Managing Covid-19 vaccines at a time of oversupply: what Spain’s regions are doing to avoid wasting doses

Every single dose of a Covid-19 vaccine that is wasted represents a small failure in a world where more than half the population is yet to receive a single shot. The expiration of more than 69,000 injections in Catalonia this week was an avoidable error, a lack of planning that the rest of the country’s regions, consulted by EL PAÍS, claim they are not guilty of (all territories responded, apart from Galicia and the Basque Country). While the fall in demand in Spain – more than 76% of the population is now fully vaccinated – means that the planning process has to be more carefully calculated than ever, the defrosting and maintenance process for the vaccines is sufficiently flexible to avoid having to throw a single dose away.

There are two main processes that can see vaccine doses lost. One is the defrosting of more shots than are needed, and for more than 30 days to pass with them in refrigeration. This is what happened in Catalonia. The other is for the expiry date to arrive while they are still frozen, something that happens six or seven months after production, for the Pfizer-BioNTech and Moderna vaccines, respectively. It is these two vaccines that are being used in Spain currently, and both are delivered to Spain deep-frozen.

Around 36,000 doses will expire in Andalusia on October 31 if they are not administered

The Health Ministry has been slowing down its requests for vaccines to avoid these frozen doses from expiring. Once the regions had enough vials to meet their needs, the government delayed a shipment from Pfizer on September 13 in order to avoid more doses accumulating in storage. For the next delivery, which arrived a week after, the ministry only ordered just over a million, less than half of what it had been receiving. Some regions are doing the same thing when they calculate they have more than they need: requesting that the ministry slow down the deliveries.

Thanks to this approach, there are still weeks or months left before the majority of the vaccines that the regions are storing expire. Among the regions that replied to EL PAÍS, Andalusia is the territory where the expiry date is closest. Around 36,000 doses will expire on October 31 if they are not administered. This month, around 20,000 doses a day are being injected, meaning that there is more than enough time to use these reserves.

What happened in Catalonia was due to a mistaken calculation, which saw more vaccines defrosted than was necessary. This has been avoided by most other regions, who have adjusted their needs based on weekly or even daily requirements in order to avoid storing them more than 30 days at a temperature of 2 to 8ºC. Rosa Sancho, vice-president of the National Association of Nursing and Vaccines (Anenvac), explains that what happened in Catalonia was an isolated incident. “Normally, the defrosting process does not go ahead without having first established how many vaccinations will take place.”

Many regions have opened mobile vaccination centers where no appointments are necessary, which requires greater improvisation

The outlook has, however, changed in recent weeks and it is now more difficult to make this calculation. “We no longer have large amounts of the population waiting,” explains Sancho. “Until now it has been easier because everyone had appointments and the population was very keen, meaning that there were very few missed appointments. Now those who are left are young people and they have a different approach, both with this and other things. The vaccine is not their priority and there are more people missing their appointments.”

Many regions have opened mobile vaccination centers where no appointments are necessary, which requires greater improvisation. Begoña Reyero, the coordinator of the vaccination plan in the Canary Islands, explains that this is leading to a more exhaustive control of the batches and their expiry dates across the islands. “We look at the schedules of people with appointments and the chance of people arriving without them, plus the approximate data of the patients who will get an additional dose. Then we make an estimate and bit by bit we take out the vaccines and take careful note of the expiry dates,” Reyero explains.

When there have been doses close to expiration, they have moved them between the islands in order to avoid losses as much as possible, although she admits that optimizing the doses these days is more “complicated.”

Catalonia has saved the vials that expired in case Pfizer determines that they can last more than 30 days while refrigerated. A spokesperson from the company has said that data is still being compiled as to the stability of the vaccine, but that for now the indications for storage continue to be those on the technical leaflet, which state one month when refrigerated.

What to do with open vials

A third possibility of waste is that once a vial is open – containing six doses in the case of Pfizer – there aren’t enough people to give the vaccine to. One example would be a place where 25 people get immunized. Five vials would be needed, but the last one would only be used for a single shot and five would be left over. These cannot be kept for another day, and must be injected within the space of hours.

Ana Ariztegui, who works on Navarre’s vaccination plan, explains that since the process began they have been preparing lists so they can call in people who had appointments the next day and thus not lose a single dose. “We have worked very well doing this,” she explains. “It’s ever-more erratic because the appointments are not so often now and there are very few people left to vaccinate. Now we have started again with senior homes and the third dose and we have new schedules so that we don’t waste those shots from the open vials,” she adds.

The group of experts that is advising the Spanish government on its vaccination program is studying the scientific evidence each week on these additional shots for new groups. A spokesperson from the Health Ministry has explained that the candidates eligible for an extra dose are likely to be extended. Right now, they are authorized for residents of care homes, people with suppressed immune systems and cancer patients. The more than five million doses currently being stored by Spain will be used for these groups, as well as the four million over-12s who are yet to complete the vaccination process. More than 76% of Spaniards now have the full protection offered by the vaccines, but it is getting ever-more difficult to increase this percentage.

Spain’s vaccine surplus is prompting the country to increase donations to developing countries. Prime Minister Pedro Sánchez announced on Wednesday at the United Nations that the country would send 30 million shots to those most in need. These will not, in principle, be those that are left over in storage, but instead purchases from pharmaceutical companies that will be sent directly to their destination. “In the case that they are expected to expire, the vaccine advisory board will have to decide how to proceed,” a Health Ministry spokesperson explains, adding that this is not the current scenario in Spain.

English version by Simon Hunter.