As the speed of COVID vaccinations picks up, so do the reports of doses going to waste. And it's more than just a handful at the end of the day because of a few appointment cancellations. Health officials are trying to address the problems that lead to waste, but without slowing down the roll out of the lifesaving vaccinations.
The incidents include the 335 discarded doses in Lee County, North Carolina that were damaged in shipping, and recent problems in Tennessee, where nearly 5,000 doses went to waste in the month of February, prompting additional federal oversight.
"I definitely have been losing some sleep over this, for sure," says Beth Ann Wilmore, the nursing director 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 accustomed to handling vaccines, but none so precious that have such special refrigeration needs.
"I was definitely waking up in the middle of the night wondering how the temperatures were doing, and thinking, 'Ok, I hope it's good, and it's not giving me a flag or anything.'"
Many community health centers are receiving the Moderna vials, which are easier to handle than Pfizer, but still tricky. The Moderna vials last up to 30 days after they're taken out of the deep freeze, unlike five days for Pfizer. But once the seal on the vial is broken, there's just six hours to use the shots.
So far, no waste has occurred at Mercy. But Wilmore has heard the horror stories from elsewhere in the state.
In neighboring Murfreesboro, Tennessee, the local school district received a thousand doses for a teacher vaccination event the last weekend of February. But they were put in an unapproved freezer. The temperature sensor on the shipment flashed an error code. As a precaution, they were advised to throw them all away.
"It hurts my heart," says Dr. Lisa Piercey, the health commissioner in Tennessee, which has disclosed one of the country's biggest spikes in reported spoilage.
She says the losses are painful because the shots are "priceless" in the midst of this deadly pandemic. But it's one of the risks of having so many places to get the vaccine.
As a way to increase access and equity, Tennessee now has more than 700 vaccination sites across the state, with more planned to open as vaccine shipments grow in the coming weeks.
"It definitely raises the level of concern when you have more partners — particularly partners that are not under your direct control," she says.
Even Tennessee's large, urban health departments — which operate independently of the state health department — are running into trouble.
In Knoxville, a thousand doses were thrown out, apparently confused for a related shipment of dry ice. In Memphis, the county health director has resigned after being slow to disclose that batches amounting to nearly 2,500 doses were allowed to expire on several occasions. Some expirations were related to winter weather, but poor management in the county's 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 stepped up audits for all local health departments in the state.
There are so many opportunities for doses to go bad. In West Palm Beach, Fla., the power on a mobile refrigerator was turned off. In Connecticut, a fridge door didn't close properly, though the doses were salvaged in time, in consultation with Moderna.
Health officials have gone to great lengths to keep from wasting doses, like an impromptu mass vaccination event in Nashville's homeless shelters after winter storms cancelled hundreds of appointments.
Dr. Kelly Moore, deputy director of the Immunization Action Coalition, says a little spoilage is expected. It's still well less than 1% of doses, even in states like Tennessee and Florida that have disclosed big losses.
"I would be more worried if I saw reports of zero doses wasted," Moore says, because then her concern would be transparency.
"You want to see some waste, because that means people are paying attention and that real world accidents happen and that they're being responded to properly," she says. "You just don't want to see negligence."
There's hope that mishaps will be easier to avoid with the newly authorized Johnson & Johnson vaccine. In addition to 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.
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