Four months into the COVID-19 vaccine rollout, a lack of supply is still Manitoba's main concern, but the province has yet to announce a plan to prevent unnecessary waste.
Mass-immunization clinics don't use standby lists, which have been adopted in some other provinces to administer leftover vaccines at the last minute, and doctors' offices and pharmacies developed their own protocols to dole out all of their vaccines before they expired. Wastage wasn't a concern, representatives for physicians and pharmacists said, because of the limited number of doses clinics and pharmacies initially received last month.
But as the vaccine rollout expands, immunizers will be looking for more guidance about what to do with leftover doses — and who to prioritize for a last-minute shot.
So far, the direction from the provincial vaccine task force has been not to bypass the eligibility criteria or age restrictions and use any extra, end-of-day doses to vaccinate staff at the clinic or pharmacy.
At mass-immunization supersites, appointment bookings are set according to vaccine supply, and immunizers are expected to closely monitor the number of people showing up for appointments to make sure vials containing several doses aren't opened unnecessarily.
Doctors and pharmacists made their own wait lists based on the province's 55-64 age and serious health condition criteria. Many of them ran out of their allotted supply within days after 18,000 doses of the AstraZeneca vaccine were distributed to 190 pharmacies and clinics in March. Others scrambled to fill bookings.
Heading into the long weekend, right before one batch of AstraZeneca doses expired, one Winnipeg physician posted on Facebook, seeking urgent vaccine appointment bookings for people 55 or older so the vaccines wouldn't go to waste. The physician couldn't be reached for comment, but the clinic later said it was fully booked.
"With a very scarce resource like these vaccines, and an abundant number of people who are eligible and willing to become vaccinated, we need to make sure that we're using those as effectively and fairly as possible." – Bioethicist Maxwell Smith
There's nothing wrong with doctors or pharmacists advertising soon-to-expire doses on social media or reaching out to clients directly via phone calls, a provincial spokesperson said.
"The medical clinics and pharmacies have the authority to reach out directly to eligible patients and age-eligible community members regarding vaccinations," the spokesperson said, adding the province is confident doctors and pharmacists will be able to use all of their available doses.
Other provinces and health authorities have introduced wait lists and detailed strategies to avoid having to toss unused doses. In its COVID-19 Vaccine Waste Strategy, Alberta's Health Department emphasizes ethical requirements and warns against distributing leftover doses in ways that could encourage people to loiter outside clinics or lead to perceived conflicts of interest.
The Opposition NDP has been calling for a strategy in Manitoba. Malaya Marcelino, public affairs critic and MLA for Notre Dame, said the province needs a prioritization plan that includes a standby list of essential workers. She said employees in Manitoba's manufacturing sector have been disproportionately affected by the pandemic, and the province needs to take into account the "ethical considerations" when trying to use vaccine doses at the last minute.
"I think this is a strategy that needs to be put in place for the extras," Marcelino said.
Public-health officials have repeatedly said some vaccine wastage is a normal part of any immunization program, but the province hasn't released recent data.
Health officials everywhere are grappling with ethical concerns about who to vaccinate first, and there's no reason leftover or end-of-day vaccines can't be distributed based on need, rather than who happens to be nearby, said Maxwell Smith, an Ontario-based bioethicist and professor at the University of Western Ontario. He suggested immunization teams could put together lists of people who are eligible or about to be eligible and randomly select from them when last-minute doses become available.
"With a very scarce resource like these vaccines, and an abundant number of people who are eligible and willing to become vaccinated, we need to make sure that we're using those as effectively and fairly as possible," Smith said. "If it were just first-come, first-serve, or open it up for anyone who wants it, you'll see that there would be inequities in terms of who could actually access it."
As doctors and pharmacists await their next shipments of the vaccine, leftovers haven't been a major concern. Long wait lists and a lack of supply are more pressing for pharmacists right now, said Pawandeep Sidhu, president of Pharmacists Manitoba.
"This was a pilot with a very limited number of doses, and we've not heard any concerns or issues about doses being wasted." – Doctors Manitoba spokesman Keir Johnson
"Wastage, from my understanding, has not been a big issue," she said, adding pharmacies are used to dealing with medication storage and shortages. "Managing inventory is nothing new for us."
Clinics and pharmacies have said they're ready to expand their distribution as soon as they get adequate supply.
"This was a pilot with a very limited number of doses, and we've not heard any concerns or issues about doses being wasted," said Keir Johnson, spokesman for Doctors Manitoba.
"Physicians have either had people show up reliably for appointments or they've used strategies to go to a wait list or a standby list if they have one. We don't think that's a strategy that they've had to use a lot in this initial pilot because of the small supply, but those are the types of tips and protocols that we would work with clinics to help develop as they get a bigger supply."
Katie May reports on courts, crime and justice for the Free Press.