‘Absolutely heartbreaking’: GP forced to throw out hundreds of expired COVID vaccines

When Dr Bernard Shiu received 600 doses of AstraZeneca in July – despite having only ordered 300 – he knew many were unlikely to ever make their way into the Australian community.
 
Increasing supplies of Pfizer vaccines had been matched by dwindling demand for the AstraZeneca alternative, and Federal Government projections indicated that millions more of the mRNA candidate – along with Moderna – were due to arrive before the end of the year.
 
In the months that followed, nursing staff at Dr Shiu’s practice have been lodging the number of doses due to expire with the Department of Health (DoH), but are still yet to receive any guidance.
 
Now, the moment he feared has arrived. On Tuesday, the Geelong GP and RACGP Victoria Co-Chair was forced to dispose of 100 expired AstraZeneca doses, and by the week’s end hundreds more will go to waste.
 
‘It’s very sad to see,’ he said. ‘Tomorrow it will be 500 doses – 500 people could have been protected.’

Australia’s vaccine rollout taskforce, Operation COVID Shield, has reportedly called on facilities, including general practices and Commonwealth-run vaccination hubs, to inform it of any unused doses, with plans to send them to developing countries.
 
But Dr Shiu says this has not been his experience.
 
‘We haven’t ordered any AstraZeneca for months now,’ he said.
 
‘Every week we have to let them know how many we have in our fridge through the ordering system – which ones will be expiring, which ones we’ve used and how many we have wasted – they are very meticulously logged.
 
‘And no response. They have not advised us what to do.’
 
A CSL spokesperson told newsGP that 19.4 million doses of AstraZeneca have been manufactured and supplied to date, while as of 4 October more than 3.5 million doses had been provided to the Department of Foreign Affairs and Trade (DFAT) for distribution across the Pacific.
 
With approximately 12 million doses administered up to 3 October, close to four million likely remain unused. The CSL spokesperson has also confirmed there are no plans to cut down on production until the 50 million dose agreement is fulfilled.
 
Nearly 83% of Australians over 16 have now received a first dose resulting in reduced demand, with many clinics now focusing on second doses.  
 
Dr Shiu says given only a few patients at his practice still require their second dose of AstraZeneca, he anticipates even further wastage, as each vial offers 10 doses.
 
‘We are trying to lump them all into one day so that they will all come in on the same day and we don’t have to keep opening up bottles,’ he said.
 
‘But at this moment in time, anyone that wants AstraZeneca just comes in. If we open a bottle, we open a bottle, even if it will only be given to one person because there’s just so many of them.’
 
Professor Peter Collignon, who is an infectious disease specialist and former World Health Organization (WHO) advisor, says this is a common issue with multidose vials.
 
‘Even with single dose vials you might waste 10%. But with multi-dose vials, I don’t know about COVID but for other vaccines, it can be 20%,’ he told newsGP.
 

Despite a global vaccine shortage, doses of AstraZeneca in Australia are going to waste. (Image: AAP)

Unlike the beginning of the rollout in March, Professor Collignon says at this stage there isn’t the same urgency in Australia to require multidose vials.
 
‘So to my mind, the answer to this is to start making single dose, pre-loaded syringes just like for influenza and everything else,’ he said.
 
‘That gets rid of a whole lot of the waste issue, and then it’s only an expiry issue, and also gives you increased safety regarding cross infections.’
 
As different parts of the country move closer to meeting vaccination targets, there is concern wastage could also occur with Pfizer and Moderna, which are also multidose.
 
But now that supply is certain and outstripping demand, Professor Collignon says Australia’s plan to collect and send unused doses to the Asia Pacific region is both vital and in the nation’s interest.
 
‘The reason we need to donate the vaccines that we’ve got in excess supply, particularly manufacturing here, is because this doesn’t go away until we’ve vaccinated the world,’ he said.
 
‘Australia is in a good position, but this virus is still everywhere and it’s going to be everywhere, so we need everybody in the world vaccinated who’s eligible and we need to do it with vaccines that are stable at fridge temperature.’
 
Beyond being locally manufactured, the advantage of transporting AstraZeneca is that it only requires standard cold chain storage, compared to Pfizer and Moderna, which are held in long-term storage at –70°C and –20°C, respectively.
 
‘So that’s logistically a problem,’ Professor Collignon said.
 
Dr Shiu also supports the idea, and believes it is Australia’s responsibility to act on equity of care on a global scale.
 
‘We know there are countries that have no access or very limited access to vaccines, so this is a good opportunity for us to make a difference in other parts of the world,’ he said.
 
‘But I’m sitting here, and no one has contacted us.
 
‘You need to have a coordinated effort; you need to have some leadership to drive this.’
 
Despite Dr Shiu’s personal experience, a DoH spokesperson told newsGP that claims of GPs having to throw out hundreds of doses each week ‘are incorrect’. 
 
‘The Department of Health carefully manages vaccine stocks to minimise wastage and ensure that all doses are distributed efficiently and effectively,’ they said.
 
‘In Australia our rate of wastage is between 1–2%. This is based on wastage rates reported to the Taskforce through Commonwealth vaccinations channels including CVCs, GPs, ACCHS and Pharmacy.’
 
When applied to the approximately 35 million doses distributed in Australia up to 26 September, the rate stated by the DoH means approximately 350,000–700,000 COVID vaccine doses have been wasted to date.
 
The spokesperson also said the Commonwealth works closely with vaccination providers to identify surplus AstraZeneca vaccines, and that there a number of processes are in place to govern and facilitate redistribution of this stock.
 
‘In the first instance, transfer of surplus stock to local administration sites with demand is encouraged and the Commonwealth is actively working with vaccination providers to assist with redirection of excess stock where practical,’ they said.
 
‘Where practical, excess stock at sites is being collected through reverse logistics and donated to our regional neighbours via the DFAT managed Vaccine Access and Health Security Initiative (VAHSI).
 
‘The Australian Government has a detailed plan to minimise wastage and is working in partnership with the jurisdictions and vaccine providers to minimise wastage.’
 
Despite these efforts, further waste seems unavoidable; for doses to be eligible for transport abroad, Operation COVID Shield is seeking alerts for AstraZeneca doses that are eight weeks from expiry or four weeks from expiry for Pfizer.
 
Looking at the expiry dates on the boxes in his fridge, Dr Shiu anticipates a further 500 doses will have to be binned next month.
 
‘I remember when they finally arrived in my clinic into my hands, I felt like I was holding gold, thinking “wow, let’s go and save lives”,’ he said.
 
‘Now we are chucking them in the bin – it’s absolutely heartbreaking.’
 
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