While Manitobans celebrated the arrival of the COVID-19 vaccine in the province, up to nine precious doses ended up in the trash at the end of the first day when a clinic manager ordered unused vaccine to be discarded, a decision that flew in the face of public-health recommendations.
The incident occurred near the end of last Wednesday's vaccination clinic at the University of Manitoba's Brodie Centre on the Health Sciences Centre complex, according to a source with knowledge of the situation.
As the clinic neared its final appointments for the day, the manager requested one more vial of the Pfizer-BioNTech vaccine be prepared for injection. That instruction appeared to be based on a miscount of the number of people who were still expected to arrive for their shots, according to the source.
Once a vial of the Pfizer-BioNTech vaccine is prepared, it must be used within six hours.
With time ticking down, public-health nurses raised concerns about preparing the final vial. But they were overruled by the manager, who does not, typically, run vaccine clinics. That work is usually performed by public-health nurses.
As a result of opening the final vial, when the clinic closed at 8:30 p.m., nine prepared doses were unused. Nurses offered to stay without pay to locate and vaccinate eligible people, but the manager ordered the doses be thrown out.
More doses availableClick to Expand
More than 1,200 eligible health-care workers have booked an appointment to be immunized against COVID-19 this week.
Manitoba has been able to expand the number of immunization appointments to more than 1,300 from 900 because immunizers have consistently been able to draw six doses of vaccine from each vial, instead of the expected five.
The phone line will remain open until all appointments are booked.
Individuals eligible for immunization are health-care workers whose work involves direct contact with patients and meet at least one of the following criteria:
• work in critical care units, born on or before Dec. 31, 1980;
• work in long-term care facilities, born on or before Dec. 31, 1962;
• work in acute care facilities, born on or before Dec. 31, 1960; or
• be assigned to COVID-19 immunization clinics.
— source: Manitoba government
At the time, there were several public-health nurses in the building who already had appointments to be vaccinated later in the week. They could have received their dose that night, thus opening up more spots for eligible health-care workers. They could also have identified eligible recipients from elsewhere in the HSC complex.
The COVID-19 vaccine clinics are run by a rotating team of managers. In subsequent clinics with different evening managers, unused doses in open vials have been used to vaccinate eligible nurses on site.
When asked about the incident during Monday's COVID-19 news conference, acting deputy chief public health officer Dr. Jazz Atwal said that he was not aware of the situation and would have to look into it.
In total, the province vaccinated 894 people last week out of an available 900 slots, he said.
Each vial of the Pfizer-BioNTech vaccine is generally said to contain five doses, though clinical teams are finding there's more than enough in each vial for six. Teams are encouraged to administer as many doses as possible from a single vial — they cannot mix unused vaccine between vials to complete a full dose.
Vials must be stored at a temperature of -70 C. Once a vial has been thawed, it must be used within five days. To prepare a thawed vial for injections, the vial is swirled and its rubber cap is pierced with a syringe to add a diluting solution, which starts a six-hour countdown.
Recognizing the risk of unused doses going wasted before that six-hour limit runs out, last week the Public Health Agency of Canada held an online information session for vaccination teams. The presentation emphasized that no vaccine dose should be wasted, encouraging vaccination teams to find any eligible takers.
“To be clear, the decision to dispose of unused vaccine was not made by the WRHA manager, but rather based on direction from provincial Public Health.”
Clinic administrators should "consider anticipated client volume" when deciding how much vaccine to dilute, a PHAC PowerPoint stressed, and "have a plan to reach eligible people" if any doses are unused. If no eligible people can be found in time, the presentation advised finding others to vaccinate, preferably those in high-risk groups.
In a news conference last week, Canada's chief public health officer, Dr. Theresa Tam, also emphasized the need to not waste vaccine, saying that "the bottom line is don’t throw it away." And on Thursday, Manitoba's chief public health officer Dr. Brent Roussin echoed that sentiment: "We absolutely don’t want any wasted doses," he said.
The province has previously pledged to draw up a list of eligible recipients that could be called in the event of any unused doses.
Late Tuesday, the WRHA released a statment that said the manager made the decision in consultation with Public Health.
"To be clear, the decision to dispose of unused vaccine was not made by the WRHA manager, but rather based on direction from provincial Public Health."
Melissa Martin reports and opines for the Winnipeg Free Press.