Avoiding Vaccine Wastage for Better Mass Deployment

The risk of vaccine wastage in a mass vaccination program is significant. Now that COVID-19 vaccines are on their way for mass immunization, several choke points arise. Taking into account many concerns such as supply and delivery timing, the supply chain requires thorough planning.

There are many incidences of vaccine wastage. This may be an effect of rigid storage temperature requirements. Such conditions are tough to manage and sustain, especially in a vaccine delivery process. Several cities in Germany found potential irregularities in their vaccination campaign. Doubts on compliance with cold chain requirements have delayed their vaccine program. In the US, outright bureaucracy has negated the sense of urgency for the deployment of these vaccines. Such bottlenecks are limitations risking millions and millions of Pfizer vaccines to expire. Cases of sabotage are also a risk that results in vaccine wastage. 

Because the COVID-19 vaccine is easy to tamper with that is prone to wastage, concerning points are valid. The urgency to fight the pandemic needs the least amount of wastage to maximize vaccine jabs. 

Acknowledging Vaccine Wastage

Vaccine wastage is an actual phenomenon, especially in mass deployment. A report from World Health Organization (WHO) accounts for 50% of vaccine wastage in the world. Industry players suggest that waste is unavoidable. The WHO has differentiation for such wastage:

• closed vial wastage (occurs before vials are opened)
• open vial wastage (occurs after vials have been opened)

The wastage occurrences are likely linked to errors during transit. There are storage lapses that contribute to closed vial wastage. Up to the point of vaccine administration, open vial wastage is present. Immunization practices are factors in vial wastage. 

The Case of Multi-Dose Vials

COVID-19 vaccines are a relative topic because they come in multi-dose vials. The current COVID-19 vaccines come with:

• Pfizer (5 doses)
• AstraZeneca (contain 8 or 10 doses)
• Moderna (contain 10 doses)

Wastage increases with the size of multi-dose vials. As such, there are indicative wastage rates:

• 5% for single-dose vials
• 15-25% for 10-dose vials

In the vaccine volume, overfill is also accounted for. Overfill is an additional liquid added to the vials to accommodate any spill or inaccuracies. Overfill for Pfizer’s vaccine is reported to be higher than the common vaccine volume. While the intention is noble, overfill often results in wastage when not planned accordingly. In an attempt to cover for inaccuracies, it increases the obligation for doses to reach its recipients. Dispensing extra quantity adds to the burden of healthcare officers.

Decreasing Spoiled Vaccines

Considering that COVID-19 vaccines are new vaccine technology, their makeup may rather be fragile. The mRNA technology needs strict temperature conditions, alluding to its delicate composition. The shelf-life of these vaccines is short.

A mass vaccination campaign will rely heavily on vaccination touchpoints. For other countries, they are referred to as vaccination hubs. Addressing the supply with adequate demand from vaccine beneficiaries will decrease wastage/

Vaccine Contingency

Significant risks are present for immunization of this size. Managing such risks is essential to negate any vaccine wastage. Some contingency plans are:

1. Outlining reservation listing to determine the amount of supply needed for vaccination;
2. Vaccine recipient categories specifying priority beneficiaries;
3. Regular inventory monitoring to check closed vial supplies in storage. Inventory will evaluate the need to order additional vaccine deployment;
4. Linkage to other health institutions as alternative vaccination hubs to utilize the current and spare supply;
5. Ensuring vaccine ancillary supplies are within the adequate amount.

Monitoring Vaccine Uptake

With vaccine supplies ready, vaccine uptake should also be complementary. This is especially important to check attendance. Specific preparation guidelines can also ensure proper vaccine uptake:

1. Scheduling of vaccine priority categories relevant to the supply at hand;
2. Monitoring with other vaccination hubs to delegate the right amount of people relative to the vaccines available;
3. Tracking of vaccine deployment to plan out following vaccine schedules

Overseeing Vaccine Administration

The key to ensuring that vaccine wastage will not happen is to streamline the actual administration process. Immunizers are frontline actors in ensuring that vaccine doses are thoroughly utilized. To maximize the vaccine supply, there are some guidelines with regards to vaccine administration:

1. Check for unused vaccines hours before the end of a vaccination schedule
2. Upon checking the number of unused vials, it should be used within six hours
3. Opening the vaccination schedule for walk-ins and consented individual recipients can be helpful
4. Make sure to use the ancillary supplies (needles and syringes) along with the vaccine
5. Label and isolated any risked vaccine in the storage
6. Record and account date and time of checking and report to any authorized healthcare personnel

Operational Impact

There are many factors to consider in the whole vaccine deployment process chain. Some of which are:

• actual immunization profile
• population
• healthcare worker density
• cold storage capacity

Studies show that relying on national-level storage capacity is not enough to target risk groups. This means that the supply chain needs to break down to subnational levels in the local health system. In the African regions, filling the subnational vaccine storage is impractical. The excess vaccines cannot be immediately dispensed. The vaccine bottleneck can be addressed through:

• decreasing reserve stocks
• shortening supply intervals
• removing products from tertiary packaging
• relegating vaccines to subnational levels
• installing additional refrigeration

As such, a proper management oversight is a must for vaccination campaigns to work. It can follow these general measures:

1. Ensuring appropriate aggregate local level storage capacities (increased standard capacity of storage refrigerator);
2. Outlining routine vaccination schedules
3. Regular monitoring of vaccine transit and deployment
4. Training plans for standard vaccine administration
5. Pre-qualification of specific emergency use

Additional solutions

Regulatory requirements are standard compliance practices. There are vaccine compliance procedures from warehouse exit up to vaccination hub storage. A such, monitoring the flow of the vaccines is critical. 

Monitoring is specific. These are evidential accounts that prove to be a concrete reference for reporting. The monitoring solutions needed are:

1. Vaccine logistics
2. live to track vaccine delivery
3. temperature sensors to ensure parameter condition
4. live and predictive data analysis for real-time delivery decisions
5. Storage monitoring
6. alert systems to secure laboratory doors and medical refrigerators
7. calibrated sensors for graphing and alerts
8. differential pressure sensors for air quality check
9. power sensors in case of power fluctuations
10. Vaccine administration
11. user platform software to check vaccine inventory
12. identify parameter lapses 

Many vaccines follow a standard storage requirement of between 2°C and 8°C. Maintaining low temperatures, especially during transport, is crucial. The risk involved during temperature fluctuation may compromise the vaccine itself.

A sound monitoring solution can negate such incidence. AKCP provides a solution for temperature-sensitive vaccines. These are solutions capable of tracking transport and storage. Some monitoring tools are:

• 2x NIST traceable, calibrated temperature sensors
• RFID proximity cards
• Air pressure sensors
• AKCP Pharma-mon server

Utilizing these tech solutions can provide:

• vaccine tracking
• data graphing
• scheduled reporting

Such capacities are essential in ensuring that vaccines are of high quality. The live monitoring feature can also assure that wastage is kept at a minimum. Sensor deployment for remote tracking can be straightforward. Through the AKCP Pharma Mon server, vaccine deployment management is easy. Through a single interface, users can achieve granular visibility. 

Process Improvement

With the urgency of vaccine deployment, concrete reporting evidence is a significant help. The pressure for mass vaccination is enormous. And because vaccines are a scarce commodity, more extensive efforts are given to reduce wastage. 

While regulatory standards serve as guides on the ground, the reality is different. No matter how stringent the measures are, sustaining the process is difficult in an iterative dynamic. Streamlining these processes is essential. Improving it through technological innovation is the correct route to go.

Reporting wastage is fundamental in vaccine deployment. In the end, accounting for vaccine wastage is a reference point for a better measure to follow. Wastages are reviewed in local hubs. When it is a tough call to make, the Health Board will take charge to outline standard steps.

Moreover, a web-based vaccine inventory interface is vital. It can be an indispensable addition to the whole deployment ecosystem. Some of its benefits are:

• record incidences of vaccine wastage 
• account of wastage incidence can be reviewed across vaccination hubs as reference checks
• record volume of wastage doses 
• identify the probable cause of vaccine waste
• amend regulations in vaccine handling

The public is the end recipient of any mass vaccination campaign. While wastage is such a critical consideration, the quality of vaccines is also crucial. Monitoring procedures can validate quality while decreasing waste. 

Investing in proper technological solutions is a giant leap in improving the whole system. Strategies and planning alone cannot present a complete picture. It is the smaller tools on the ground that achieve results. 

In the end, we value sustainability and reasonable outcome. Much is the reason to exert efforts to maintain a sound vaccine deployment. Vaccine wastage is but mistake that should not happen again. Learning from it and developing best practices is the right approach to improve the process. 

Reference Links:

https://www.gov.scot/publications/coronavirus-covid-19-guidance-to-avoid-unnecessary-vaccine-wastage/

https://www.medrxiv.org/content/10.1101/2020.08.13.20147595v2.full

https://theconversation.com/covid-vaccine-some-waste-is-normal-but-heres-how-it-is-being-kept-to-a-minimum-152772

https://www.reuters.com/business/healthcare-pharmaceuticals/cold-chain-doubts-delay-covid-19-vaccinations-some-german-cities-2020-12-27/

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