‘A perfect storm’: Vaccine wastage doubles as demand falls

Jolyon Attwooll

18/11/2021 5:05:42 PM

With immunisation rates plateauing and most not yet eligible for boosters, GPs are warning that more COVID-19 vaccine doses are going to waste.

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The rate of COVID-19 vaccine wastage has roughly doubled in a month, according to figures supplied by the Department of Health (DoH).
Last month, following reports of vaccine doses being thrown out, the DoH said that wastage levels stood at between 1–2%. In their latest response, sent to newsGP on 18 November, that level was cited as 3.5%.
That would translate to more than 1.33 million doses wasted in the rollout so far, a figure newsGP put to the Federal Government without receiving a response in time for publication.
GP Dr Joe Garra has described the current situation as ‘a perfect storm’, where Pfizer vaccine doses, which only last 31 days once shifted into storage at standard refrigeration temperatures, cannot be used in time.
With most people having had a second dose of a primary vaccination course, many clinics now have ample vaccine supply but not enough patients to give it to.
Only a small proportion of the population is currently eligible for a third dose of the vaccine, either as part of their primary vaccination course among the severely immunosuppressed, or as a booster for those who had their second dose at least six months ago.
Dr Garra has run a hitherto busy vaccination clinic in the Wyndham local government area of Melbourne and has recently brought concerns about wastage to light.

‘We’ve all really cut back our orders [but] we’ve dropped from giving probably 700–800 [doses] a week to 100,’ he told newsGP.
‘That’s the problem. It’s just plummeted suddenly. That’s why you get caught with stock, we’ve hit a wall suddenly.’
He believes the true wastage rate may currently be significantly higher than the 3.5% rate cited by the Government.
‘About two weeks ago, we started realising people were not showing up,’ Dr Garra said. ‘For example, we might have booked 18 people for Pfizer [using] three vials.
‘And then two don’t show up. We’ve got no one to ring to come in their place. So that’s two doses gone. I think our wastage is getting closer to 10% on a daily basis.’
He said the clinic needed to throw out close to 500 Pfizer doses at the weekend. While Primary Health Networks (PHN) are primed to co-ordinate supplies with vaccine clinics that have too much or too little in stock, Dr Garra says they have limited options.
‘The PHN can’t help,’ he said. ‘Everyone wants to pass on the vaccine to someone else, but no one wants it at the moment.’
And despite the developing world struggling for access to COVID vaccines, the option of sending doses to other countries comes with its own complications.
‘If you find out you’ve got too much vaccine with two weeks to go [until its expiry date], you can’t get that anywhere overseas,’ Dr Garra said. ‘You can’t pack it on a plane and get it into people’s arms within two weeks.’
No patients at the clinic are yet due for a booster dose either, Dr Garra says. With the earliest second doses for the AstraZeneca vaccine administered on June 21, it means those people will only become eligible for third dose a few days prior to Christmas. 
Would a shorter booster wait help?
Dr Garra hopes there is a case for allowing people to have their booster vaccinations earlier to minimise the wastage – and urges staff at nursing homes and hospitals to ring their GP if they need a booster imminently rather than waiting.
‘The staff could just get it done now if it’s more than six months since their last one,’ he said.
‘And we maybe need some clarity whether five and a half months or five months [after a second dose] is okay rather than six. At the moment it’s six, and if it’s five we can start doing [boosters] now.’
The possibility of bringing forward the date for boosters is also something UNSW epidemiologist Professor Mary-Louise McClaws believes should be considered – particularly with mounting evidence of waning vaccine efficacy.
‘I would ask the authorities to start allowing everybody to [have] their booster shot now,’ she told newsGP.
‘Not just the elderly or those who are immunosuppressed, or live with somebody who has immunosuppression, but [open boosters] to anybody now and not necessarily wait six months.
‘It does break my heart to think that there is wastage. It’s so sad, considering that the Government got so much flack for the slowness in getting the vaccine here.
‘And then when we have got it, that GPs can’t maximise the usage of that wonderful resource.’
A DoH spokesperson said the department is doing what it can to provide adequate vaccine supply while guarding against waste.
‘The Australian Government has a detailed plan to minimise wastage and are working in partnership with the jurisdictions and vaccine providers to minimise wastage across the supply chain,’ it said in a statement to newsGP.
‘This is balanced against ensuring that there is sufficient supplies of vaccine at vaccination sites to ensure easy access for everyone who wants a vaccine.’
They said the 3.5% wastage figure is based on ‘rates reported to the [COVID] Taskforce through Commonwealth vaccinations channels including CVCs, GPs, ACCHS and pharmacy and state and territory vaccination clinics.’
The spokesperson also pointed out the level is ‘well below the World Health Organization [WHO] international average rate of vaccine wastage’.
Other countries have warned of much higher wastage rates. In France, for example, reports indicate health authorities there expected to lose between a quarter and 30% of all vaccine doses.
Overseas distribution
Director of the Immunisation Coalition, infectious disease and vaccine expert Professor Robert Booy, said ensuring stock is well managed and that eligible people come forward as soon as possible will help reduce waste. He also believes greater quantities of Australia’s vaccine supply should go abroad.
‘The Government [should] be donating [vaccines] now, at bigger levels to Papua New Guinea and Indonesia where they really need it,’ he told newsGP.
‘As I say, no one is safe until we’re all safe. So why don’t we donate as much as possible right now, to prevent the virus from transmitting and mutating to a point where vaccination might not work anymore?’
Previously, GPs had highlighted AstraZeneca going to waste – but much more of that vaccine is now being shipped overseas.
According to the Indo-Pacific Centre for Health Security, Australia has donated almost 8.49 million AstraZeneca doses to neighbouring countries so far, including more than a million doses to Fiji and 4.6 million for Indonesia.
A spokesperson for CSL, the company which manufactures the AstraZeneca vaccine in Australia, told newsGP it has currently produced around 24 million doses of its 50 million dose order.
With 13.4 million doses of AstraZeneca administered as of 14 November according to the Therapeutic Goods Administration (TGA), it leaves around 2.1 million surplus doses – with 26 million doses yet to be produced.
Prime Minister Scott Morrison has previously stated Australia will supply 60 million vaccine doses overseas by the end of 2022.
The DoH also said mRNA vaccines could be included ‘as part of the humanitarian program’ next year.

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Dr Aline Suan Lin Smith   19/11/2021 7:54:10 AM

We got delivered 600 last week , vials expire on 30th November
That only gives us 2+ weeks to deliver.
We approached our local RACF says they are don't want GPs to do it as they have contract with government to get the jabs from the corporate guys.
The PHN unable to do anything or broker any solution.
All they told us was to ring VOC.
Totally disappointing
We should be giving vaccines to these folk 4 to 6 months from 2nd dose.
The evidence of waning immunity is there.
We don't want an outbreak just before Xmas.
We are in Sydney surrounded by previous hot spots and sporadic covid cases.

Rural GP   19/11/2021 9:15:12 AM

C’mon DoH. Make the obvious sensible decision. Start boosters early . Just get out of the way and let us do our jobs. This is just stupid . We are ready to go .

Dr Thomas Rolley   19/11/2021 12:00:42 PM

I wouldn't stress too much.

We have 280 million doses for a population of 25 million.

Even with 10% wastage, we will have boosters for years.

Perhaps the expert advisory group would have benefitted from a mathematician?

Dr Jitendra Natverlal Parikh   19/11/2021 3:15:13 PM

This has been an on going feature of this issue
Nothing goes right
Either not enough or too much
I think immediate booster for anyone who wants is the best way to prevent wastage

Dr Jane Elizabeth Burges   21/11/2021 10:27:13 AM

I strongly agree with bringing forward the booster dose (3rd dose) in view of waning immunity, adequate/excess vaccine supply and Christmas looming. Unrestricted movement of vaccinated and unvaccinated from mid December combined with large gatherings will mean many elderly and vulnerable people who were vaccinated at the earliest opportunity will be very exposed over Christmas unless the 3rd dose (booster) is brought forward.