While millions of Americans across the country are lining up to get the Covid-19 vaccine, health officials are still struggling to meet growing demand as a result of a lack of supplies.
“It’s more valuable than liquid gold, truth be told,” said Melanie Massiah-White, director of pharmacy for Inova Health System, a network of non-profit hospitals based in North Virginia.
Some pharmacists say there is a simple solution that can vaccinate thousands of people each week, but the Food and Drug Administration is on the way.
It’s called “pooling” – and it’s not a new concept. Pharmacists have been doing this for years with everything from flu shots to some chemotherapy drugs and antibiotics. It involves taking what’s left of a bottle of medicine and combining it with what’s left in another bottle 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 in the end, in total, it ends up resulting in a lot of doses that end up being wasted, and we are not allowed to use this additional vaccine. But there are times when there is almost a full dose at the end of the bottle, which is painful to waste. “
Pharmacists at Inova Health, one of the largest hospital systems in the Washington, DC area, say they have begun to notice significant amounts of leftover vaccine in almost all vials, even after using the additional sixth dose of the Pfizer vaccine. But, due to FDA regulations, they are now being forced to discard any extra vaccines.
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“It is painful for us,” said Massiah-White. “We had a lot of team members around here and, at least daily, someone says, ‘Why can’t we collect the trash?'”
Inova pharmacists did an experiment, taking 100 vials that contained residual vaccine. Of these, 80 of them left significant amounts. Pharmacists found that with the vaccine left in the 80 vials, they could make an additional 40 full doses. This meant that on a typical vaccination day, when that hospital would normally deliver more than 4,000 injections, they could administer an additional 400 vaccines with the same stock.
“If we can just start putting them together, using them immediately, we will increase the amount of vaccines available for free,” said Jones.
Experts say it is a simple process that pharmacists have been doing for years.
If a bottle becomes contaminated, this practice can spread the contamination to others, prolonging the presence of the pathogen and increasing the potential for disease transmission.
“This is a common practice that you see in vaccines,” said Stefanie Ferreri, president of the advance practice and clinical education division at the University of North Carolina’s Eshelman School of Pharmacy. She said that only vaccines from the same batch should be bundled together, so doctors can track where they came from, in case there is a problem, as an unusual side effect.
Even though pooling is a common practice, the FDA says that pharmacists and other doctors cannot collect the remnants of the Covid-19 vaccine because neither Moderna nor Pfizer products contain preservatives, which help prevent microbial growth in the event of the vaccine is contaminated with bacteria or other germs.
“This is an infection control measure,” an FDA spokeswoman told NBC News in a statement. “Cross-contamination of multidose drugs by the use of the same needle and syringe occurred with other drugs when this practice was used, causing serious bacterial infections. If a bottle is contaminated, this practice can spread the contamination to others, prolonging the presence of the pathogen and increasing the potential for disease transmission. “
But pharmacy experts say the danger of cross-contamination is low and that the benefits of having more doses of the Covid vaccine far outweigh any risk.
“If the bottle is not used immediately, the risk of contamination is greater because no preservatives are contained in the bottle,” said Ferreri. “If the bottle is used immediately, with a new bottle with the same batch number, 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 type of cross-contamination.
“We would use these doses in 60 minutes,” said Massiah-White. “They are not going to sit. They will not reach room temperature. We would be able to deliver these injections very quickly right here in our clinic. “
But for now, the vaccination process remains a waiting game, while Americans wait for the injection and vaccine manufacturers increase production to meet ever-increasing demand.
“Ultimately, when there are enough vaccines, wasting some at the bottom doesn’t matter,” said Jones. “But now, millions of doses are missing. Therefore, a few extra doses of each set of bottles will make the difference to literally hundreds of people a day. “