Amid COVID-19 surge, massive vaccine wastage opens up another battlefront for India
Well-planned vaccination drives, opening of vials only after the arrival of 10 beneficiaries, adequate training to healthcare workers to minimise wastage
As the Centre and states prepare to begin inoculation of all those above 18 years of age from 1 May, a RTI reply revealed that over 44 lakh vaccines — more than the population of Tripura — were wasted between January (when the vaccination drive started in India) and 11 April.
Tamil Nadu reported the highest vaccine wastage of over 12 percent, followed by Haryana (9.74 percent), Punjab (8.12 percent), Manipur (7.8 percent) and Telangana (7.55 percent), according to the Centre's response to the RTI query. Meanwhile, West Bengal, Himachal Pradesh, Mizoram, Goa, Daman and Diu, Andaman and Nicobar Islands and Lakshadweep reported “zero wastage” of doses.
The Delhi High Court also on Tuesday pulled up the Centre for “criminal wastage” of vaccines, and said “whomsoever you can vaccinate” should be vaccinated, regardless of age, to ensure “all doses are fully utilised”. Blaming the wastage on bad planning, the bench said, “We cannot make an app to deal with this situation? You should have known that there would be a situation that people may not turn up, because if a person turns up and you have to open a new vial, you will not tell him to come tomorrow.”
“Whether he is 16 years, 20 years or 60 years doesn’t matter. All need vaccination. Please look at this aspect,” said the court, adding that even one shot should not be wasted as the pandemic is hitting young people too. At least two state governments – Delhi and Maharashtra – had requested the Central government to expand vaccination coverage to younger people, as they make up for the majority of the COVID-19 cases.
National Health Authority CEO Ram Sewak Sharma had said the wastage of coronavirus vaccine has been an area of concern for the government, suggesting that consolidating smaller vaccination centres into larger ones can help address this issue. “There are other minor details like the need to consolidate vaccine centres into larger centres and if that happens then vaccination wastage will also reduce. Wastage takes place generally in the last vial. People at times not turning up after getting appointment is also an issue," he said.
Israel, which has vaccinated 56 percent of its population against COVID-19 , avoided wastage when its elderly population was being vaccinated by allowing its youth to get vaccinated with underused vials at the end of the day.
The Centre has urged states to limit vaccine wastage to less than 1 percent in April and also appealed for more inoculations by reducing wastage. The only way to avoid vaccine wastage is to mobilise beneficiaries by instilling confidence in them, health experts told Bloomberg Quint. PJ Srinivas, joint secretary (south zone) of Indian Public Health Association, a public health policy organisation based in Andhra Pradesh, said there were also cases of inexperienced vaccinators drawing more than required from vials, leading to wastage.
Wastage of doses can occur after or before the opening of vials. Once a vial is punctured, it must be utilised within four to six hours or must be discarded. In January, the size of the Covaxin vial was reduced to contain 10 doses instead of 20. Wastage in opened vials can occur due to five reasons - while discarding remaining doses at the end of the session, not being able to draw the number of doses in a vial, submergence of opened vials in the water, suspected contamination, and poor vaccine administration practices.
In the case of unopened vials, there are problems of expiry, heat exposure, theft and breakage that lead to wastage.
Well-planned vaccination drives, opening of vials only after the arrival of 10 beneficiaries, adequate training to healthcare workers and an effective cold chain system are important to minimise wastage.
As the third nationwide inoculation drive approaches, the government has sanctioned large sums of money to the Serum Institute of India and Bharat Biotech to scale up production, fast-tracked clearance of COVID vaccines approved in other countries, and allowed states to buy doses directly from vaccine makers.
In the third phase of nationwide inoculation, vaccine manufacturers would supply 50 percent of their monthly Central Drugs Laboratory (CDL) released doses to the Centre and would be free to supply the remaining 50 percent to states and in the open market.
The Centre, from its share, will allocate vaccines to states and UTs based on extent and curve of infection (number of active COVID cases) and performance (speed of administration). The allocation to states will also be negatively impacted by the wastage of doses.
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The National AEFI Committee however said that all benefits of vaccination are overwhelmingly greater than the small risk of harm
The study, which is a preprint and has not been peer-reviewed, should not be used to guide clinical practice. However, it claimed that seropositivity rates to anti-spike antibodies were significantly higher in Covishield recipients