Developing and producing COVID-19 vaccines within 12 months of the pandemic’s start was a feat in itself, but getting the vaccines into the arms that need them is another challenge, and possibly an even greater one.
Healthcare providers are struggling to roll vaccines out as fast as possible while also keeping vaccine wastage to a minimum. But with the WHO reporting 50% wastage rates for previous vaccine rollouts in developing countries, COVID-19 vaccine wastage seems almost inevitable.
COVID-19 raises the stakes for vaccine wastage
Wastage is particularly acute for COVID-19, both because vaccines are so crucial, and because vaccine deployment faces particular challenges. France is estimating 30% wastage for COVID vaccines.
Professor Mike Toole, who has previously been involved in vaccine campaigns in developing countries, notes that “We always used to add 20% to our order to cover wastages,” even though he is hopeful that the expense of the COVID vaccines will drive everyone to be more careful. “We do need to make the most of each vial of vaccine,” he adds.
To make things harder, the three vaccines in use in Arizona need special storage conditions, with Moderna vaccines needing to be kept at -20℃, Pfizer at -70℃, and Johnson and Johnson at 2-8℃. Varying storage requirements can increase the risk that someone will make a mistake about temperature control.
On top of that, Arizona’s healthcare providers are under a lot of pressure to reach vast numbers of people, many of whom live in rural communities, on tribal lands, and/or aren’t easily accessible by modern communication. It doesn’t ease the challenge that the Pfizer and Moderna vaccines have a specific dosage regimen, requiring recipients to return for a second dose within a specific timeframe.
Fortunately, there are solutions that can help providers overcome these obstacles.
Ensuring vaccines are transported safely
Vaccine hesitancy for COVID vaccines is higher than usual, so it’s even more important to reassure the public about vaccine quality, especially since two of the most widely-used vaccines are extremely temperature-sensitive.
To support public trust, pharma companies, shipping companies, and health providers need accurate, real-time information about the conditions vaccines are kept in, from the moment they leave the manufacturers until the moment they are administered.
The case of a Wisconsin pharmacist who deliberately left vaccines outside the fridge to spoil made headlines, but vaccines can expire by accident too. In January, La Paz County Health Department had to discard 100 doses after the first shipment it received arrived spoiled.
These incidents can be minimized, and sometimes prevented entirely, through shipment tracking. Transport condition monitoring system provider Logmore allows healthcare companies to track shipment, movement, and temperature in real time, so they’ll know exactly when vaccines will arrive and can schedule appointments more accurately.
In Finland, Logmore enabled healthcare staff to salvage vaccines that were temperature-compromised. Although the cold chain had broken, data showed that healthcare professionals had precisely seven hours to administer the vaccines before they expired, and providers busted a gut to meet the deadline.
Removing obstacles to receiving a vaccine
No one can afford no-shows or a mismatch between doses prepared and appointments booked. Sarah Schiffling, an expert in supply chains at Liverpool’s John Moore University, says, “Obviously you have to start using these vaccine vials, you have to open them up, but once they’re opened, they have quite a short shelf life. If there’s a little bit left in each vial, it does add up rather quickly.”
Limiting vaccine wastage requires streamlining scheduling and improving coordination between healthcare providers and healthcare workers on the ground. Unfortunately, software snafus across the US caused a lot of unbooked slots and wasted shots early in the rollout.
Smooth scheduling software like VaxAtlas enables eligible recipients to find open vaccine appointments and book a slot online immediately, while vaccine providers can easily respond to demand and instruct healthcare workers to prepare the right number of vials. Scheduling apps also send automatic reminders that limit no-shows.
After hundreds of vaccines went unused in Arizona, the health department altered scheduling processes, adjusted the number of doses to thaw, and sent unused shots to other vaccine sites. On March 18, 2021, for example, over 200 doses went bad and had to be discarded because of no-shows at nighttime appointments.
Providers are also using tech like the Notable Health app to automate identifying, contacting, and prescreening eligible individuals for appointments. This type of solution helps providers locate and contact citizens who might not know how to use software to book an appointment online.
Finally, standby lists allow providers to quickly contact the next eligible person if there are vaccines going unused. After it emerged that over 500 doses had to be discarded in Maricopa county during the first month of vaccine rollout, there were calls to create a standby list like those which already existed in Texas, New York, Colorado, and Tennessee.
Improving vaccine delivery
The more product you can draw out of every vial, the more vaccines you can administer. It’s estimated that at least 5% of every single-dose vial vaccine is wasted by inefficient delivery practices, and that can reach up to 25% for ten-dose vials like Moderna.
As if to emphasize the point, Pfizer originally shipped vials labeled as five-dose vials, but it became apparent (and Pfizer changed labeling advice to reflect) that vaccinators with the right equipment and training can draw six doses out of every vial, or close to 200 more doses from every 1,000-dose box.
Although it’s possible to yield the full six doses with regular syringes, advanced low-dead space syringes make it easier for trained professionals to get an extra dose out of every vial. To this end, Australia ordered extra low-dead space syringes in February.
Beyond the need to use every drop delivered, vigilant and verifiable quality assurance is key to the current information war surrounding vaccine hesitancy.
Reliable data like Logmore’s increases confidence about vaccine quality. To that end, DHL began using Logmore for transporting millions of Covid vaccine doses in Europe in March, intending to expand to more continents throughout the year. Sofrigam, a logistics company specializing in pharma transport, also partnered with Logmore in February.
Vaccine wastage doesn’t have to be inevitable
With the right attitude and the right tools, we can overcome vaccine wastage and help stop COVID-19. Better scheduling, improved temperature monitoring, and more efficient vaccine application enable more precious COVID-19 vaccines to make it to the arms of global citizens.
By April 10th, Arizona had vaccinated over a third of its population. Let’s hope we can all keep up the pace and return to normal life.
