Covid: Why up to one-in-six Pfizer vaccine doses may have been wasted

This is an unashamed public information blog.

It is prompted by a conversation I've had with an anxious doctor who is vaccinating against Covid-19 in east London.

It is about why up to one-in-six Pfizer/BioNTech doses are being wasted in at least some vaccination centres.

Here is why this shocking waste is occurring. The vaccine arrives at the centres in small vials. As you can see from the attached Public Health England/NHS document, the original protocol said each vial contains only five doses.

The original protocol said each vial contains only five doses.

But my doctor source tells me there is usually a sixth dose in each vial, and that she and her fellow vaccinators have been instructed to throw way the vial after five doses.

In her centre, all these sixth doses are being thrown away, and she assumes this practice is widespread.

As it happens, Public Health England has clocked that most of the vials contain a sixth dose and on 4 January it issued revised "Patient Group Direction" for the Pfizer/BioNTech vaccine that allowed from 5 January "for administration of a sixth dose if obtainable from the multidose vial".

  • Vaccine minister Nadhim Zahawi on updated guidance to doctors

The problem is NHS Trusts and others in charge of vaccination do not seem to know that the protocol has changed.

So I am flagging it up. Just to be clear, it is theoretically possible on the basis of Thursday's vaccination stats that more than 150,000 doses of the precious vaccine have already been wasted. Which would be appalling. So fingers crossed all vaccinators now deploy the sixth dose when it is in the vial.

Here is the updated patient group direction.

PS The Department of Health has been in touch to point me to this "information for UK healthcare professionals", which allows sixth doses to be taken when "low dead-volume syringes and/or needles are used". An official says it was issued on 17 December.

Here is that revised information for UK healthcare professionals.

9pm update: Public Health England has now issued a response to my blog.

Dr Mary Ramsay, Head of Immunisation at PHE said: “The NHS issued guidance on the sixth dose to the health system in December and the relevant regulations were amended shortly after. “Therefore, clinicians could and were using the sixth dose before the PGD was published.”

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