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Tennessee Attempts To Rein In Waste Without Slowing COVID Vaccinations

Blake Farmer

As the speed of COVID vaccinations picks up, so do the reports of doses going to waste. And it’s more than just a handful at the end of the day because of a few appointment cancellations. But health officials are trying to rein in waste without slowing down vaccinations.

The incidents range from 335 discarded doses in Lee County, North Carolina that were damaged in shipping to Tennessee, where nearly 5,000 doses went to waste in the month of February, prompting additional federal oversight.

“I definitely have been losing some sleep over this, for sure,” says Beth Ann Wilmore, the nursing director at Mercy Community Healthcare in Franklin, Tennessee. She manages the COVID vaccine inventory at the nonprofit clinic, which started receiving shipments a month ago.

Clinics like Mercy are accustomed to handling vaccines, but none so precious that have such special refrigeration needs.

“I was definitely waking up in the middle of the night wondering how the temperatures were doing, and thinking, ‘Ok, I hope it’s good, and it’s not giving me a flag or anything.’”

Many community health centers are receiving the Moderna vials, which are easier to handle than Pfizer but still tricky. The vials last 30 days after they’re out of the deep freeze, unlike five for Pfizer. But once the seal on the vial is broken, there’s just six hours to use the shots.

So far, no waste at Mercy. But Wilmore knows the horror stories from around the state.

In neighboring Murfreesboro, Tennessee, the local school district received a thousand doses for a teacher vaccination event the last weekend of February. But they were put in an unapproved freezer. The temperature sensor on the shipment flashed an error code. And out of caution, they were advised to throw them all away.

“It hurts my heart,” says Dr. Lisa Piercey, the health commissioner in Tennessee, which has disclosed one of the country’s biggest spikes in reported spoilage.

She says the losses are painful because the shots are “priceless” in the midst of this deadly pandemic. But it’s one of the risks in having so many places to get the vaccine.

As a way to increase access and equity, there are now more than 700 vaccination sites across Tennessee with more planned to open as vaccine shipments grow in the coming weeks.

“It definitely raises the level of concern when you have more partners — particularly partners that are not under your direct control,” she says.

Even Tennessee’s large, urban health departments — which operate independently of the state health department — are running into trouble.

In Knoxville, a thousand doses were thrown out, apparently confused for a related shipment of dry ice. In Memphis, the county health director has resigned after being slow to disclose nearly 2,500 doses being allowed to expire over several occasions — related to winter weather as well as poor management in the county’s pharmacy.

The state has called in staff from the Centers for Disease Control and Prevention to monitor vaccine distribution in Shelby County and stepped up audits for all local health departments in the state.

There are so many opportunities for doses to go bad. In West Palm Beach, Florida, the power on a mobile refrigerator was turned off. In Connecticut, a fridge door didn’t close properly, though the doses were salvaged in time in consultation with Moderna.

Health officials have gone to great lengths to keep from wasting doses, like an impromptu mass vaccination eventin Nashville’s homeless shelters after winter storms cancelled hundreds of appointments.

Dr. Kelly Moore, deputy director of the Immunization Action Coalition and former pandemic planner for the state of Tennessee, says a little spoilage is expected. It’s still well less than 1% of doses, even in states like Tennessee and Florida that have disclosed big losses.

“I would be more worried if I saw reports of zero doses wasted,” Moore says, because then her concern would be transparency.

“You want to see some waste because that means people are paying attention and that real world accidents happen and that they’re being responded to properly,” she says. “You just don’t want to see negligence.”

There’s hope that mishaps will be easier to avoid with the newly authorized Johnson & Johnson vaccine. Aside from being a single dose, it can last in a normal refrigerator for months.

Blake Farmer is Nashville Public Radio's senior health care reporter. In a partnership with Kaiser Health News and NPR, Blake covers health in Tennessee and the health care industry in the Nashville area for local and national audiences.
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