Vaccine waste in the midst of scarcity

It’s a problem that we have not given much thought to yet, as we anxiously await the arrival of the bulk of the COVID-19 vaccines. But, if the issues that cropped up in the initial weeks of the vaccine rollout in other countries are instructive at all, we should brace for what may be one of the biggest tragedies of all in this pandemic—vaccine waste in the midst of scarcity and urgency.

The reality of waste stems from the inherent properties of these new vaccines. Almost all of them require special storage and handling to preserve their stability. And, most important of all, their durability is limited. Every batch carries an expiry date. Once thawed and opened for use, they must be administered within a very short time frame. They cannot be re-frozen.

In the United States, where the first available COVID-19 vaccines were allocated to nursing facilities, to be given on a priority basis to the elderly and the infirm, some doses of the defrosted vaccine have had to be given to nonpriority individuals who were on call and ready to be injected at any given moment. The vaccines would have just gone to waste when some of the eligible residents backed out at the last minute.

In Japan, a sixth dose from every vial of the Pfizer vaccine could not be drawn because the standard syringes that were available could extract only five shots. That meant a wastage of one dose per vial while the government scrambled to obtain these special syringes from various sources.

This is a new situation of catastrophic proportions, and very few countries have adequately prepared for it. Even those with the most advanced logistical and protocol systems have been found wanting. We, who, for some reason, were late in procuring the vaccines, may find a little consolation in the fact that there’s always something to learn from the missteps and oversights of those who acted early.

Some of the lessons seem so commonsensical that one must wonder why authorities ignored them. In the United States, vaccine rollout during the early weeks was uneven across the different states. Some of those that had an early start managed to inoculate a large percentage of their population, dutifully reserving a second dose of the vaccine for every vaccinated person.

This created a situation where large amounts of reserved vaccines were kept in storage in some states, while eligible residents in other states were still awaiting their first jabs due to inadequate supplies. It took some intrepid officials to unlock these reserves and reallocate them by guaranteeing their prompt replacement.

It may not be so easy to persuade local officials to give up their reserved supplies when you’re dealing with a broad range of vaccine brands (as we are), whose delivery is contingent on a variety of factors. In the context of uncertain global supply, no one can offer iron-clad assurances that the same brand with which one was injected the first time would be available when it’s time for the second dose. The advisories we have seen do not recommend mixing vaccine types in one person.

And yet, given that even one dose of the vaccine is better than none, it is a no-brainer that all available vaccines at this point must be administered as first doses to as many people as possible. Any decision of this sort will almost always entail a reallocation of limited vaccine supplies, a move that may invite political controversy.

We caught the first glimpse of this the other day, when President Duterte ordered the utilization of all available AstraZeneca vaccines donated by the COVAX facility as first-dose vaccination before their expiration date in May. Health Secretary Francisco Duque III also announced that the Department of Health would be recalling vaccines from areas where the “uptake” has been “low” and where infection rates have been minimal, in order to augment the vaccine supply in the NCR where there has been a surge in new infections. And we are just in the pilot phase of this mass vaccination program.

I dare not think what the need to minimize wastage (by ensuring the proper handling and speedy administration of scarce vaccines) would do to our vaccination priority system when the real vaccine rollout begins. The DOH has put out a plan to create an “Electronic Immunization Registry” in partnership with local government units. It aims to create a master list of targeted and eligible sectors following a priority system of groups and phases.

In Group A, phase 1 (pilot phase) covers all workers in frontline health services. Phase 2 covers all senior citizens, phase 3 all indigents, and phase 4 all military and uniformed personnel. Group B, which includes all “other frontline workers and special populations,” will be served during phase 5 of the program, and the rest of the population, under Group C, will be covered during the final 6th phase.

At once, we may imagine the infinite ways these categories can be stretched. In the pilot phase, we saw how “frontline health workers” could be reformulated to include family members of HCWs. Will “military and uniformed personnel” likewise include members of their immediate families? Presumably. What about the category “indigents”? Does it refer to income level? Informal settlers? So vast is this sector in our society, however it is defined, that we may as well claim herd immunity once we are able to persuade those who belong to it to get themselves vaccinated.

Having witnessed the chaos that attended last year’s distribution of the “ayuda,” a relatively much simpler process, I can only say: “Good luck po on the vaccine rollout!”