As providers at the Alaska Native Medical Center began injecting workers with the new COVID-19 vaccine from Pfizer and BioNTech this week, they started noticing something surprising: Leftover liquid in each five-dose vial, sometimes enough for a full extra dose or even two.
“It was one of those hot topics,” said Kara King, the Anchorage hospital’s director of pharmacy. “Word was starting to spread that there were extra doses.”
The discovery was simultaneously thrilling and confounding, presenting providers with an array of questions: Were they doing the injections correctly? Could they use the extra vaccine? If they did, would there be enough in their next shipment for each recipient to get their required second injection?
Pharmacists around the country were making similar observations. And on Wednesday, the Food and Drug Administration issued a statement saying that “given the public health emergency,” it’s acceptable for providers to use “every dose obtainable” — though the agency cautioned against pooling leftover vaccine from multiple vials.
It’s not yet clear how many extra vaccines can now be administered, collectively, from ANMC’s total allotment, King said.
The bonus doses are also likely to present logistical headaches for the officials charged with distributing and tracking the scarce vaccine. But it’s a great problem to have, King added.
Alaska’s initial shipment of the Pfizer vaccine was expected to be enough for just 35,000 doses — only about 5% of the state’s population. Front-line health care workers, first responders providing medical care and residents and staff at nursing homes are among those prioritized in the first round of vaccinations.
“This is a super-scarce resource right now,” King said. “So, it is just really fantastic that we could potentially get more doses out of the vial and get more people vaccinated.”
At least one other Anchorage hospital, Providence Alaska Medical Center, said it had also discovered extra doses in its Pfizer vials. On the Kenai Peninsula, providers were contemplating what to do with their extra doses Wednesday, and whether they should find people to take them.
Pfizer told the New York Times that there’s the same amount of vaccine in each vial. But the amount left over after each dose could be different depending on the type of needles, syringes and diluting solutions used by providers, it said.
It told the newspaper that it was studying the issue with the FDA and couldn’t make its own recommendations about what to do with the extra vaccine.
At a media briefing Thursday, Dr. Joe McLaughlin, the state epidemiologist, echoed Pfizer by explaining that the leftover vaccine appears to connect to the size of the needles used for the shots: Smaller ones leave less fluid stuck to the side of the metal, because there’s less surface area.
““If you have a thick needle, there’s still going to be a lot of vaccine left in it,” he said. “If you have a really thin needle, you’re going to have a lot less vaccine that’s still in that needle.”
State officials said providers could use the extra vaccine as long as they can ensure they’ll be able to use the same size needles when they get their vaccine shipments.
If there’s one extra dose per five-dose vial, state officials note that that translates into some 200 extra vaccines per tray of 1,000 doses — or about 7,000 extra in Alaska’s initial shipment of 35,000 vaccines from Pfizer.
Sabine Poux with KDLL in Kenai contributed reporting.