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'Do not waste doses.' Leftover Covid-19 vaccine injected into non-priority arms

caption: Chideya Wilson, a medical assistant at Carolyn Downs prepares to administer the first dose of the Moderna Covid-19 vaccine for Laura Endres, a pharmacist at Country Doctor Community Health Center on Thursday, January 7, 2021, at a drive-thru vaccination clinic for healthcare workers in Renton.
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Chideya Wilson, a medical assistant at Carolyn Downs prepares to administer the first dose of the Moderna Covid-19 vaccine for Laura Endres, a pharmacist at Country Doctor Community Health Center on Thursday, January 7, 2021, at a drive-thru vaccination clinic for healthcare workers in Renton.
KUOW Photo/Megan Farmer

As of yet, Washington state has only officially made Covid-19 vaccinations available to select demographics, considered most vulnerable to the disease.

But at the end of the day, thawed out doses that can't be refrozen are going into whatever arms health care providers can find.

If you book an appointment online at Swedish Hospital's vaccination clinic at Seattle University, you'll be met with this message:

We are currently ONLY vaccinating individuals who are categorized as Phase 1A or Phase 1B/Tier 1 by the WA State DOH. DO NOT SCHEDULE IF YOU ARE NOT IN THESE PHASES!

We DO NOT have "extra" vaccine doses and will not be able to accommodate walk-ins.

But that message wasn't always there.

When Jenna Anderson-O'Neil saw on Facebook that her cousin had been vaccinated against Covid-19 on January 14, she was perplexed.

Anderson-O'Neil's cousin is in her mid-twenties, has no underlying health conditions, and doesn't work in a health care setting. She wondered how her cousin could have gotten vaccinated before her 65-year-old mother who has underlying health conditions and, was at that time ineligible.

But still, her cousin had managed to book an evening time appointment online to get the shot at Swedish's Seattle University clinic.

Amid Washington's phased approach to vaccinating people against Covid-19, only groups designated under 1a and 1b are currently eligible. That includes long term care facility residents and staff, health care workers, anyone 65 or older, and people 50-plus who live in multigenerational households.

Washingtonians can check the status of their vaccine eligibility online, by identifying health factors such as age, underlying conditions, and occupation.

Timestamped screenshots show that on January 16, Swedish's web form did not emphatically discourage people outside of the state's vaccine eligibility criteria from booking appointments. Nor did it deny having "extra" vaccine doses.

That was also before thousands more, designated under phase 1b, became eligible for vaccinations this week.

"My mom called me upset she had missed out so I went on a desperate search to find out anything about 'extra' vaccines," Anderson-O'Neil said.

She learned through anecdotes that some people, who fall outside of the state's recommended eligibility criteria, had still managed to get vaccinated. That's because both the Pfizer-BioNTech and Moderna vaccines must be stored at extremely cold temperatures. And once thawed for use, the clock starts ticking.

A logistical — and ethical — dilemma

Vials of the Pfizer-BioNTech vaccine has to be kept frozen at temperatures between -112ºF to -76ºF. If thawed in a refrigerator, the doses keep up to five days. But if thawed at room temperature, you've got half an hour before effectiveness is lost, according to the Food and Drug Administration.

The Moderna vaccine isn't as fussy. It can be frozen at between -13º and 5ºF, and can also be refrigerated for up to a month before use. Additionally, unpunctured vials can be kept at room temperature for up to 12 hours. But like its counterpart, Moderna's vaccine can't be refrozen.

The particulars of Covid-19 vaccine storage has left health care practitioners with a largely unforseen ethical dilemma: Allow a lottery of non-priority patients to jump the vaccination line, or let unused and expiring doses go to waste.

READ: Mass vaccination sites set up around Seattle: Goal is 45,000 shots per day in state

Robert Hood, 56, is currently ineligible for the vacccine under state guidelines. But he happened to be in the right place at the right time on Friday, when an opportunity to get vaccinated at a Fred Hutch clinic presented itself. A photographer for the cancer research center, he'd stayed later than normal to finish a project, he said.

On his way out, Hood encountered a nurse who offered to vaccinate him with a leftover dose of the Pfizer-BioNTec vaccine. He accepted.

"I looked out into the parking lot to see if there was any old person who needs this shot more than me, and there was no one," Hood said.

He described it as a serendiptous and emotional moment.

"I've photographed so many people getting vaccinated and at least half start sobbing afterwards," he added. "And I kind of experienced that. I think it hits people pretty hard in that moment that something profound just happened to them after all this time. It all hits at once like a giant tidal wave and takes people away.

"I feel like I got struck by lightening but in a good way. I completely lucked out."

Ferry County Memorial Hospital also vaccinated a people on the fly to avoid having to pitch leftover doses "borrowed" from neighboring health care providers in mid-December, CEO Aaron Edwards said. He said that he and a doctor had driven themselves to pick up the vials.

"The guidance that we’ve gotten from the state is ‘Do not waste doses,'" Edwards said during Washington State Hospital Association briefing earlier this month. “We did not waste any doses.”

The hospital keeps a “call list” of people suggested by physicians who are vulnerable but may not have been eligible under the state's guidelines at the time, Edwards added.

MultiCare executive Dr. Michael Myint also outlined how his staff handles leftover Covid-19 vaccine doses.

“Usually it’s because someone cancels, because we try to line up the scheduling with how many doses we have," he said. "And if someone cancels at the last minute, we have anywhere between one and a few doses.”

Like Ferry County Memorial Hospital, MultiCare has been trying to ensure that people at higher risk of Covid-19 complications are the ones getting any leftover doses, even if they’re not in the priority groups, Myint said.

It’s not malfeasance, Myint said; just people trying to do the right thing and “find an arm to put a vaccine in.”

But even as health care providers scramble to make use of perishing vaccine doses, officials say the overall amount of vaccine doses they're receiving isn't enough.

King County public health officer Jeff Duchin said Tuesday that many health care workers here remain unvaccinated, considering the county has received less than a quarter of Washington’s vaccine doses so far, although it has nearly half the state’s health care workers, and long-term care residents and staffers.

“Proportionally, we haven’t received the amount of vaccine that we would expect to be able to offer it to all of the eligible health care providers,” Duchin said.

Moreover, people eligible to get vaccinated have reported significant difficulties this week with finding available appointments, due to the lack of supply.

READ: Having trouble finding a vaccine appointment in Seattle? You’re not alone

But despite that shortfall, Gov. Jay Inslee this week directed hospitals to schedule more vaccination appointments — even if those clinics have to get cancelled later.

But health care providers say that's a bad idea, considering the uncertainty surrounding vaccine allocation.

They don’t want to tell patients their vaccination appointments are cancelled, and they don’t want to pull nurses into staffing clinics that don't materialize. Besides, they say, the choke point isn’t scheduling appointments.

“We’re not sitting on vaccine,” said Dr. Chris Dale, who is on Swedish Hospital’s senior leadership team. “As soon as we get it, we can almost in real time book the appointments.”

For her part, Anderson-O'Neil said she was able to schedule an appointment online on January 16 with Swedish, by indicating she was looking to get a "surplus" vaccination. But she ultimately canceled the appointment after becoming aware that Swedish was insisting there are no "extra" vaccine doses.

"I'm a licensed dental assistant and I'm so tempted to just take my license and get myself a damn vaccine," said Anderson-O'Neil, who doesn't currently practice in the medical field. "But I will behave."

Eilis O'Neill contributed to this report.

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