'More valuable than liquid gold': Pharmacists propose a simple solution to vaccine shortages

As millions of Americans across the country campaign to try to get the Covid-19 vaccine, health officials are still struggling to meet increasing demand that is the result of scarce supplies.

“It’s more valuable than liquid gold, to be honest,” said Melanie Massiah-White, chief pharmacy officer of Inova Health System, a not-for-profit hospital network based in Northern Virginia.

Some pharmacists say there is a simple solution that could get thousands more people vaccinated every week, but the Food and Drug Administration is getting in the way.

It’s 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. The point is to take the leftovers in one medicine bottle and combine them with the leftovers in another vial to get 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. “But the end result is that many doses are wasted, and we are not allowed to use that extra vaccine.” But there are times when there is almost the full dose at the end of the vial. It’s heartbreaking to waste it. “

The amount of leftover vaccine in these vials could be enough for up to 13,000 additional doses, according to Inova Health Systems. Instead, they are being discarded due to FDA regulations prohibiting the collection of Covid-19 vaccine residues.Lauren Dunn / Inova Health Systems

Pharmacists at Inova Health, one of the largest hospital systems in Washington, DC, said they noticed significant amounts of residual vaccine in almost every vial, even after using the extra sixth dose in Pfizer’s vaccine. Due to the regulations of the FDA, they are now forced to throw away any additional vaccine.

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“It’s heartbreaking for us,” said Massiah-White. “We had several team members going crazy here, and at least every day someone says,” Why can’t we bundle the garbage? “

The Inova pharmacists performed an experiment with 100 vials of residual vaccine. Of these, 80 had significant quantities left. The pharmacists found that the vaccine left in those 80 vials could make 40 additional full doses. That meant that on a typical vaccination day, when this hospital typically fires more than 4,000 shots, another 400 vaccines could be given with the same supply.

“If we can just put them together and use them right away, we’ll increase the amount of free vaccines available,” Jones said.

Experts say it’s a simple process that pharmacists have been doing for years.

If one vial becomes contaminated, this practice can spread the contamination to the others, thereby prolonging the pathogen’s presence and increasing the potential for disease transmission.

“This is a common practice seen with vaccines,” said Stefanie Ferreri, chair of the practice promotion and clinical education department at the University of North Carolina’s Eshelman School of Pharmacy. She said only vaccines with the same lot number should be pooled so clinicians can track where they came from in case there are problems like an unusual side effect.

Although pooling is common practice, according to the FDA, pharmacists and other clinicians cannot pool Covid-19 vaccine residues because neither Moderna nor Pfizer products contain preservatives that stop microbial growth in the event the vaccine is contaminated with bacteria or other germs.

“This is an infection control measure,” an FDA spokeswoman said in a statement to NBC News. “Cross-contamination of multi-dose drugs from using the same needle and syringe has occurred with other drugs using this practice, resulting in severe bacterial infections. If one vial becomes contaminated, this practice can spread the contamination to the others, thereby prolonging the pathogen’s presence and increasing the potential for disease transmission. “

The Inova Health System pharmacists found significant amounts of vaccine residue in almost every vial.Lauren Dunn / NBC News

However, pharmacy experts say the risk of cross-contamination is low and that the benefits of higher doses of the Covid vaccine far outweigh the risk.

“If this 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 extremely low.”

Inova health officials say that in large vaccination clinics like hers, all doses are used almost immediately and they already have protocols to protect against any type of cross-contamination.

“We’d use these cans within 60 minutes,” said Massiah-White. “You won’t sit down. You won’t get to room temperature. We could embrace these shots here in our clinic very quickly.”

The vaccination process remains a waiting game for now, however, as Americans wait for the shot and vaccine manufacturers ramp up production to meet ever-growing demand.

“If there are enough vaccines, in the end it doesn’t matter to waste some on the ground,” Jones said. “But at the moment, millions of cans are too short for us. So a few extra doses from each set of vials literally works for hundreds of people a day. “

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