As the speed of COVID vaccinations accelerates, so do the reports of lost doses. And that’s more than a handful at the end of the day because of a few appointment cancellations. Health officials are trying to solve the problems that lead to waste, but without slowing the rollout of life-saving vaccinations.
The incidents include the 335 doses released in Lee County, North Carolina, which were damaged in transit, and recent problems in Tennessee, where nearly 5,000 doses were wasted in February, resulting in additional federal oversight.
“I certainly lost some sleep because of it for sure,” says Beth Ann Wilmore, director of nursing at Mercy Community Healthcare in Franklin, Tennessee. She manages the COVID vaccine inventory at the nonprofit clinic, which started receiving shipments a month ago.
Clinics like Mercy are used to handling vaccines, but none are so valuable that have such special refrigeration needs.
“I would definitely wake up in the middle of the night wondering how the temperatures were going and thinking, ‘Okay, I hope this is good, and that doesn’t give me a flag or anything.'”
Many community health centers receive Moderna vials, which are easier to handle than Pfizer, but still delicate. Moderna vials last up to 30 days after coming out of freezing, unlike five days for Pfizer. But once the seal on the vial is broken, there are only six hours left to use the injections.
So far no waste has taken place at Mercy. But Wilmore has heard the horror stories from elsewhere in the state.
In nearby Murfreesboro, Tennessee, the local school district received a thousand doses for a teacher immunization event on the last weekend of February. But they were put in an unapproved freezer. The shipment temperature sensor flashed an error code. As a precaution, they were advised to throw them all out.
“It hurts my heart,” says Dr. Lisa Piercey, Tennessee’s health commissioner, who revealed one of the nation’s biggest reported spikes in deterioration.
She says the losses are painful because the gunfire is “priceless” amid this deadly pandemic. But that’s one of the risks of having so many places to get vaccinated.
In order to increase access and equity, Tennessee now has more than 700 vaccination sites across the state, with more expected to open as vaccine shipments increase in the coming weeks.
“It certainly increases the level of concern when you have more partners – especially partners who are not under your direct control,” she says.
Even Tennessee’s large urban health departments – which operate independently of the state health department – are having problems.
In Knoxville, a thousand doses were thrown away, apparently mistaken for an associated cargo of dry ice. In Memphis, the county health director resigned after delay in revealing that batches representing nearly 2,500 doses may have expired multiple times. Some expirations were related to winter weather conditions, but mismanagement at the county pharmacy was also a factor.
The state has called in staff from the Federal Centers for Disease Control and Prevention to help monitor vaccine distribution in Memphis and has stepped up audits for all local health departments in the state.
There is such a chance that the doses will get bad. In West Palm Beach, Florida, power to a portable refrigerator was cut. In Connecticut, a refrigerator door did not close properly, although doses were collected on time, in consultation with Moderna.
Health officials have gone to great lengths to avoid wasting doses, such as an impromptu mass vaccination at Nashville homeless shelters after winter storms canceled hundreds of appointments.
Dr Kelly Moore, deputy director of the Immunization Action Coalition, says a bit of deterioration is expected. That’s still well under 1% of doses, even in states like Tennessee and Florida that have shown large losses.
“I’d be more worried if I saw reports of zero wasted doses,” says Moore, because then his concern would be transparency.
“You want to see waste, because it means people are paying attention and real world accidents are happening and they are being treated properly,” she says. “You just don’t want to see neglect.”
It is hoped that accidents will be easier to avoid with the newly authorized Johnson & Johnson vaccine. Besides being a single dose, it remains effective even after being stored in a normal refrigerator for months.
This story was produced as part of NPR’s partnership with Kaiser Health news and Nashville Public Radio.