As demand for COVID-19 vaccines plummets in many parts of the United States, states are scrambling to use up stockpiles of doses before they expire and need to be added to the millions that have already been wasted.

From some of the least vaccinated states, like Indiana and North Dakota, to some of the most vaccinated states, like New Jersey and Vermont, public health departments are mixing doses in hopes of finding suppliers. who can use them.

State health departments told The Associated Press they have tracked millions of doses that were wasted, including those that expired, were in a multi-dose vial that could not be used completely or had to be discarded for some other reason such as temperature issues or broken vials.

Nearly 1.5 million doses in Michigan, 1.45 million in North Carolina, 1 million in Illinois and nearly 725,000 doses in Washington could not be used.

The percentage of wasted doses in California is only about 1.8%, but in a state that received 84 million doses and administered over 71 million, that equates to about 1.4 million doses. Providers there are asked to store the doses until they expire and then dispose of them properly, the California Department of Public Health said.

The national wasted dose rate is about 9.5% of the more than 687 million doses that were delivered in late February, the Centers for Disease Control and Prevention said Thursday. This equates to approximately 65 million doses.

The problem is not unique to the United States. More than a million doses of Russia’s Sputnik vaccine expired this week in Guatemala because no one wanted to get vaccinated.

Immunization program managers say throwing away doses is unavoidable in any inoculation campaign because of the difficulty in matching supply and demand for a product with a limited shelf life.

But the coronavirus pandemic has killed nearly 6 million people and destroyed economies around the world, and every lost dose seems like a missed opportunity given the success of vaccines in preventing death and serious illness.

It also comes just about a year after people desperate to get vaccinated tried to queue to get ahead of those deemed higher priority. Hospital board members, their trustees and donors in the United States won early access or vaccination offers, raising complaints of favoritism and inequity at a time when the developing world had no virtually no doses.

And many poor countries still have low immunization rates, including 13 countries in Africa with less than 5% of their population fully immunized. They are plagued by unpredictable deliveries, weak health care systems, vaccine hesitancy and some supply issues, although health officials say stocks are significantly stronger than at the time. start of the pandemic.

In fact, the supplies are so strong that the CDC is now advising doctors that it’s okay to throw away doses if it means opening the standard multi-dose vials to vaccinate one person and the rest must be thrown away.

“Based on what’s happening now, you have a lot more production and distribution in low-income countries,” Dr. Joseph Bresee, who leads the COVID-19 vaccine implementation program, told the group. Global Health Workplace in Decatur, Georgia. “The problem of certain stocks in the United States, Germany and Japan, which are not redistributed to sub-Saharan Africa, it is a less acute problem now because the production and distribution of vaccines is booming in this time serving these low-income countries.”

The Department of Health and Human Services has also stated that redistribution of excessive doses from states to other countries is not feasible due to the difficulty of transporting the injections, which must be kept cold, in addition to not be cost-effective due to the relatively small number concentrated at sites.

Of the more than 687 million doses sent to states, 550 to 600 million have been administered, HHS said Monday. Vaccines licensed in the United States, made by Pfizer, Moderna, and Johnson & Johnson, can last up to about six months from the date of manufacture.

A senior HHS official familiar with vaccine distribution plans disputed the word “waste,” saying it implies mismanagement when states effectively monitor their inventories. The CDC, however, uses the term “waste” on its website and asks states to report their numbers.

The CDC said Thursday that the federal government, jurisdictions and vaccine suppliers have a strong partnership to get as many people vaccinated as possible while reducing vaccine waste, and the likelihood of leaving unused doses in a vial can increase as demand slows, even as providers continue to follow best practices to use all possible doses.

Drop in demand comes as the pandemic itself wanes in the U.S. On Thursday, the CDC said about 90% of the U.S. population lives in counties where the risk of coronavirus poses a low or medium threat — that which means residents do not need to wear masks in most indoor settings. That was up from 70% last week.

FILE – Prepared Pfizer COVID-19 vaccine syringes wait for patients at a college in Wheeling, Illinois, June 11, 2021.

The average number of Americans receiving their first vaccine has fallen to around 70,000 a day, the lowest point since the US vaccination campaign began in December 2020. About 76% of the US population has received at least one vaccine and about 65% of all Americans are fully immunized.

With such low demand, states will undoubtedly face more waste in the coming months, even as they benefit from any recall extensions.

Idaho, for example, has 230,000 doses, but averages fewer than 2,000 doses per week.

Oregon’s vaccination rate is slightly above the national average, but the health authority said last week that it has “a significant surplus of vaccines” due to the recent drop in demand. The state is trying to use the 716,000 doses in its inventory as much as possible.

Rhode Island has the highest percentage of fully immunized residents in the nation, at just over 80%, but the health department said it had 137,000 doses on hand as of last week. Health officials say they need it for a big boost to boost vaccination rates for booster doses.

Health officials in some states have developed “matchmaker” programs to match vaccine providers with overdoses with providers looking for doses. Many said they were trying to redistribute doses with rapidly approaching expiration dates. New Jersey has a task force that has transferred more than 600,000 doses statewide since June. West Virginia has offered to transfer adult doses of Pfizer to neighboring states.

Immunization officials have called for single-dose vials, particularly for pediatricians, but it may not yet work for manufacturers to package them that way, said Claire Hannan, executive director of the Association of Immunization Managers. She said vaccine wastage “just can’t be a problem”.

“We tell the providers, but the most important thing is to get people vaccinated. And that’s hard when the demand goes down. You don’t have a constant flow,” she said. “But it’s just a necessary evil, I guess.”

HHS said states are ordering cautiously as demand declines. The minimum order for Pfizer was nearly 1,200 doses, but it is now 100, and Moderna has reduced the number of doses per vial, the agency said.

“Given what we’ve seen in terms of the number of people not yet vaccinated, I think it’s still important to find a way to get shot, even at the cost of potential waste,” Katie said. Greene, research assistant. director of the Duke-Margolis Center for Health Policy.

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