As millions of people across the country set up their coronavirus vaccination shots, health officials are struggling to meet the rising demand, due to lack of supplies.
“It’s worth more than liquid gold, the truth is,” said Melanie Massiah-White, chief pharmacist at Inova Health System, a nonprofit hospital network in Northern Virginia.
Some pharmacists believe that a simple solution can get thousands of people vaccinated every week, but the Food and Drug Administration stands in the way.
This is called ‘pooling’ – and it’s not a new concept. Pharmacists have been doing this for years with everything from flu vaccines to some chemotherapy drugs to antibiotics. It involves taking what is left in a medicine vial and combining it with what is 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, in Falls Church, Virginia, said. ‘Eventually, however, it comes with many doses that are eventually wasted, and we are not allowed to use the additional vaccine. But sometimes there is almost a full dose at the end of the vial, which is heartbreaking to let it go. ‘
Pharmacists from Inova Health, one of the largest hospital systems in the Washington, DC area, say they noticed significant amounts of vaccine in almost every vial, even after using the additional sixth doses in Pfizer vials. But because of FDA regulations, they are forced to throw out any extra vaccine.
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“It’s heartbreaking for us,” Massiah-White said. “We’ve had several team members wandering around here, and at least daily someone says, ‘Why can’t we take the rubbish with us?’
The pharmacists from Inova did an experiment with 100 vials that had leftover vaccination. Eighty of them had considerable sums left over. The pharmacists found that with the vaccine remaining in the 80 scales, they were able to make 40 additional doses. This means that on a typical vaccination day, when the hospital will usually give more than 4,000 shots, it can give an extra 400 vaccination shots with the same stock.
“If we can simply start putting it together and use it right away, we will increase the amount of vaccines available,” Jones said.
Experts believe it is a simple process that pharmacists have been doing for years.
“This is a common practice that you see in vaccines,” said Stefanie Ferreri, chair of the division for practice advancement and clinical education at the Eshelman School of Pharmacy at the University of North Carolina. She said only vaccines of the same lot number should be added together so that clinicians can track where they come from if there are problems, such as unusual side effects.
Although pooling is common, the FDA says pharmacists and other clinicians cannot combine the remaining Covid-19 vaccine because Moderna and Pfizer products do not contain preservatives, which help stop microbial growth if the vaccine is contaminated. with bacteria or other germs.
“This is an infectious agent,” an FDA spokesman said in a statement. “Cross-contamination of multidose drugs by using the same needle and syringe occurred with other drugs when this practice was used, causing severe bacterial infections. pathogen and increasing the potential for disease transmission. “
But pharmacists believe that the risk of cross-contamination is low and that the benefits of having more doses outweigh any risk.
“If the vial is not used immediately, the risk of contamination is higher because there is no preservative in the vial,” Ferreri said. “If the vial is used immediately, with a new vial with the same lot number, the risk of contamination is very low.”
Inova’s health officials say that all doses are used almost immediately at large vaccination clinics as they are and that they already have protocols to protect against any form of cross-infection.
“We will use the doses within 60 minutes,” Massiah-White said. “They are not going to sit down. They are not going to get to room temperature. We will be able to get the shots here in our clinic very quickly.”
But for now, the vaccination process remains a wait-and-see game, as Americans wait for the shots and for vaccine producers to increase production to meet the ever-growing demand.
“Ultimately, if there are enough vaccines, it will not matter,” Jones said. “But now we are short of millions of doses. A few extra doses of each vial will literally make a difference to hundreds of people a day.”