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Some vaccine wastage is unavoidable due to the characteristics of the vaccine, issues with cold chain supply, storage failure, vial size and specific clinical situations.
Following these best practice guidelines will help you to minimise the risk of unnecessary wastage:
Plan appointment numbers based on doses from a vial
Vaccination clinic appointment numbers should be planned taking into consideration the maximum number of doses possible to be extracted from a vial in order to make maximum use of available vaccine.
Pfizer vaccine - 6 doses from a vial of the Pfizer vaccine (there must be sufficient to extract a full 0.3 mL dose). Where a full 0.3 mL dose cannot be extracted, the remaining volume should be discarded.
Oxford Astra Zenica vaccine - 11 doses or 9 doses from the 10-dose or 8-dose multi-dose vials of the vaccine respectively (there must be sufficient to extract a full 0.5 mL dose). Where a full 0.5 mL dose cannot be extracted, the remaining volume should be discarded.
A contingency plan should be put in place to manage the risk when less vaccine than expected is used during a clinic.
This could include:
maintaining a reserve list to ensure vaccine is not wasted (e.g. care home or front line health and social care staff or second doses). Ideally this should be from within the same cohort however the JCVI has also indicated that there should be some flexibility in including other cohorts concurrently such as those age 75 years and over but not at the expense of earlier cohorts, particularly care homes. A bundling approach has been agreed for the Island Health Boards and for cohorts 3, 4 and 5.
reducing subsequent orders if the remainder of the vaccine is in un-punctured vials which are still in the fridge.
maintaining awareness of local arrangements with other immunisation services who would be able to use the spare vaccine within short notice.
ensuring there is enough needle and syringe supplies
Monitoring uptake and attendance
At the moment little is known about projected uptake and attendance rates. Scheduling teams and planners should keep in touch to monitor this closely in order to ensure the pharmacy is supplying an optimal number doses and maximising the use of the supply chain.
Good oversight and management
Good oversight and management in vaccination clinics and centres is essential, especially when there are multiple immunisers. This is key to avoiding multiple immunisers each with unused doses.
ensure any unused vaccine is used within six hours of the multi-dose vial being punctured.
use the combined needle and syringes provided with the vaccine wherever possible. These are dose-sparing (low dead space) combined needles and syringes and will help optimise the number of doses that can be extracted from a vial.
label and isolate the affected vaccine in the fridge and seek advice as soon as possible if there is any evidence that the vaccine has been stored incorrectly. You should label this in line with local procedures, for example contact the vaccine holding centres or your immunisation coordinator. Depending on the specific circumstance, the vaccine may still be acceptable for use.
Use additional doses from one vial only
If you are using any additional dose in a vial then this must come from one vial. The dose should never be made up from wastage in multiple vials
Improving the process
All wastage should be reviewed locally and at Health Board level to ensure any preventable loss is avoided in the future.
A web-based vaccine waste recording tool has been developed on the Service Now platform and is available for use. It enables vaccinators to record any vaccine wastage produced at any Covid-19 vaccine clinic. It records the number of wasted doses along with the reason they were wasted. This helps identify common reasons for vaccine wastage and how to prevent them .
If you have significant wastage you should treat this as a serious adverse event to make sure learning is applied.