MISSED CHANCES
CVS, Walgreens account for more wasted vaccine doses than most states combined
CVS and Walgreens — two national pharmacy chains that the federal government entrusted to inoculate people against COVID-19 — together account for the lion’s share of vaccine doses that have gone to waste.
That’s according to federal Centers for Disease Control and Prevention data obtained by KHN that shows the agency recorded 182,874 wasted doses as of late March, three months into the country’s effort to vaccinate the masses against the coronavirus.
Of those, CVS was responsible for nearly half and Walgreens for 21% — a combined total of nearly 128,500 wasted shots.
According to CDC data, the companies have wasted more doses than states, U.S. territories and federal agencies added together.
Pfizer’s vaccine was the first to be made available, in December, and initially required storage at ultracold temperatures. It represented nearly 60% of the doses that were tossed out.
It’s not clear from the CDC data why the two chains wasted so much more vaccine than states and federal agencies.
Some critics have pointed to poor planning early in the rollout of the vaccine, when the Trump administration leaned heavily on CVS and Walgreens to inoculate residents and staff members of long-term care facilities.
In response to questions, CVS said “nearly all” of its reported vaccine waste occurred during that effort. Walgreens did not specify how many wasted doses were from the longterm care program.
The bigger issue regarding the government’s role in the distribution of the vaccine is that, months into the nation’s drive to get Americans inoculated against the coronavirus, the CDC still has only a limited view of how much vaccine is going to waste, where it’s wasted and who is wasting it. This potentially complicates efforts to direct doses to where they are needed most.
Public health experts say having a good handle on waste is crucial for detecting problems that could derail progress and risk lives.
The Pfizer-BioNTech and Moderna vaccines, which come in multidose vials, are fragile and have limited shelf lives.
Overall, waste has been minuscule. As of March 30, the United States had delivered roughly 189.5 million vaccine doses and administered 147.6 million, including 7.7 million in long-term care facilities, according to the CDC.
But it still amounts to wasted taxpayers’ money. Because the federal government is footing the bill for the country’s doses, any waste amounts to “basically throwing [taxpayer] money down the chute,” says Dr. Bruce Y. Lee, a professor of health policy and management at the City University of New York.
CVS, Walgreens and other retailers don’t
pay for the vaccine. The government provides it. And, under the Medicare program, it pays providers roughly $40 for each dose administered.
Beyond that, tracking wasted doses helps identify bottlenecks where distribution adjustments might be needed, Lee says.
Early on in particular, officials didn’t adequately assess where there would be demand and set up sites in response, Lee says — something that’s especially important when trying to get shots to as many people as possible as quickly as can be done.
“If you think of any business, they’re going to determine where the customers are first,” he says. “It’s not just a matter of loading up vaccine and going to a place.”
KHN’s survey was based on public records requests to the CDC and all 50 states, five major cities, Puerto Rico and Washington, D.C. The records document more than 200,000 wasted doses.
Missed appointments
The reasons for waste ranged from broken vials and syringes to provider storage errors to leftover doses from open vials that couldn’t be used.
The biggest instances of waste — hundreds of doses at a time lost — tended to be due to freezer malfunctions or workers leaving doses at room temperature for too long.
State records also show the little things that can go wrong. On Dec. 16, the Gunnison County, Colorado, health department lost a single dose of the Pfizer vaccine when someone bumped into a table and a vial spilled. On Jan. 5, the Tri-County Health Department in Westminster, Colorado, wasted a Moderna dose because a hypodermic needle bent.
Remi Graber, a registered nurse who has vaccinated people at mass sites and community clinics in Rhode Island, says it’s not uncommon for a vial to have one too many or one too few doses, which can lead to a dose being counted as wasted.
But the biggest problem, according to Graber, is people not showing up for appointments.
Once a vial is punctured, Pfizer’s vaccine must be used within six hours. On April 1, Moderna said an opened vaccine vial was good for 12 hours — double what it was previously.
“What could happen is you get people who just decide, ‘You know what? I don’t need my vaccine today. I’m not going to show up,’” Graber says. “Well, now we’re scrambling to find somebody to take the vaccine because we don’t want to waste it.”
There are shortcomings with the data, though. Figures from 15 states, the District of Columbia and multiple U.S. territories aren’t included in the CDC’s records. And waste reporting in general has been inconsistent.
In addition to the CDC, 33 states and D.C. provided at least some data in response to those records requests. They reported at least 18,675 additional doses that have been wasted across 10 jurisdictions not represented in the CDC figures. These include 9,229 doses wasted in Texas as of March 26 and 2,384 in New Hampshire as of March 10.
An additional eight states told KHN of more wasted doses than they’d reported to the CDC.
But no city or state comes close to the amount of doses waste reported by CVS and Walgreens, whose long-term care vaccination drive was criticized by some officials as slow and ineffective. Among nursing home staffers, a median of 37.5% reported they got a shot in the first month, according to a February CDC study.
“To me, this ultimately correlates with just poor planning,” says Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine and a critic of the corporate effort.
According to Wasserman, the companies’ approach was too restrictive, and their unfamiliarity with long-term facilities’ needs hampered the effort.
“CVS and Walgreens didn’t have a clue when it came to interacting with nursing homes,” he says. “Missed opportunities for vaccination in long-term care invariably results in deaths.”
CVS spokesman Michael DeAngelis blames wasted doses on “issues with transportation restrictions, limitations on redirecting unused doses and other factors” but says, “Despite the inherent challenges, our teams were able to limit waste to approximately one dose per onsite vaccination clinic.”
Walgreens says its wasted doses amounted to under 0.5% of vaccines the company administered through March 29, which totaled 3 million shots in long-term care facilities and 5.2 million more through the federal government’s retail pharmacy partnership.
Before scheduled clinics, Walgreens’ Kris Lathan says, the chain based the number of doses needed on registrations, “which minimized excess and reduced overestimations.”
The CDC’s Kate Fowlie says that because the retail pharmacy giants were administering a large number of doses, “A higher percentage of the overall wastage would not be unexpected, particularly in an early vaccination effort that spanned thousands of locations.”
Since President Joe Biden took office in January, his administration has directed pharmacies to prioritize vaccinations for teachers and school employees.
Pharmacies accounted for nearly 75% of wasted doses reported to the CDC. States and some large cities accounted for 23.3% of vaccine waste reported, and federal agencies, including the Bureau of Prisons and the Indian Health Service, for just 1.54%. The figure for the Virgin Islands — the only U.S. territory in the federal data — was 0.19%.
“Though every effort is made to reduce the volume of wastage in a vaccination program, sometimes it’s necessary to identify doses as ‘waste’ to ensure anyone wanting a vaccine can receive it, as well as to ensure patient safety and vaccine effectiveness,” Fowlie says.
Vaccine waste could increase as officials shift tactics to inoculate harder-to-reach populations, health experts say.
“I think we are getting to a place where, to continue to be successful with vaccination, we’re going to have to tolerate some waste,” says Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials.
People unwilling to travel to a mass-vaccination site might go to a primary-care physician or smaller rural pharmacy that might not be able to use every dose in an open vial, Plescia says.
Claire Hannan, executive director of the Association of Immunization Managers, says concerns about waste shouldn’t trump getting shots into arms.
“If someone’s there, you need to vaccinate them,” Hannan says. “In our efforts not to waste a dose, we may be missing opportunities to vaccinate because we don’t have 15 people lined up or 10 people lined up.”
The 15 states not included in the CDC’s data are Alaska, California, Colorado, Kansas, Louisiana, Maine, Maryland, Michigan, Nebraska, Nevada, New Hampshire, Ohio, Oklahoma, Oregon and Texas. The District of Columbia is also missing.
Of those jurisdictions, 11 provided data to KHN: Alaska, Colorado, Kansas, Maryland, Nebraska, Nevada, New Hampshire, Ohio, Oregon, Texas and D.C., most reporting minimal waste.
Texas had the most wasted doses of any state. Its records showed 9,229 wasted doses as of March 26, putting it behind only CVS and Walgreens.
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues.