As millions of Americans across the country line up to get vaccinated against Covid-19, health officials are still struggling to meet growing demand, a result of the supply shortage.
“It’s more valuable than liquid gold, actually,” said Melanie Massiah-White, chief pharmacy officer at Inova Health System, a nonprofit hospital network based in Northern Virginia.
Some pharmacists say there’s a simple fix that could get thousands more people vaccinated every week, but the Food and Drug Administration is blocking it.
It’s called “pooling” – and it’s not a new concept. Pharmacists have been doing this for years with everything from the flu shot to some chemotherapy drugs to antibiotics. This involves taking what’s left in one vial of medicine and combining it with what’s left in another vial to create a full dose.
“It doesn’t look like much at the bottom of the bottle,” said Dr. Stephen Jones, CEO of Inova Health System, based in Falls Church, Virginia. “But at the end of the day, that results in many doses that end up being wasted, and we are not allowed to use this additional vaccine. But there are times when there’s almost a full dose at the end of the vial, which is heartbreaking to let it go to waste.
Pharmacists in Inova Health, one of the largest hospital systems in the Washington, DC area, say they began to notice significant amounts of vaccine remaining in almost every vial, even after using the additional sixth dose. of Pfizer’s vaccine. But due to FDA regulations, they are now forced to throw away any additional vaccine.
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“It’s heartbreaking for us,” Massiah-White said. “We’ve had several crew members spinning here and at least every day someone says, ‘Why can’t we pool the trash? “”
Inova pharmacists made an experiment by taking 100 vials with residual vaccine. Of these, 80 of them had significant amounts remaining. Pharmacists found that with the vaccine left in those 80 vials, they could prepare 40 additional full doses. This meant that on a typical immunization day, when this hospital would typically give more than 4,000 injections, it could administer an additional 400 vaccines with the same supply.
“If we can just start putting them together, using them right away, we’ll increase the amount of vaccine available for free,” Jones said.
Experts say it’s a simple process that pharmacists have been doing for years.
If a vial becomes contaminated, this practice can spread the contamination to others, prolong the presence of the pathogen and increase the potential for disease transmission.
“It’s a common practice that you see in vaccines,” said Stefanie Ferreri, chair of the Practice Advancement and Clinical Education division at the Eshelman School of Pharmacy at the University of North Carolina. . She said only vaccines with the same lot number should be grouped together, so clinicians can know where they came from if something goes wrong, such as an unusual side effect.
Even though pooling is standard practice, the FDA says pharmacists and other clinicians cannot pool leftover Covid-19 vaccine because neither Moderna nor Pfizer products contain preservatives, which help stop the spread. microbial growth in case the vaccine is contaminated with bacteria or other germs.
“This is an infection control measure,” an FDA spokesperson told NBC News in a statement. “Cross-contamination of multidose drugs by using the same needle and syringe has occurred with other drugs when this practice has been used, causing serious bacterial infections. If a vial becomes contaminated, this practice can spread the contamination to others, prolong the presence of the pathogen and increase the potential for disease transmission.
But pharmacy experts say the danger of cross-contamination is low, and the benefits of having more doses of the Covid vaccine far outweigh any risk.
“If this vial is not used right away, the risk of contamination is higher because there is no preservative in the vial,” Ferreri said. “If the vial is used right away, with a new vial with the same lot number, then the risk of contamination is extremely low.”
Inova health officials say that in large vaccination clinics like theirs, all doses are used almost immediately and they already have protocols in place to protect against any kind of cross-contamination.
“We would use these doses within 60 minutes,” Massiah-White said. “They are not going to sit down. They will not reach room temperature. We would be able to get those arm shots very quickly right here in our clinic.
But for now, the vaccination process remains a waiting game, as Americans wait their turn for the vaccine and vaccine makers ramp up production to meet ever-increasing demand.
“At the end of the day, when there are enough vaccines, it doesn’t matter how much is wasted,” Jones said. “But at the moment we are missing millions of doses. So a few extra doses of each set of vials will make a difference for hundreds of people a day. “