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Pharmacists deciding what to do with extra vaccine doses left in multi-dose vials

At the end of the day, pharmacists are often left with a few extra doses. Many are taking measures into their own hands to ensure those doses don’t go to waste.

COLUMBIA, Pa. — Pharmacists are encountering an unexpected consequence of the COVID-19 vaccine process: at the end of the day, they’re often left with a few extra doses. Many are taking measures into their own hands to ensure those doses don’t go to waste.

There are several reasons for leftover doses.

Most often, a patient doesn’t come in for their appointment, leaving their dose unused in the vial.

Vaccine distributors also report both the Moderna and Pfizer vaccines sometimes contain an extra dose within the vial. The additional vaccine is due to a practice called overfill, meant to ensure vials never have too little vaccine.

When there are extra doses left, they can’t be saved for another day.  Both the Moderna and Pfizer vaccines must be used within six hours after opening of the vial, according to the CDC.

Providers on the frontlines are now deciding how to use those extra doses and who should get them.

Some pharmacies have created an “on call” list of people available to come in quickly.

“I call it the “Do Not Waste” list,” said Melissa Koehler, pharmacy manager and co-owner at Hillcrest Pharmacy in Columbia.

Hillcrest’s waiting list has only people eligible under Pennsylvania’s Phase 1A, which includes healthcare workers and those in long-term care facilities.

“We’ve had many, many calls from people that are healthcare providers,” Koehler said. “What I’ve been doing is taking down their numbers and then I’ll call them and say, ‘Can you please come in?’”

Pennsylvania is currently in Phase 1A, when vaccines are prioritized for healthcare workers and those in long-term care facilities.

Phase 1B will include first responders, essential workers and people with high-risk conditions.

However, there’s no hard-and-fast rule that the on-call list must be Phase 1A candidates.

Though the FDA has approved use of any extra doses left in vials, the federal government hasn’t specified if they can go to lower-priority groups.

“There have been instances that I’ve heard that people that people are recruiting maybe individuals that aren’t in group 1A and giving them the shots even if they’re not in group 1A, because the vaccines are going to go bad anyway. You might as well give these individuals the vaccine,” said Erik Hefti, executive director and assistant professor of pharmaceutical sciences at Harrisburg University of Science and Technology.

Pennsylvania Secretary of Health Dr. Rachel Levine echoed the logic that no vaccine should go unused at a Department of Health update on Jan. 11.

“We don’t want any vaccine wasted, so if they’re going to vaccinate someone in 1B as opposed to wasting it that’s absolutely fine. We want to make sure at the end of the day that we get vaccines into arms,” Levine said.

Another issue raised is how to get the second dose to those given leftover first doses. But that issue shouldn’t deter people from taking the extra doses, Hefti said.

“Even if you don’t have a robust infrastructure to get them that second shot, at this point with the cases going up and the hospitals stressed as much as they are, we really need to reduce harm as much as possible,” Hefti said.

Providers are in effect left to choose what to do with leftover doses.

National pharmacies have varied policies on the extra doses.

CVS wrote FOX43 in a statement,

“We follow all CDC and manufacturer guidelines with regard to the proper storage and distribution of each COVID-19 vaccine. If one of our long-term care facility vaccination teams is onsite and cannot use doses remaining in a partially used vial or all doses requested by the facility, our team determines if the remaining doses will remain clinically viable and can be transported for use at another facility or for another eligible population. In the rare instance that doses have reached their expiration they are disposed of per CDC and manufacturer guidelines.”

Walgreens’ website says,

“As part of the federal government’s vaccine distribution plans, states are responsible for prioritizing populations for initial COVID-19 vaccine administration, which may include healthcare workers and long-term care facility employees, and how the vaccines will be administered. We are continuing to collaborate with each state to support initial administration of COVID-19 vaccines based on their needs.”

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