Pharmacists say ‘pooling’ Kovid vaccines can save thousands of doses

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With millions of Americans across the country in line for their shot at receiving the Kovid-19 vaccine, health officials are still struggling to meet growing demand, a result of short supply.

“This liquid is more valuable than gold,” said Melanie Masiah-White, chief pharmacy officer at Innova Health System, a Northern Virginia-based nonprofit hospital network.

Some pharmacists say there is a simple solution that allows thousands of more people to be vaccinated each week, but the Food and Drug Administration stands in the way.

This is called “pooling” – and is not a new concept. Pharmacists have been doing everything from flu vaccine to some medicines of chemotherapy to antibiotics for years. What is left in a vial of medicine and it is left in another vial to make a full dose.

“It doesn’t look like a lot at the bottom of the bottle,” Dr. Stephen Jones said the CEO of Innova Health System located in Falls Church, Virginia, Drs. “But ultimately overall, it ends up with a lot of supplements that are wasting in the end, and we are not allowed to use that vaccine. But many times there is almost a full dose at the end of the vial, which is heartbreaking to waste it. “

The remaining vaccine volume in the Innova vials may be sufficient for an additional 13,000 doses. Instead, they are being discarded due to FDA regulations that ban pooling of leftover Kovid-19 vaccines.Lauren Dun / Innova Health Systems

Pharmacists at Innova Health, one of the largest hospital systems in the Washington, DC, area, say they have started seeing significant amounts of leftover vaccine in nearly every vial even after using the sixth dose in addition to Pfizer . But due to FDA regulations, they are now being forced to throw away any additional vaccines.

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“It’s heartbreaking for us,” Masia-White said. “We have many team members who go through here and say to someone at least daily, ‘Why can’t we stop wasting?’

Innova pharmacists conducted an experiment, with 100 vials containing the residual vaccine. Of those, 80 of them had significant amounts left. Pharmacists found that the vaccines released in those 80 vials could make up to 40 additional full doses. This means that on a typical vaccination day, when that hospital would usually give more than 4,000 shots, they could deliver 400 additional vaccines with a single supply.

“If we can just start putting them together, then by using them immediately, we will increase the amount of vaccines available for free,” Jones said.

Experts say this is a simple process that pharmacists have been doing for years.

If one vial is contaminated, this practice can spread contamination to others, reduce the presence of pathogens and increase disease transmission capacity.

“It’s a common practice that you see in vaccines,” said Stephanie Ferreri, division chair of practice advancement and clinical education at the Eshelman School of Pharmacy, University of North Carolina. She said that vaccines should only be pooled by the same number, so that doctors can find out where it came from in the event, any problems, such as any unusual side effects.

Even though pooling is common, the FDA states that pharmacists and other physicians cannot pool the leftover Kovid-19 vaccine because neither modern nor Pfizer products contain preservatives that are infected with bacteria or other germs. Help prevent microbial growth.

“This is an infection control measure,” an FDA spokesman told NBC News in a statement. “Cross-contamination of multidose drugs with the use of the same needle and syringe has occurred with other drugs when this practice was used, causing serious bacterial infections. If a vial is contaminated, this practice For others, it can spread the infection, reduce the presence of the pathogen and increase the transmission capacity of the disease. “

Pharmacists at Innova Health System saw significant amounts of leftover vaccine in almost every vial.Lauren Dunn / NBC News

But pharmacy experts say the risk of cross contamination is low and the benefit of taking high doses of the Kovid vaccine eliminates any risk.

“If the vial is not used correctly, the risk of contamination is high because the vial contains no preservatives,” Ferrari said. “If the vial is used immediately, with the same number with the same vial, then the risk of contamination is very low.”

Innova health officials say that in large immunization clinics like theirs, all doses are used almost immediately, and they already have protocols in place to protect them from any form of cross contamination.

“We’ll use those doses within 60 minutes,” Masia-White said. “They are not going to sit. They are not supposed to come at room temperature. We will be able to weaponize those shots very early in our clinics. “

But for now, the vaccination process remains a waiting game, as Americans wait their turn for the shot and to increase production to meet growing demand for vaccine manufacturers.

“Ultimately, when there are enough vaccines, it wouldn’t matter to waste something on the floor,” Jones said. “But right now, we are millions of doses short. So a few extra doses from each set of vials will make a difference in literally hundreds of people a day. “

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