The Middletown Press (Middletown, CT)
Good to the last dose
What happens to unused COVID vaccine doses in Connecticut?
Once the first dose of a COVID-19 vaccine is taken from its vial, it needs to be used quickly.
That means short notice appointment cancellations or leftover doses can pose the risk of vaccine waste if hospitals or health districts don’t have a last dose strategy in place to ensure priority populations receive it.
Several Middletown officials and town employees, including Mayor Ben Florsheim, raised eyebrows in December when they got inoculated ahead of schedule so as not to waste doses after several people either canceled or didn’t show up to a vaccine clinic at city hall.
Across the nation, there have been issues with the vaccine rollout as local health departments and hospitals struggle to get the doses to those eligible in a timely manner. This comes at a time when the U.S. continues to record high daily death tolls — it reached 4,000 deaths on Thursday alone.
Connecticut recorded 202,758 COGood
VID-19 cases with 1,087 currently hospitalized as of Friday. More than 6,000 people have died in the state since the pandemic began.
Paul Liistro, administrator and managing partner of Manchester Manor Health Care Center and Vernon Manor Health Care Center, said they partner with CVS to administer vaccinations, so however many consent forms they have from staff, CVS will bring that many doses.
Their strategy has been to reach an internal herd immunity rate among residents and staff and so far, one building is already at 70 percent immunized, he said.
Additionally, Liistro said they’re utilizing the Centers for Disease Control and Prevention’s Vaccine Administration Management System, a web-based application for health care providers, health departments and individuals to track vaccination doses.
“You have to have a last vial strategy and I was so glad to hear about this VAMS program,” Liistro said.
The VAMS application is a way for jurisdictions and health care providers to manage clinics, schedule patients, monitor vaccination and administration. Liistro said they use VAMS to coordinate with the town and Manchester Hospital, so they’re on standby if a dose becomes available.
CDC spokesperson Kristen Norlund said 10 jurisdictions and three federal partners are currently using VAMS.
The Connecticut Department of Public Health did not respond to a request for comment on how VAMS is being used throughout the state.
Since CVS runs the nursing home vaccination clinics, unused doses are handled by the pharmacy.
“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,” said CVS Health spokesperson Tara Burke.
Burke said in the rare instance a dose expires, they’re disposed of per CDC guidelines, but those discarded doses are not counted.
Each Pfizer vaccine vial contain five doses and a diluted vial can be kept for six hours before it must be discarded.
The Moderna vaccine can keep for about a month in a refrigerator, which is typical of some other vaccines including those for measles. The vaccine remains stable at room temperature for up to 12 hours. But once the first dose has been drawn, the vaccine is only usable for six hours, according to the U.S. Food and Drug Administration.
Other providers, such as Hartford HealthCare, use their own management system to track and document the vaccinations they administer across their hospitals.
“We review our inventory each week based on how many vaccine doses we have left on hand and appointments in the next week to determine the appropriate amount of doses to request,” said Hartford HealthCare Director of Pharmacy Eric Arlia.
Their goal is to have a minimal one to two day stock left at the beginning of each week in case there’s a delay in shipping, he said.
Nevertheless, most of their sites also have staff on standby whenever feasible in case there is a partial vial left at the end of a clinic day, he said.
About 55 percent of the front line workers at Hartford Hospital have been vaccinated to date, and sign-ups are on target with what they expected, Arlia said.
Community Health Centers similarly coordinate internally between its nursing and registration staff throughout the day to ensure all viable doses are being used, according to CHC Vice President of Communications Leslie Gianelli.
While CHC isn’t seeing people canceling or not showing up to vaccination appointments, they still maintain a wait list “so we can plug people into the schedule at the last minute to make sure all doses get used,” Gianelli said.
And the numbers are about what they expected, she said, with 1,300 Phase 1a recipients having appointments in the next week.
But just because all the doses are being used, doesn’t mean all staff are electing to receive them.
“We have learned quickly as we rolled out the vaccine in our nursing facilities that the uptake among workers, many of whom are women of color, has been very low,” Acting Commissioner of the Department of Public Health Deidre Gifford said during a Thursday Zoom panel discussing distrust in the vaccine among Black and brown communities.
Nearly 90 percent of nursing assistants are female, and Black NAs represent about 33 percent of staff, according to U.S. Census data.
Gifford said 40 to 50 percent of workers in Connecticut nursing facilities so far have taken the vaccine, and it’s not that much more among other health care workers.
The panel, which included State Treasurer Shawn Wooden, Access Health CT CEO James Michel and doctors in the Black community, discussed the origins of distrust in health care and vaccines among people of color and the present day disparities in medical treatment for those communities.
“It would be the tragedy on top of tragedy of this pandemic that if we (people of color) continue to get infected at higher rates, get hospitalized at higher rates, die at higher rates once we have the vaccine because of this well understood fear,” Wooden said.
Much of the reluctance toward vaccination at Manchester Manor and Vernon Manor so far has involved concerns about unknown impacts on pregnancies or breastfeeding, said Liistro, since 93 percent of his staff are women.
Genesis Health Care, which runs more than a dozen nursing homes in Connecticut, is also partnering with CVS for vaccination clinics. So far all but one of their facilities in the state has received the first vaccine doses, according to Chief Medical Officer Dr. Richard Feifer.
“We are striving to get as many people vaccinated as quickly as possible at each clinic,” he said. “We notify CVS in advance how many people are planning to receive the vaccine at the clinic and CVS brings the appropriate amount of vaccine. We are not seeing any evidence of vaccine waste.”
Feifer said they’ve seen varying acceptance rates throughout their nursing homes ranging from 80 percent at the most successful center to below 50 percent in other locations where there’s been the most staff resistance.
“In all cases, we are working to increase vaccination rates during the second visit by engaging them directly and addressing their concerns, reinforcing the low side effect rates that we experienced among those who were vaccinated first,” Feifer said.
Multiple vaccination clinics are still ongoing each day, so final acceptance rates can’t be known yet, he said.
President-elect Joe Biden announced Friday he would plan to release most available doses of the COVID-19 vaccine to speed delivery to more people, the Associated Press reported.
This is a reversal on President Donald Trump’s administration’s approach thus far, which has withheld millions of doses of vaccine to guarantee that people can get a second shot, since both the Pfizer and Moderna vaccines require two doses about three weeks apart for maximum effectiveness.
Of the 29.4 million doses distributed across the country, about 5.9 million have been administered, accounting for only 27 percent, according to the CDC.