Out of the 7 crore vaccine doses, more than 3.46 crore have been administered and from the remaining, 6.5 per cent — over 23 lakh, have been wasted so far. MUSBA HASHMI speaks with experts to tell you the reason behind this wastage, whether we can afford it keeping in mind the pandemic and solutions

Wasting food, water, electricity or even fuel is not an alien concept to humans. However, to take this a notch higher, even Covid vaccines are getting wasted. Surprising enough? Well, it shouldn’t be.  The disappointing fact is the number of vaccine doses that have gone waste —  23 lakh, around 6.5 per cent of the total 7 crore vaccines, out of which 3.46 crore vaccines have been administered, that have been provided by the Centre to States so far, according to the data release by The Ministry of Health and Family Welfare. What is the reason you ask?  Low turnout of beneficiaries reportedly.

The State that is leading the wastage chart is Telangana with a whopping 17.6 per cent followed by Andhra Pradesh, Uttar Pradesh and Karnataka with 11.6, 9.4 and 6.9 per cent respectively. Delhi, however, is not listed in the chart which means there is either zero wastage or it is less than Himachal Pradesh’s i.e. 1.4 per cent, if at all.

During a time, when several countries are waiting for their turn to get their required number of doses, this huge amount of wastage is something that we should feel sad about. Moreover, the recent surge in cases with the country reporting 50,000 cases in a day is a reality check for all of us that we definitely can’t afford to waste even a single dose of the vaccine.

“It is indeed unfortunate that such wastage has occurred in our country and should have been avoided at all costs. Since we are running the second largest vaccination programme in the world, we should have seen this coming and therefore been better prepared. One of the major reasons being cited are the unexpectedly low turnout of beneficiaries after the opening of a vial,” Dr Arunesh Kumar, Senior Consultant and Head of Respiratory Medicine/Pulmonology, Paras Healthcare and a part of the team of doctors involved in the vaccination process, tells you.

Since each vial of Covishield contains 10 doses and Covaxin 20 doses, it is crucial that all the doses are used up within four hours of opening.  Otherwise, it becomes unusable and hence goes waste.

“In fact, apart from the low turnout, poor and inadequate coordination between vaccine suppliers, cold chain facilities and vaccination centres on one hand and between vaccine centres and end-users on the other is more responsible for this wastage. A vial should be opened only when sufficient number of end users are physically available at the vaccination centres,” Kumar opines.

In addition to this, an already confirmed beneficiary must be checked with again on the day of the slated inoculation programme. And any postponement request by a beneficiary must be immediately followed up with making the vaccine available to those slated for the next session/day or those on waiting list.

The vaccination centers must also use technology to be able to connect and coordinate with local populations in case of unexpectedly lower turnout of intended beneficiaries.

While the latest decision of bringing down the age of eligible candidates for vaccination would help in preventing wastage at least of the kind that occurs due to low attendance of end-beneficiaries, expanding the list further will help.

“It is also being suggested that the Government should expand the list of beneficiaries from those aged 45 and above with comorbidities and the elderly to those below 45 years old. This should definitely solve the problem of low turnouts post-opening of a vial. Another way out for the authorities could be to focus on states, cities and populations where there has been a resurgence of Covid cases,” Kumar adds.

But having said that, we would still need to think of prioritising certain age or demographic segment. “Otherwise, the demand for doses may outstrip the supplies we have and create operational nightmare for the authorities,” Kumar asserts.

Dr (Col) Vijay Dutta, Senior Consultant — Internal Medicine, Indian Spinal Injuries Centre, who is the key member of the Adversary Emergency Response Committee at the hospital tells you that number of people coming for vaccination are increasing day by day. Around 100 to 150 are coming daily for getting their dose of Covid jab.

“We are expecting an increase of about 15 per cent in the next few weeks,” Dutta says.

However, even those who are turning up for the vaccination are apprehensive about getting jabbed. They are worried about the common side effects. “They ask whether it is better to get natural immunity to COVID-19 rather than immunity from a vaccine or is it safe to get a COVID-19 vaccine if they have an underlying medical condition. Moreover, some even fear that will the vaccine give them COVID-19. While others are just worried about the precautions to be taken and what to do in case of fever after vaccination,” he tells you.

While this might be one of the main reasons behind the low turnout of beneficiaries, what can be done to prevent wastage is that the Government can provide logistics for anyone and everyone who is willing to get vaccinated.

“The Government must take such initiatives so that maximum people can get the dose. Opening vaccination for all people above 45 is one such commendable move. The Government must assess the availability of vaccines so that more categories of people are inoculated in the coming days. Also it will help in creating awareness among the people about the world’s biggest vaccination drive,” he asserts.

Kumar too agrees with Dutta and says that making vaccines available in the open markets would help people lap up the shots.

“It’s unfortunate to see how the turnout for Covid-19 vaccines are so less in many States. Making the vaccine available in the open market would allow vaccine demand to lap up the shots, eliminating wastage. India being the vaccine-maker in the world, it would be a matter of shame if it were to lag other countries in vaccination in the long run, simply because the private sector was not trusted with the job. So, the capping on 250 doses per day from the private hospitals should be removed immediately. And in order to encourage people to get their vaccination done, Government should make the arrangement of dedicated logistics for the people,”  Kumar says.

Dr Shuchin Bajaj, Founder Director, Ujala Cygnus Group of Hospitals, the hospital which has been successfully running vaccination drives, is no exception and agrees with what the other doctors has to say on the wastage of the vaccines. 

“Before the vaccination was opened for everyone above 45, the wastage was quiet high because the number of people walking in was low. Hence, we were only able to utilise 50 per cent of the total vaccine slots available in a day. Now with the vaccination open to everyone above 45 regardless of their co-morbidities, the wastage is going to get lower. We will be  able to utilise more doses. With that being said, Tamil Nadu has taken a commendable step with allowing walk-ins of any age adults to get vaccinated. This is a good policy and we could replicate it in the rest of the States to decrease the wastage. Our aim should be to bring down the wastage to one per cent,” Bajaj says.

One of the many solutions to prevent this wastage one can probably think of is to bring down the age below 45 for vaccination. However, Dr Jyoti Mutta, Senior Consultant, Microbiology, Sri Balaji Action Medical Institute, tells you that this will not be a feasible option.

“The eligibility criteria for vaccination can be expanded when there are enough supplies to meet the increased demand and not at the moment. More vaccine candidates will be approved in the coming months based on safety and efficacy data. This will boost the immunisation programme,” she says. Till the time mass vaccination is feasible and even after getting the vaccination done, people need to continue following safety precautions like wearing masks covering nose and mouth, hand hygiene and social distancing, she adds.

Even Kumar’s views resonate with Mutta and he says that at the moment we don’t have enough vaccines to vaccinate everybody.

The idea at the moment is to vaccinate the risk group. “As we build up our vaccine reserve, this can be rolled out to above 18 group. We need more private sector involvement and increased slots for vaccination making it a 24*7 phenomena. For the time being, gradual extension to further young age group should be implemented,” he insists.

Out of the several challenges that is being faced in the vaccination drive, one of the most prominent one is to increase accessibility given the huge amount of population we have.

“We have a geographically diverse country with over one billion population; hence the level of accessibility varies. Also to ensure transportation of vaccine across multiple States requires a well-coordinated network. Sufficient number of doses, temperature conditions for storage during transportation and sanitation protocols are also important. Vaccines from more manufactures would also be needed to ease the waiting lines. Trained vaccinators and staff in large numbers would be required to target vaccine for larger population,” Mutta suggests.

However, the silver linning in the dark clouds is that Delhi is no where to be mentioned in the vaccine wastage graph provided by the Government.

“Government’s efforts to make this vaccine drive a successful one definitely calls for a special mention. There has not been wastage issues in Delhi-NCR and the process is running smoothly. People too are cooperative and enthusiastic for the vaccination. Further, the above 45 vaccination decision is another effort that will help ramp up the vaccination process and make this drive more successful,” Dr Piyush Goel, Senior Consultant — Pulmonary and Critical Care, Columbia Asia Hospital, Palam Vihar, Gurugram, says.

Let’s dispose it of

• According to Operational Guidelines issued by Ministry of Health and Family Welfare, all unused vials along with used/empty and partially used vials must be returned through alternate vaccine delivery persons to the vaccine distribution/ice lined refrigerator point, maintaining a reverse cold chain.
• At the vaccination site itself, while the plastic portion of the cut syringes has to be put in a designated red bag, the broken vials have to be stored in the puncture-proof blue container for further disposal.
• Remember, used vaccine vial returned from the field have to be kept separately in a zip lock bag.