CVS, Walgreens waste more COVID vaccine than most states combined, data shows

5/3/2021 11:18:00 PM

Two national pharmacy chains that the federal government entrusted to inoculate people against COVID-19 account for the lion’s share of wasted vaccine doses, according to government data obtained by KHNews.

.“To me, this ultimately correlates with just poor planning,” said Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine and a critic of the corporate effort.Wasserman said the companies’ approach was too restrictive and their unfamiliarity with long-term facilities’ needs harmed the effort.

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“CVS and Walgreens didn’t have a clue when it came to interacting with nursing homes,” he said. “Missed opportunities for vaccination in long-term care invariably results in deaths.”A CVS spokesperson, Michael DeAngelis, in an email blamed wasted doses on “issues with transportation restrictions, limitations on redirecting unused doses, and other factors.”

“Despite the inherent challenges, our teams were able to limit waste to approximately one dose per onsite vaccination clinic,” he added.Walgreens said its wastage amounted to less than 0.5% of vaccines the company administered through March 29, which totaled 3 million shots in long-term care facilities and 5.2 million more through the federal government’s retail pharmacy partnership.

“Our goal has always been ensuring every dose of vaccine is used,” company spokesperson Kris Lathan said in an email. Before scheduled clinics, she said, Walgreens would base doses it would need on registrations, “which minimized excess and reduced overestimations.”

CDC spokesperson Kate Fowlie said that because the retail pharmacy giants were tasked with administering a large number of doses, “a higher percentage of the overall wastage would not be unexpected, particularly in an early vaccination effort that spanned thousands of locations.” Since President Joe Biden took office in January, his administration has directed pharmacies to prioritize vaccinations for teachers and school personnel.

Overall, pharmacies accounted for almost 75% of wasted doses reported to the CDC. States and some large cities accounted for 23.3% of vaccine waste reported, and federal agencies, including the Bureau of Prisons and the Indian Health Service, for just 1.54%. The Virgin Islands — the only U.S. territory in the federal data — was 0.19%.

“Though every effort is made to reduce the volume of wastage in a vaccination program, sometimes it’s necessary to identify doses as ‘waste’ to ensure anyone wanting a vaccine can receive it, as well as to ensure patient safety and vaccine effectiveness,” Fowlie said. Even still, the CDC has provided guidance and worked with health departments to train staff members to reduce wastage, and clinic staffers should do “everything possible” to avoid wasting shots, she added.

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Vaccine waste could increase in the coming weeks as officials shift tactics to inoculate harder-to-reach populations, public health experts say.“I think we are getting to a place where, to continue to be successful with vaccination, we’re going to have to tolerate some waste,” said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. People unwilling to travel to a mass-vaccination site might go to a primary care physician or smaller rural pharmacy that might not be able to use every dose in an open vial, he said.

Claire Hannan, executive director of the Association of Immunization Managers, said concerns about waste should not trump getting shots into arms.“If someone’s there, you need to vaccinate them,” she said. “In our efforts not to waste a dose, we may be missing opportunities to vaccinate because we don’t have 15 people lined up or 10 people lined up.”

CDC Numbers Don’t Match State DataThe federal government collects information about vaccine waste through federal systems called VTrckS, which manages ordering and shipments, and Tiberius, a platform run by the Department of Health and Human Services that monitors distribution. VTrckS can exchange data with state and local immunization registries that track who has received a shot, but some states rely on manual data entry, Hannan said.

The 15 states not included in the CDC’s data are Alaska, California, Colorado, Kansas, Louisiana, Maine, Maryland, Michigan, Nebraska, Nevada, New Hampshire, Ohio, Oklahoma, Oregon and Texas. The District of Columbia is also missing.Of those jurisdictions, 11 provided data to KHN: Alaska, Colorado, Kansas, Maryland, Nebraska, Nevada, New Hampshire, Ohio, Oregon, Texas and D.C.

Most of those reported minimal waste to KHN: Colorado, Kansas, Nebraska and D.C. together registered just 1,090 wasted doses.In others, the numbers are more significant. On March 19, the Maryland Department of Health said it knew of 3,175 wasted doses.

Texas had the most wasted doses of any state in either the CDC’s data or the data states provided to KHN. Its records showed 9,229 wasted doses as of March 26, putting it third in overall waste behind CVS and Walgreens.Fowlie, the CDC spokesperson, said the agency is “working closely” with states that have technical issues to ensure accurate reporting.

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Broken Freezers, Bent Needles, No-ShowsThe reasons states gave for waste varied, from broken vials and syringes, to provider storage errors, to leftover doses from open vials that couldn’t be used.The largest waste incidents, in which hundreds of doses were lost at a time, tended to be due to freezer malfunctions or workers leaving doses at room temperature too long.

But state records also register the little things that can go wrong.On Dec. 16, the public health department in Gunnison County, Colorado, lost a single dose of the Pfizer vaccine when someone bumped into a table and a vial spilled. On Jan. 5, the Tri-County Health Department in Westminster, Colorado, reported that it wasted a Moderna dose because a hypodermic needle bent.

Remi Graber is a registered nurse who has vaccinated people at mass sites and community health clinics in Rhode Island. They said it’s not uncommon for a vial to have one too many or one too few doses, which can lead to a dose being counted as wasted. There are also sometimes syringe problems that result in waste.

But Graber said the biggest problem is people not showing up. Once a vial is punctured, Pfizer’s vaccine must be used within six hours. On April 1, Moderna announced that an opened vaccine vial was good for 12 hours — double what it had been previously.

“What could happen is you get people who just decide, ‘You know what? I don’t need my vaccine today. I’m not going to show up,’” they said. “Well, now we’re scrambling to find somebody to take the vaccine, because we don’t want to waste it.” Read more: ABC News »

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