Expired drugs discarded, highlighting technical challenges of distribution and inoculation plans
Hundreds of doses of highly sought H1N1 flu vaccine have been thrown out because the costly drug had hit its best-before-date, health officials say.
Some provincial officials estimate that as much as 2 per cent of the vaccine has been discarded.
The loss of the doses across the country highlights the particular technical challenges confronting health officials as they roll out a vaccine strategy aimed at protecting first those most at-risk and then the general population. Unlike the seasonal influenza vaccine, the H1N1 has a short shelf-life and can’t be saved because researchers don’t know whether it retains its efficacy.
“We are running a very efficient program,” said Anne Marie Akins of Toronto Public Health. “But no matter how hard you try, there’s going to be some waste.”
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Most flu vaccines can last up to a month after being injected, but Arepanrix, the H1N1 vaccine, is more difficult to manage. The vaccine is delivered as two components, known as antigen and adjuvant, which are mixed on-site, then injected. Each dose contains enough for 10 patients and must be used within 24 hours after being mixed.
Sheila Rougeau, a spokeswoman for Alberta Health Services, said most of the waste in the provincial program occurred because there weren’t enough patients available after the vaccine was mixed. To minimize this, nurses attempt to inject any leftover vaccine into front-line health-care workers who have not yet been immunized.
Even so, Ms. Rougeau said, perfect efficiency has proven impossible: “It has happened occasionally where we have had some pre-mixed vaccines left over at the end of the day.”
Discarded vaccines, however, are not the only inefficient part of the process. When health-care workers draw the vaccine into a syringe, they often take more than is needed to immunize a person. The leftover amounts to between 2 and 10 per cent of the vaccine, said John Tuckwell, a spokesman with Alberta Health and Wellness.
“There is wastage. It’s just part of how the vaccine is packaged,” he said.
“When you draw your dose, you have to take more vaccine into the syringe than you’re going to deliver. It’s the same with giving any injection. So you’re going to end up with a small amount of fluid left in the syringe.”
Losing doses is just one hiccup in a rollout of the H1N1 vaccine that has been fraught with problems from the beginning. First, the H1N1 virus proved difficult to grow in eggs, meaning it took more time to harvest antigen. As well, a decision was made to finish manufacturing seasonal flu vaccine before moving on to the production of H1N1 vaccine, which delayed it by about two weeks.
The fact that Canada’s vaccine was produced in a single plant also meant that getting vaccine into vials took more time.
Then came the decision to produce unadjuvanted vaccine for pregnant women, which meant that production of adjuvanted vaccine was shut down briefly.
Time was also not on officials’ side: With H1N1, flu season arrived early and that meant provinces and territories were not quite ready to vaccinate when the second wave of the flu arrived. The chronic shortage of nurses meant that there were limits on how many vaccines could be administered.
When vaccines were first made available, public-health officials published priority lists for vaccination but made the mistake of saying no one would be turned away, which create huge line-ups and long waits.
Robert Strang, Nova Scotia’s chief public-health officer, said he understands it might be frustrating for groups still waiting to get immunized to hear that some of the vaccine is being discarded. But he said health officials are trying to keep waste to a minimum.
A Montreal public-health official said some H1N1 vaccine has had to be discarded, though she was unable to say how much. A final tabulation will be done at the end of the province’s vaccination campaign.
“I’m aware that some doses were lost, but I don’t know the number, the reason or when it happened,” said Lauréanne Collin of the Montreal Health and Social Services Agency. “All I know is that it wasn’t anything major and it won’t disrupt vaccinations or penalize anyone. We won’t lack vaccine because of it.”
Officials in Winnipeg and Halifax have also acknowledged that some of the vaccine they have received has been wasted. In a press conference last week, Winnipeg Health Authority CEO Brian Postal said the amount of waste was less than 1 per cent.
David Butler-Jones, Canada’s chief public-health officer, also addressed the issue earlier this month, saying that determining the exact number of doses required each day is difficult but that public-health authorities were doing a good job in their efforts to minimize how much vaccine is discarded.
“If you throw away a few doses a day, that’s normal business,” Dr. Butler-Jones said.
With reports from Ingrid Peritz, Nathan VanderKlippe, André Picard and The Canadian Press
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