As the speed of Covid vaccinations increases, so do reports of dose waste. And it’s more than a handful at the end of the day as some appointments have been canceled. Health officials are trying to contain waste without slowing down vaccinations.

This story comes from a partnership that includes NPR, Nashville Public Radio, and KHN. It can be republished for free.

Incidents range from 335 discarded cans in Lee County, North Carolina that were damaged in shipping to nearly 5,000 cans that were wasted in Tennessee in February, leading to additional federal oversight.

“I definitely lost some sleep,” said Beth Ann Wilmore, director of nursing at Mercy Community Healthcare in Franklin, Tennessee. She manages the inventory of Covid vaccines at the non-profit clinic, which has been receiving supplies for a month.

Clinics like Mercy are used to dealing with vaccines, but none are as valuable as those for Covid that have special cooling needs.

“I definitely woke up in the middle of the night and wondered how the temperatures were going. I was like, ‘OK, I hope it’s good and it doesn’t give me a flag or anything.'”

Many community health centers receive the Moderna vials, which are easier to use than the Pfizer BioNTech vaccine but still difficult. The vials last 30 days after frozen, compared to only about five for Pfizer. Once the seal on the vial is broken, there are only six hours left to use the shots.

So far there has been no waste at Mercy. But Wilmore has heard horror stories from across the state.

In neighboring Murfreesboro, Tennessee, the local school district received a thousand doses for a teacher vaccination event last weekend in February. But they were put in an unapproved freezer. The temperature sensor on the shipment has displayed an error code. Out of caution, they were advised to throw them all away.

“It hurts my heart,” said Dr. Lisa Piercey, Tennessee Health Commissioner, who uncovered one of the biggest spikes in the country in terms of reported spoilage.

She said the losses were painful because the shots were “priceless” amid this deadly pandemic. But having so many places to get the vaccine is a risk.

To improve access and justice, there are now more than 700 vaccination sites in Tennessee. More are to be opened as vaccine deliveries increase in the coming weeks.

“It definitely increases concern when you have more partners – especially partners who are not under your direct control,” she said.

Even Tennessee’s large urban health departments that operate independently of the state health department are getting into trouble.

A thousand cans were thrown away in Knoxville, apparently confused for a related shipment of dry ice. In Memphis, the county health director has resigned after slowly announcing that nearly 2,500 doses were allowed to expire multiple times due to winter weather and poor management at the county pharmacy.

The state has enlisted staff from the Centers for Disease Control and Prevention to oversee vaccine distribution in Shelby County and stepped up audits for all local health departments in the state.

There are so many ways that cans go bad. In West Palm Beach, Florida, the power supply to a portable refrigerator was turned off. In Connecticut, a refrigerator door was not properly closed, although the cans were recovered in time, in consultation with Moderna.

Health officials have gone to great lengths to prevent doses from being wasted, such as a spontaneous mass vaccination at Nashville’s homeless shelters after winter storms canceled hundreds of appointments.

Dr. Kelly Moore, associate director of the Immunization Action Coalition, said a little spoilage is expected. It’s still far less than 1% of the doses, even in states like Tennessee and Florida, which have reported large losses.

“I would be more concerned if I saw reports of wasted zero doses,” said Moore, because then her concern would be a lack of transparency.

“You want to see some trash because that means people are paying attention and that accidents happen in the real world and that they are getting the right response,” she said. “You just don’t want to see negligence.”

Hopefully, mishaps will be easier to avoid with the newly approved Johnson & Johnson vaccine. Aside from being a single dose, it can be kept in a regular refrigerator for months.

This story was produced in association with Nashville Public Radio, NPR, and KHN.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation that is not affiliated with Kaiser Permanente.

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