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COVID vaccines – the controversial waste dilemma

by in Coronavirus, COVID-19

Since the COVID-19 vaccine programme commenced, healthcare staff and volunteers have worked tirelessly to administer the vaccine to those patients sitting in the high-priority groups. To date, c18 million people have had their first dose of the vaccine; this equates to one in three adults across the UK. The roll-out continues at pace, and the challenge to vaccinate everyone over the age of 18 in the UK with one dose has been set for the end of July 2021 (no pressure).

With the Prime Minister announcing on Monday the ‘Roadmap out of lockdown’ and stating that he is ‘very optimistic’ all coronavirus restrictions will be removed by 21st June under the four-stage plan, you’d be forgiven for impersonating Pharrell Williams:

“Because I’m happy

Clap along if you feel like a room without a roof

Because I’m happy

Clap along if you feel like happiness is the truth

Because I’m happy

Clap along if you know what happiness is to you

Because I’m happy

Clap along if you feel like that’s what you wanna do (hey)”

Come on, the sun has been shining and the temperatures are rising; shouldn’t we all be happy or at least happier with this news? Well, I know I was, until yesterday when I read an article that said a GP practice was under investigation by their CCG for administering leftover doses of the COVID vaccine to patients outside current eligible cohorts in order to avoid wastage! In my opinion this is absurd. No vaccines should be wasted and if individuals can be opportunistically vaccinated to avoid wastage, then why not?

Hypothetically speaking, at the end of a long day at the COVID vaccination centre, there are three doses of the vaccine left in a vial and there are a number of police officers who have been there supporting the session. Surely, you’d offer them the vaccine rather than dispose of it and waste it at a cost? Let’s face it, they’re going to get vaccinated at some point between now and the end of July; don’t you think it’s criminal to waste it? (See what I did there?)

Don’t you think what’s called for in such circumstances is a common-sense approach? Sadly, it is said that there’s nothing more uncommon than common sense!

Whilst the incident that led to the investigation took place in January, the goalposts have moved more than once since then! On 13th February, a letter issued to Local Vaccination Sites (LVSs) stated, “Vaccine should not be given to people outside of cohorts 1-6”. However, on 22nd February, the Enhanced Service Specification COVID-19 vaccination programme guidance was updated, with paragraph 9.2 stating:

“Vaccination will be permitted to patients outside of the announced cohort where the GP practice can demonstrate exceptional circumstances, that it is clinically appropriate and where resources would otherwise have been wasted.”

Hang on, isn’t seizing the opportunity to vaccinate someone with leftover doses preventing resources from being wasted?

This draws me to think of another song, aptly named ‘Confused’ by Olivia Mitchell – particularly these two lines:

“I am so confused

So shocked I don’t know what to do”

From a very young age, I was always taught to ‘ask if I didn’t understand’ and that’s exactly what I have done. I asked NHS(E) the following question: “Given the drive to ensure all over 18s have received the COVID-19 vaccine by the end of July, shouldn’t vaccination centres opportunistically vaccinate people outside of eligible cohorts in order to avoid wastage?” At the time of writing, a reply hasn’t yet been received.

Was the question considered controversial? I would argue that it isn’t as controversial as wasting a dose that can cost between £3 and £28 or multiples thereof!

It is, however, reassuring to learn whilst talking to colleagues (no names, no pack drill) that they have opted for the common-sense approach and are calling people at short notice who sit in the eligible cohorts to be vaccinated, or opportunistically vaccinating those outside the eligible cohorts in order to avoid wastage.

Some vaccination centres have reported having queues of people waiting for any ‘leftover’ vaccines. So, let me ask a question: ‘At the end of a session, where there are leftover vaccines, would it be morally right to turn these people away and throw the vaccine in the clinical waste bin or welcome them with a smile and vaccinate them, thereby avoiding waste and contributing to achieving the aim of vaccinating all adults by the end of July?’

Controversial? No, it’s just common sense (in my humble opinion)!

Doesn’t commissioning focus on “achieving the best possible health outcomes for the local population”? So rather than investigate a practice for doing what many would consider the right thing, shouldn’t they be supportive and thankful that vaccines aren’t going to waste?

It’s important to realise that this isn’t a case of widening health inequalities, nor is it a case of first come, first served, or a blatant disregard for ‘current’ guidance. It’s more a case of introducing the CDF (Common Dog Factor) – that is, ‘the application of pure common sense’.

Let us now think for a moment about the CDF approach and the benefits. We know it will avoid wastage, ergo save money – so what else? Well, what about patient perception? Wouldn’t this approach go a long way towards influencing public perception, showing that practices and PCNs are working tirelessly to meet the target set by the government of vaccinating all eligible patients by the end of July?

I wonder what the perception of the CCG in question is? I could offer my thoughts, but like much of this blog, they too may be considered controversial.

For now let me you with the words of Dr Vautrey, Chair of the BMA General Practitioners Committee: “The cardinal rule is not to waste the vaccine”.

Stay safe.

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2 Responses to “COVID vaccines – the controversial waste dilemma”
  1. Phil Coates
    Phil Coates Says:

    We contacted NHS England and NHS Improvement and they kindly came back with some comments to our email. Please see below:

    Our email:

    “Practice index is writing a blog in regards to the current confusion surrounding whether any surplus COVID vaccines are offered up to patients outside of cohorts 1-6, to avoid wastage. Whilst it is understood that these patients may “queue jump”, it is a pragmatic solution, especially given the drive to ensure all over 18s have received the COVID-19 vaccine by the end of July.

    Is there an NHS England viewpoint on this as there does seem to be
    conflicting advice, given that a CCG is challenging one of their practices this week following them doing this very thing.”

    NHS England’s response:

    “Ensuring vaccines are available for those who need them most

    Local NHS teams are working hard to offer the first crucial dose of the vaccine to everyone in the top priority groups by the middle of February.

    The NHS has the staff and the facilities to do this, with more than 1,600 individual vaccination services already in operation and more set to follow.

    But meeting this ambition depends on the NHS getting enough doses of vaccine from suppliers, and then making sure that every dose gets to the arms of those who need it the most.

    That means that only those who are in the highest priority groups should be vaccinated right now – those who are aged 64 and over, care home residents and staff, those who the Government have identified as being clinically vulnerable, registered adult carers, and frontline health and social care workers who come into contact with vulnerable children and adults.

    The vast majority of school and early years workers don’t fall within this criteria, so it is important that this group and others wait for when it is their turn to be called.

    It means that vaccines have to be spread around the country based on how many people in each area are yet to be protected. Every part of the country should have enough vaccine for the priority groups who live there.

    And it means the NHS needs to follow the guidance from the JCVI and the four UK Chief Medical Officers on delivering vaccines 12 weeks apart.

    The first dose gives you the vast majority of the protection from serious disease, so doing these three things will help us protect those who need it most quicker, and save more lives.

    This is a question of fairness.

    When supplies of vaccines are limited, every vaccine given to someone who isn’t eligible, and every second dose given early, means early protection is denied for someone who would benefit the most.

    Of course vaccines should never be wasted, which is why all services have been told to have a backup list of people who need a first dose they can invite to take up any missed appointments. We would urge everyone with an appointment to do everything they can to attend to avoid this happening.

    And to be clear, people – including NHS staff – do not require an NHS number or GP registration to receive a vaccination, and should never be denied one on this basis, either when attending for a vaccine in person, or through the design of booking systems.

    If someone does not have an NHS number but is within an eligible group, services should vaccinate now, record locally via a paper system and ensure vaccination is formally documented later.”

    Reply

  2. Avatar
    Dianne Lambdin Says:

    I have read this twice and still can’t find the answer to the question! Have I missed it?

    Reply

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