GPs have been given new guidance that allows them to use Covid-19 vaccine doses that were previously being wasted, the Telegraph has learned.
Every vial of the Pfizer/BioNTech vaccine was expected to include five doses, allowing five people to get their first shot of the vaccine as the mass roll-out begins across the country. It takes two doses, delivered 21 days apart, to protect against the coronavirus.
However, GPs have found that it is actually possible to make six doses out of the vials. Until Thursday, they were advised to dispose of the extra dose – meaning large volumes of the vaccine had to be thrown away.
But in a weekly webinar with NHS England on Thursday, clinicians were told that they could use the sixth dose “at their discretion”.
The guidance follows similar advice from the US regulator, the US Food and Drug Administration, which told clinicians on Wednesday they could use the sixth dose “given the public health emergency”.
The Medicines and Healthcare products Regulatory Agency (MHRA), the British regulator, is understood to be looking at the feasibility of getting six vaccines out of the vials and consulting with NHS England on the changes.
GPs on the call described the decision as “only sensible”, after Nikki Kanani, medical director of Primary Care for NHS England and NHS Improvement, confirmed that theoretically the sixth vaccine dose could be administered.
However, as in the United States, clinicians were told not to mix vaccine doses from two different vials.
Pharmacists on the webinar were also cautious about the sixth dose, warning that there is no guarantee that there will be enough doses in the vials to vaccinate six people again when doctors administer a second dose, ensuring full protection, in three weeks’ time.
When mixed, the small Pfizer vials contain just over 2ml of vaccine – the active ingredient and then saline solution to dilute it. A dose requires 0.3ml, meaning there are five doses comfortably or six at a push in each vial.
Dr Elliot Singer, a GP in Waltham Forest, North London who is involved in the vaccine roll-out, said: “This means you cannot afford to waste a single drop, but there is an inaccuracy in syringes.
“If you are reliant on getting six doses from every vial, you are reliant on incredibly accurate drawing up of the vaccine.”
A spokeswoman for Pfizer added: “At this time, we cannot provide a recommendation on the use of the remaining amount of vaccine from each vial; this is a matter for regulators to advise on. Excess vaccine from multiple vials must never be pooled.”
Ahead of the suggestion from NHS England last night, Dr John Allingham, medical director at the Kent local medical committee told The Telegraph that, “at the moment, you could argue that we are wasting one sixth of potential stock.”
GPs have been told to try to keep wastage of the vaccine for other reasons – such as missed appointments or error – down to five per cent, a huge challenge considering that they have just 3.5 days to deliver each batch of 975 vaccines.
However, doctors said GP surgeries were trying their best to rise to it, by keeping last-minute call lists of people who could come in for jabs and also vaccinating frontline healthcare workers in the practice if there was spare vaccine.
Wessex local medical committee chief executive Dr Nigel Watson, the clinical lead for the Covid-19 vaccination programme in Hampshire – representing just over 3m patients – said: “Across our 40 sites vaccinating, we are being really careful and there has been virtually no wastage.
“I know some sites have put care home staff on notice that if we have spare vaccine left over, we’ll call them to come in and be vaccinated.”
But some doctors told The Telegraph that they fear that as many as one in 10 doses could be wasted if the system is not improved, as the logistical challenge of getting enough people through the door to use the temperature sensitive vaccine within its viable window is proving immense.
Dr Singer said there is currently a crunch moment after three days, at which point there is just one morning before jabs become unusable.
“If you haven’t got enough people booked in, you’re potentially looking at significant wastage,” Dr Singer said. “I worry that we may have 100 plus [doses] out of this batch that aren’t used because we can’t get people here.”
He said this was particularly problematic in trying to get over-80s to the practice last minute – uptake was just 12 per cent in one surgery.
The NHS is also facing challenges in getting the vaccine out to GPs in an orderly manner, he added. For example, one group of GPs was asked at midnight to confirm by midday the following day whether they could administer a second batch of 975 doses, which would arrive on Sunday.
“This does not allow us to plan in advance,” he said. “We have just a few days to book in the best part of 1,000 patients. If we don’t sort that then we will have wastage too.”
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