As Connecticut begins vaccinations for COVID-19, state and local officials are coping with the vaccine’s limited shelf life, and an unpredictable supply, as they work to immunize high-risk workers and nursing home residents first.
The limited shelf life of the vaccines – six hours once the vial is open – means that health departments left with excess doses must quickly find an alternate or lower-priority person to vaccinate, or let the doses go bad.
That’s the position Middletown found itself in when it was left with ten excess doses over two days of administering the vaccine to city firefighters last Wednesday and Thursday, which is how 28-year old Mayor Ben Florsheim and other city employees were able to receive a vaccine.
Slow distribution and the limited shelf-life of the COVID vaccine have placed vaccine distributors in a difficult position – the need to prioritize certain groups of individuals must be weighed against the imperative to not let any vaccine go to waste.
“It’s definitely a planning, balancing act,” said Steve Mansfield, the director of Ledge Light Health District.
The Middletown Health Department began by vaccinating firefighters ending their 24-hour shifts ahead of their three days off. Doses were left over either because firefighters called in sick or otherwise missed appointments, said acting Health Director Kevin Elak.
There were also more doses than expected because some vials meant to hold 10 doses actually had 11, according to both Mansfield and Florsheim.
Wasted vaccines as a result of poor distribution have been a concern nationwide. Data from the CDC suggests that although nearly 15.5 million vaccines have been distributed so far, only about 4.5 million people have received their first dose. Out of the 149,900 doses of vaccine distributed in Connecticut, 75,946 have been distributed, or just over 50 percent.
The vaccine will last 30 days in the Pfizer thermal shippers, after which they can be transferred to hospital refrigeration for another 5 days. After they are taken out of their ultra-cold storage, they must be used within a certain number of hours.
Florsheim said the vaccine is “better in anybody’s arm than in the trash.”
“I was not willing to have happen in Middletown what has been happening around the country, which is that those contingency plans aren’t being made, and that people are literally allowing doses to expire rather than get them to people who are ready, willing and able to take the vaccine.”
Extra doses in Middletown
Elak said they found themselves with extra doses the first two days of administering vaccines at the Main Street and South fire stations – 10 doses in total.
Because the vaccine can only be administered up to six hours after the vials are opened, those doses had to be used quickly, so they were brought back to City Hall where Florsheim and some public-facing city employees received the excess doses.
By Friday, the third day the department was administering vaccines, the city had put together a “backup list” of who should receive a dose if there were extras at the end of a day, Elak said. The city hasn’t used the list yet, as it used all the doses it had available on Friday, Saturday and Sunday, he said.
“Having extra doses was not something that we had a plan for,” Florsheim said. “We had a plan for sort of the order of who falls into what category and then sometimes subcategories within that, but we didn’t have a specific plan for contacting people at the end of a clinic because we weren’t expecting to have vials that had extra doses.”
The Connecticut Department of Health released a set of guidelines about what to do to prevent vaccines from being wasted. According to the document, vaccination providers should keep a waitlist of people they can call in if they have leftover vaccine doses at the end of the day.
If an exposure to high temperatures requires that vaccines are used immediately, the document said that priority should be given to people in the 1A category, followed by people 75 years of age or older, frontline essential workers, and people between the ages of 65 and 75.
Mansfield and Patrick McCormack, director of the UNCAS Health District, said that there was no shortage of people who wanted to get a vaccine.
In fact, both said that they were receiving fewer doses of the vaccine than they originally requested – both districts had requested 200 doses of the vaccine for this week. Each received only 100.
This is the first shipment of vaccines that UNCAS and Ledge Light have received, and both directors said they would begin by vaccinating the healthcare workers who would be distributing vaccinations in the clinics. After that, they would move on to vaccinating individuals who fall within the 1A category – healthcare workers, school nurses, dentists, and patients and staff at long-term care facilities.
Individuals who are eligible to receive the vaccine under the 1A category are uploaded into the CDC’s Vaccine Administration Management System. A designated staff member at health districts, municipalities and other organizations will upload a list of employees who would be considered eligible. Those employees then receive emails that will allow them to register within the system.
McCormack said that most health districts were starting slowly with the vaccine orders until they were sure of how many doses they would be able to distribute within a week.
In a press conference on Monday, Gov. Ned Lamont spoke about the “Just in Time Inventory,” a system which, according to Connecticut CEO Josh Geballe, would use pre-planning and daily contact with providers to allocate the correct number of vaccines to each distribution center so that none were wasted. Geballe said that the National Guard could also move excess vaccines from one site to another in the rare case that a site might have more vaccines than it could use.
Florsheim said one lesson from the past year is that there have to be contingency plans – it was true with the rollout of testing, distribution of masks and disbursement of small business relief grants. Everyone has to be prepared to use the resources they have to the best of their abilities, he said.
“I think vaccines are kind of an inherently politicized issue. There are going to be people who say one group shouldn’t get it from another group, or people saying nobody should be getting it,” Florsheim said. “Our focus is going to be just getting the vaccine in as many arms as possible, prioritizing folks who are on the front lines, and trying to improve every day the processes that we’re using to make that happen.”