COVID-19 vaccines

How some countries lessen, manage COVID-19 vaccine wastage

Michelle Abad
How some countries lessen, manage COVID-19 vaccine wastage

VACCINE. A medical worker prepares a dose of COVID-19 vaccine after Israel approved a second booster shot for immunocompromised people over 60 and medical staff, in Tel Aviv, on January 3, 2022.

Amir Cohen/Reuters

Vaccine wastage is anticipated in any vaccination program, but some countries have been able to lessen waste by planning ahead and anticipating no-shows

MANILA, Philippines – Lawmakers have sounded the alarm over millions of expiring COVID-19 vaccines supposedly worth billions of pesos, as they call for a probe into the wastage in each chamber.

The Department of Health said on Tuesday, August 9, that out of the 245 million doses of COVID-19 vaccines the Philippines got from donations or procurements, wastage was at 6.6%, or around 16.1 million doses. The DOH maintained it was still within the World Health Organization’s standard of 10%

The DOH did not disclose estimated costs, citing confidential agreements with manufacturers.

Vaccine wastage is a regular occurrence that happens with other vaccination campaigns as well. The Global Alliance for Vaccines and Immunization (GAVI) has recommended that countries aim for a maximum wastage rate of 25% for the first year, with a gradual reduction to 15% by the third year.

There are two types of wastage: closed vial and open vial. Closed vial wastage happens due to ineffective temperature control and issues in managing storage and transportation.

Open vial wastage, on the other hand, happens when health workers discard unused doses of multi-dose vials. Some COVID-19 vaccines like the ones manufactured by Moderna, Pfizer-BioNTech, and AstraZeneca are multi-dose vials. Once opened, doses need to be used within hours or they must be discarded. 

Vaccine wastage has been happening in different parts of the world, at various levels. How did other countries minimize waste, or deal efficiently with expiring doses?

Canada

In May 2021, Alberta Health Services (AHS) in Canada said that just 0.2% of its doses administered by then were wasted.

One way the AHS kept this number low was by allowing for some overbooking in vaccination appointments to prepare for no-shows. 

They also planned for staff substitutes who would get vaccinated in the event that open vials still had doses.

“All immunization programs have some degree of inadvertent vaccine wastage due to issues such as refrigeration errors, broken vials, expirations and appointment no-shows. That is expected, and usually minimal,” the AHS said in January 2021, when it reported 0.3% wastage.

Meanwhile, in other Canadian regions like Nunavut, vaccines expired because people lived far apart and in different communities, and it was challenging for health workers to administer all doses in one vial.

In an April 2022 study published in the Canadian Journal of Public Health, researchers said using single-dose vials or pre-filled syringes could be used as an alternative to reduce open vial wastage in areas with low population density, like in Nunavut. 

United States

The United States, the country with the most cumulative COVID-19 cases in the world, has discarded at least 82.1 million COVID-19 vaccine doses from December 2020 to May 2022, according to an NBC News report.

The wastage occurred due to a number of factors: expiration, spoilage due to power outages, and open vials that were tossed at the end of the day when these had doses no one came for.

University of Michigan operations professor Ravi Anupindi told NBC News that demand for COVID-19 vaccines has plateaued or is going down, which led to open vial wastage.

The US Centers for Disease Control and Prevention recommended the following tips to prevent vaccine wastage:

  • If the number of expiring vials is substantial, reach out to vaccination partners to discuss redistribution of vaccines to areas that need them.
  • Work with vaccination jurisdictions in advance to determine thresholds for the number of vials in danger of being wasted that would trigger a call for guidance. “Jurisdictions” in the US context may translate to Philippine local government units rolling out their vaccination programs.
  • Make every effort to coordinate the number of vials needed with the anticipated number of patients set to get vaccinated per day. This would help reduce over-thawing vaccines – some of which, like Pfizer and Moderna, cannot be refrozen.
  • Healthcare providers should not miss any opportunity to vaccinate every eligible person who presents at a vaccination site. These can include family members or friends who accompany patients to medical visits, or community partners.
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Israel

Israel has been acclaimed for its rapid vaccine rollout. More than 10% of Israel’s population received their first dose of the COVID-19 vaccine within the first two weeks of their national vaccination campaign, which started on December 20, 2020. Meanwhile, only less than 1% of America’s population were vaccinated then. 

During the rollout, certain groups of the population were deemed as priority to get the vaccine first, such as the elderly, and those who were at high risk. Rather than waiting for everyone in the current priority group to be vaccinated before opening vaccination for another subset of the population, Israeli authorities, within the first few months of the campaign, allowed for people of the next priority group to receive the vaccine when clinics had excess supply of the vaccine. 

Authorities also worked with civil society organizations to inform the public about whether a vaccination site still had vaccines that needed to be administered for the day. 

Concerns of vaccine waste were raised as Israel had more COVID-19 vaccines than people it could vaccinate. Israel had already purchased 17 million doses of AstraZeneca and Moderna vaccines for the first months of its campaign. Then, in March 2021, the Israeli government intended to purchase 36 million doses of the vaccine which would be enough to vaccinate 30 million people, despite the country having a population of about 9.4 million.

After political opposition, a final purchase was made for 18 million doses. Israel’s acquisition of more vaccines was a move initiated by then-prime minister Benjamin Netanyahu in the lead up to a national election, where he was gunning for reelection. Netanyahu’s government prioritized stockpiling vaccines to have booster shots ready when they would be needed. 

There was also a preference for Pfizer-BioNTech vaccines as Israel agreed to share medical data with Pfizer in exchange for more vaccines.

With its unused COVID-19 vaccines that were set to expire, Israel negotiated exchange deals with countries that urgently needed the vaccines. For example, Israel signed a deal with South Korea in July 2021, when Israel sent 700,000 Pfizer vaccines that were set to expire, in exchange for South Korea returning the same number of vaccines when it received its new batch orders.

The 700,000 soon-to-expire vaccines given to South Korea were initially supposed to be given to the Palestinian Authority (PA) in a similar exchange deal. In this deal, Israel was to give the PA one million soon-to-expire vaccines in exchange for the PA giving the same number of fresh vaccine doses, but the deal fell through.

“It is highly doubtful that the PA will be able to use all the vaccines, as they are about to expire,” Physicians for Human Rights Israel tweeted.

United Kingdom

Around 4.7 million or 4% of the total COVID-19 vaccine doses in the UK became waste by the end of October 2021, according to a National Audit Office report.

Vaccine wastage was lower than expected. It was predicted that 20% of the UK’s vaccine stock will become waste. 

Similar to Israel, the UK sent its soon-to-expire vaccines to other countries. Around 4.5 million AstraZeneca doses were given to other countries. However, 1.9 million AstraZeneca doses expired.

The National Health Service England and Improvement “issued guidance that vaccination sites should have a reserve list of patients and/or health and social care workers that can be called in at short notice to receive a vaccine to avoid wastage.”

Like Israel and the UK, the Philippines also announced plans in April to donate its expiring vaccines to Myanmar and Papua New Guinea. – with reports from Jeromel dela Rosa Lara/Rappler.com

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Michelle Abad

Michelle Abad is a researcher-writer with the investigative unit of Rappler. She also covers overseas Filipinos and the rights of women and children.