The slowdown in COVID-19 vaccinations means that vaccine administrations may shift to smaller settings such as doctor’s offices, a prospect that increases the likelihood of wasted doses and complicates the end stage of the vaccination campaign.
Once-busy vaccine clinics are seeing fewer patients as the rate of vaccination in the United States has dropped more than 20% in the last two weeks. If that decline continues, then vaccinations may switch to settings that are better suited to administer vaccines to one or two patients a day.
Vials of the vaccine are geared for a mass vaccination campaign with high demand. Both Johnson & Johnson and Pfizer use vials containing five doses of the vaccine, and Moderna vials contain 10. Once a vial is opened, the vaccines must be administered within a limited number of hours, after which they are no longer unusable. If a physician vaccinates fewer patients than there are doses in a vial, then doses will be wasted.
“I think most states are now anticipating that we will be moving away from high volume clinics, and we need to look for ways to get vaccines out to doctor’s offices,” said Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials. “I’m on calls with state health officials, and there is a lot of interest in whether we can shift to different sized amounts for the vaccine.”
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It is unclear if Pfizer, Moderna, or Johnson & Johnson have any plans to re-size their vials for more limited use. None of the companies responded to the Washington Examiner’s request for comment.
“I think the manufacturers are getting a lot of feedback about this, but we understand that it is expensive to repackage and redo all of this,” Plescia said.
The issue has caught the attention of the Biden Administration.
“We know that around 80% of people who are trying to decide about a vaccine say that they want to talk to their doctor about that decision, and we’ve heard that loud and clear,” said Surgeon General Vivek Murthy on Friday. “That’s why we not only want to engage with doctors who are talking to their patients, but we also want to make it easier for people who may get a vaccine through their doctor, and there’ll be more to say about that initiative and in the days ahead.”
Dr. Horis Stedman is a primary care physician in Marble Falls, Texas, who administers vaccines to his patients. He tries to schedule at least 10 patients at a time to be vaccinated so that doses are not wasted, but it is a challenge.
“It is difficult for a family practice to use Moderna and not waste doses,” he said. “If you could get the vaccines in pre-filled syringes, that would be much better.”
Yet it may be more desirable to have doctor’s offices administer vaccines the longer the campaign continues. As those who are most eager to get the vaccine do so, those who remain are more reluctant. But they may change their mind if they talk to a trusted physician.
“I’ve definitely had some of those types of patients,” Horis said. “And everybody that comes in, I ask them about it.”
But a few of his patients cannot be persuaded. One patient refused because he believed the injection would insert a microchip into his body.
“I asked him, ‘Well, how would you change the battery on the chip? And if there are 10 doses in a vial, how do you know if you are going to get a chip in each dose?’” Horis said.
It is not just physicians with small practices who would find vials with fewer doses more convenient. So would some clinics.
“It would absolutely help,” said Dr. Jeffrey Chapman, chief medical officer at Cheyenne Regional Medical Center in Wyoming. “That is something we were facing to the point we had waiting lists and we’d call people on that list to [avoid wasting doses]. Now, with demand down, there are not as many people interested in coming to the clinic when they are called.”
The clinic at Cheyenne Regional was vaccinating close to 1,000 people a week at its peak. Volume is now down to 25% of that.
Plescia has also been hearing concerns about wasting doses from nursing homes. Most nursing homes and other long-term care facilities have by this point vaccinated most of their staff and residents.
“The long-term care facilities have to vaccinate new staff and residents as they come in, but they only need one or two doses, not a vial with 10 doses in it,” he said.
Plescia said his organization has been in touch with the Biden administration.
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“The administration is aware of the issue, but I’m not sure if they will be taking action on it,” Plescia said. “The Biden administration is probably in the best position to negotiate with the vaccine manufacturers.”
