injection, is important.
Both the CDC and the Maryland health department urge providers to avoid wasting what limited doses are available. They say it’s better that someone gets inoculated, regardless of their eligibility under state or federal guidelines, than to have a dose spoil.
That means luck has some role to play in deciding who gets vaccinated and when. Shoppers have been approached at retail pharmacies when excess doses surface, and others have sought to put their names on waitlists at clinics for end-of-day excess.
One Maryland researcher, who has published findings about the state’s vaccination rate compared with that of West Virginia, had a local health department staffer tap on his car window with a miraculous extra dose after initially being turned away from a vaccination appointment. And on the Facebook group Maryland Vaccine Hunters, frustrated Marylanders have traded tips about whether any providers were likely to have excess shots available due to a recent winter storm.
To become a vaccinator, providers have to sign an agreement with the CDC, which directs them to report vaccine waste according to their jurisdiction’s mandates. The Maryland health department requires providers to report all COVID-19 vaccine wastage and reserves the right to reduce the allocation to any provider or facility that commits or allows spoilage.
Charles Gischlar, a health department spokesman, said no provider has been sanctioned for wasting vaccines.
It’s unclear how other states have fared with wastage. The CDC has been collecting information about national waste, spokeswoman Kristen Nordlund said, and would make it public “when the data is more complete.”
To avoid waste, providers should maintain active lists of people they can call on short notice when extra vials surface, said Dr. Eric Toner, a senior scholar at the Johns Hopkins Center for Health Security. Vaccinating people outside the prioritization schedule is an acceptable strategy to ensure no dose goes unused, he said.
Under Maryland guidelines, it’s up to local health departments to devise a plan to minimize waste for all providers in their jurisdictions.
Even then, disaster can occur. That’s what happened on Maryland’s Eastern Shore early in the state’s vaccine rollout.
On Dec. 31, an ultra-low-temperature freezer at TidalHealth Peninsula Regional hospital in Wicomico County malfunctioned. The resulting temperature shift rendered 1,580 doses unusable, Gischlar said.
The hospital quickly replaced the special freezer and worked with the health department to improve the cold-storage logistics by reinforcing the temperature monitoring system for the freezer, said Roger Follebout, a TidalHealth spokesman.
Follebout called the loss of vaccines “devastating,” but said TidalHealth pushed forward, administering 17,000 doses of the vaccine as of Thursday afternoon.
Some say government officials could have provided more support to local health departments, hospitals, pharmacies and other immunizers, who have adapted to great personal and professional challenges in an extraordinarily condensed timeline to get shots into arms.
Brian Castrucci, president and CEO of the public health advocacy group the de Beaumont Foundation, said vaccinators should not be singularly blamed for what wastage has occurred.
“We knew while the Pfizer and Moderna vaccines were being developed that they’d need to be at extremely low temperatures. And we knew we didn’t have the capability to do that,” Castrucci, an epidemiologist, said. “The fridge infrastructure isn’t there, and we knew this. What were we doing while these vaccines were going through these trials?”
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The Eastern Shore hospital’s story, while rare, also stresses the need for more vaccine candidates to come online, especially single-dose products and those that don’t require ultra-cold storage, Toner said.
He said both approved products are made using fragile messenger RNA that must be kept frozen at specific temperatures, giving providers just a few hours to deliver it into an arm from after doses are pulled from the freezer. And while the two products use similar ingredients, they must be stored at different temperatures.
The Moderna vaccine requires storage between 5 and minus 13 degrees. It can also be kept in a refrigerator for 30 days without spoiling. Meanwhile, the vaccine made by Pfizer/BioNTech must be kept between minus 112 and minus 76 degrees, requiring an ultra-cold freezer or thermal shipping container, according to the CDC. It can be stored in a refrigerator, but only for five days. A new Israeli study suggests it might work just as well with standard freezer temperatures within two weeks.
For now, “there’s real restrictions on which facilities can handle the Pfizer,” Toner said. “Not only the cold handling, but also the way it’s packaged.”
Boxes of the Moderna vaccine contain 10 multidose vials, each of which has enough vaccine for 10 shots, according to the CDC, though the company has proposed adding more doses per vial. But the thermal shipping containers of the Pfizer product contain up to five trays. Each tray has 195 vials, good for 975 doses.
“Once you open the box, you’ve got to use it,” Toner said. “You can’t use that in a setting where you don’t have a thousand people.”