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National pharmacy chains have wasted hundreds of thousands of doses of Covid vaccine



Two national pharmacy chains that the federal government has commissioned to inoculate people against Covid-19 represent the lion’s share of wasted vaccine doses, according to government data from KHN.

The Centers for Disease Control and Prevention registered 182,874 wasted doses at the end of March, three months after the country’s efforts to vaccinate the masses against the coronavirus. CVS is responsible for nearly half, and Walgreens is responsible for 21 percent, or nearly 128,500 wasted photos combined.

CDC data suggest that companies have wasted more doses than the states, US territories and federal agencies combined. The Pfizer vaccine, which was first introduced in December and initially required storage in ultra-cold temperatures, accounts for nearly 60% of the doses released.

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It is not entirely clear from the CDC data why the two chains have wasted much more vaccine than the states and federal agencies. Some critics pointed to poor planning early in the implementation, when the Trump administration relied heavily on CVS and Walgreens to vaccinate residents and employees of long-term care facilities. In response to questions, CVS stated that “almost all”

; of the reported vaccine waste was generated during these efforts. Walgreens does not specify how many doses are wasted during the long-term care program.

One thing is clear: Months of vaccination The CDC has a limited view of how much vaccine will waste, where it is wasted and who is wasting it, potentially complicating efforts to target doses where they are most needed. Public health experts say good waste management is crucial to identifying problems that could hamper progress and risk lives.

The Pfizer-BioNTech and Moderna vaccines, which are available in multi-dose vials, are fragile and have a limited shelf life. The total waste is negligible: As of March 30, the United States had delivered about 189.5 million doses and administered 147.6 million, including 7.7 million in long-term care facilities, according to the CDC.

Among other things, tracking lost doses helps identify bottlenecks where distribution adjustments may be needed, said Dr. Bruce J. Lee, a professor of health policy and management at City University in New York. Since the federal government passes the bill, all waste is a “major disposal” [taxpayer] money down, “he said. CVS, Walgreens and other retailers do not pay for vaccines; the government provides them. And under the Medicare program, it pays suppliers about $ 40 for each dose administered.

Related: The United States relies on a patchwork network of vaccine monitoring systems.

Especially early on, employees did not adequately assess where there would be a search and set up response sites, Lee said, “which is especially important when you’re trying to hit as many people as possible as quickly as possible.”

“If you think about a business, they will determine where the customers are first,” he said. “It’s not just about loading the vaccine and going to the place.”

The KHN study on vaccine waste is based on requests for public records to the CDC and all 50 states, five major cities, Puerto Rico and Washington, DC, combined, documents documenting more than 200,000 wasted doses. However, the data have obvious shortcomings. Data from 15 states, the District of Columbia and many US territories are not included in the CDC records. And in general, waste reporting is inconsistent.

In addition to the CDC, 33 states and the District of Columbia provided at least some data to KHN in response to requests for records. They reported that at least 18,675 additional doses were wasted in 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.

Eight other countries told KHN about more wasted doses than reported to the CDC.

But no city or state comes close to the waste reported by CVS and Walgreens, whose long-term vaccination has led some employees to be criticized as slow and inefficient. Among nursing home staff, a median of 37.5 percent reported receiving photos in the first month, according to a February CDC survey.

“For me, this ultimately correlates with just bad planning,” said corporate effort critic Dr. Michael Wasserman, the former president of the California Long-Term Care Association.

Wasserman said the companies’ approach was too restrictive and that their ignorance of long-term facility needs was detrimental to the effort.

“CVS and Walgreens had no idea when it came to interacting with nursing homes,” he said. “Missed vaccination opportunities in long-term care invariably lead to deaths.”

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A CVS spokesman, Michael De Angeles, blamed the wasted doses for “problems with transport restrictions, restrictions on diverting unused doses, and other factors.”

“Despite the inherent challenges, our teams have been able to limit waste to approximately one dose for an on-site vaccination clinic,” he said in an email.

Walgreens said his waste was less than 0.5 percent of the vaccine doses the company had administered until March 29, amounting to 3 million photos in long-term care facilities and 5.2 million more through the federal government partnership. for pharmacies.

“Our goal has always been to ensure that every dose of vaccine is used,” company spokesman Chris Latan said in an email. Prior to the planned clinics, she said Walgreens would base the doses it needed on registrations, “which minimize surpluses and reduce mark-ups.”

CDC spokeswoman Kate Foley said that because retail pharmacy giants were tasked with administering a large number of doses, “a higher percentage of total waste would not be unexpected, especially with early vaccination efforts spanning thousands of sites.” Since President Joe Biden took office in January, his administration has ordered pharmacies to prioritize vaccinations for teachers and other school staff.

Overall, pharmacies account for almost 75 percent of the wasted doses reported to the CDC. States and some large cities account for 23.3% of reported vaccine waste, and federal agencies, including the Bureau of Prisons and the Indian Health Service, account for only 1.54%. The Virgin Islands – the only US territory in federal data – account for 0.19%.

Although every effort is made to reduce the volume of losses in a vaccination program, it is sometimes necessary to define doses as ‘waste’ to ensure that anyone who wants a vaccine can receive it, and to ensure patient safety and vaccine effectiveness, “Foley said. However, the CDC has provided guidance and worked with health departments to train staff to reduce waste, and clinic staff must do “everything possible” to avoid wasting photos, she said.

Vaccine waste may increase in the coming weeks as officials change tactics to inoculate the hard-to-reach population, public health experts say.

“I think we are getting to a place where we will have to tolerate some waste in order to continue with vaccination,” said Dr. Marcus Plesia, chief medical officer of the Association of State and Territorial Health Professionals. People who do not want to travel to mass vaccination sites can visit primary care physicians or smaller pharmacies in rural areas, who may not be able to use each dose in open vials, he said.

Claire Hannan, executive director of the Association of Immunization Managers, said waste concerns should not outweigh gunfire.

“If someone is there, you have to vaccinate them,” she said. “In an effort not to lose a dose, we may miss vaccination opportunities because we don’t have 15 people in line or 10 people in line.”

CDC numbers do not include many countries

The federal government collects information on vaccine waste through federal systems called VTrckS, which manages procurement and delivery, and Tiberius, a platform managed by the Department of Health and Human Services that monitors distribution. VTrckS can exchange data with state and local immunization registries, which track who received photos, but some countries rely on manual data entry, Hanan said.

The 15 countries not included in the CDC 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 the District of Columbia.

Most of them report minimal KHN waste: Colorado, Kansas, Nebraska and the District of Columbia together report only 1,090 wasted doses.

In others, the numbers are more significant. On March 19, the Maryland Health Department said it knew of 3,175 wasted doses.

Texas had the most wasted doses of each condition in the CDC data or in the data provided to KHN. His records show 9,229 wasted doses as of March 26, a third after CVS and Walgreens.

Foley, a CDC spokesman, said the agency “works closely” with countries that have technical problems to ensure accurate reporting.

Broken freezers, bent needles, absenteeism

The reasons given by countries for waste vary from broken vials and syringes to storage errors from suppliers to residual doses of open vials that cannot be used.

The largest waste incidents, in which hundreds of doses are lost at once, are usually due to malfunctions in the freezer or leaving doses by workers at room temperature for too long.

But state registers also register small things that can go wrong.

On December 16, the Department of Public Health in Gunnison County, Colorado, lost a dose of the Pfizer vaccine when someone crashed into a table and the vial spilled. On Jan. 5, Tri-County Health Department in Westminster, Colorado, announced that it had wasted a dose of Moderna because the hypodermic needle had bent.

Remy Graber, a registered nurse who has vaccinated people at mass sites and health clinics in Rhode Island, said it is not uncommon for there to be too many or too few doses in the vial, which could lead to the dose being reported as lost. . Syringe problems sometimes lead to waste.

But Graber said the biggest problem is people who don’t show up. Once the vial is punctured, the Pfizer vaccine should be used within six hours. On April 1, Moderna announced that the open vial of vaccine was good for 12 hours – twice as long as the previous one.

“What can happen if you get people who just decide, ‘You know what?’ I don’t need my vaccine today. I won’t show up, “Graber said.” Well, now we’re struggling to find someone to get the vaccine because we don’t want to waste it. “


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