It is a daily conundrum that has dogged medical staff since the vaccine rollout began. How do you avoid wasting leftover doses while also making sure that the people most in need get priority?
In the early stages of the vaccination scheme, the answers came easily. Younger medical staff who were on the government’s priority list were grabbed from hospital wards or GP surgeries to receive vaccinations from the few doses left over at the end of the clinic. As the numbers of people receiving their first dose ticked into the millions, volunteers at vaccination clinics were next in line.
But now they have all been jabbed, vaccinators are turning to police officers, firefighters, taxi drivers, teachers, supermarket staff and family and friends – anyone who can be contacted easily and is free to hotfoot it to the clinic at a few minutes’ notice.
The alternative would be unthinkable – throwing away perfectly usable vaccine doses when millions of people are still at risk of catching Covid and passing it on.
Yet that practice has been both praised and criticised by political leaders and senior NHS figures, and now a strange code of omertà hangs over the vaccine programme.
“You can’t use my name,” one GP told the Observer, “or which city I am in. If you do, we will all get an email telling us that we shouldn’t be doing it. But we are also not allowed to waste vaccines.”
“There’s no official guidance,” another said. “Just do not waste vaccine. We just have to do what is sensible. It was fairly easy at the beginning when we were focusing on the over-70s, and you’ve got some 55-year-olds. You think ‘well, they’re going to be done in two weeks’ time anyway’.
“But as you start going down the list, it starts getting controversial. And now that we’re doing the first nine categories, the next people are the under-50s.”
The cohorts were drawn up by the Joint Committee on Vaccination and Immunisation which set priorities based on age and vulnerability. Everyone in the first nine cohorts – and anyone 50 or over – should have been offered a jab by the end of March.
Leftovers are an inevitable consequence of a high-speed mass vaccination campaign. When 350 people are booked into a clinic at a few days’ notice, some do not show up.
But the Pfizer vaccine lasts for three days once defrosted, and both it and the AstraZeneca vaccine have use-by dates. And the vaccine vials usually contain extra doses. “Pfizer is meant to have five, but we get six,” one of the GPs said. “The AstraZeneca 10-dose vials can give you 13.”
She described the clinic as a juggling act: “At the end, you work out how many doses you’ve got left – hopefully no more than one or two. All the people you’ve booked should be in cohorts one to nine. So then you start looking for someone else.”
“There have been calls to fire stations for anyone off-duty,” one NHS source said. “Carers bringing their 80-year-old mother to get her jab. Taxi drivers.
“On days when it’s been a bit quiet, they have been unofficially reaching out to headmasters of local schools,” a volunteer at a vaccination clinic in London said. “Teachers coming in, policemen and women – people on frontline services, people who most of us believe should be getting it anyway.”
“We try not to pull people off the street,” said one GP who runs a vaccination centre. “That’s no way to run a clinic. But our lead marshal does have the number of a local police station, and we’ve also had contact from a local secondary school saying ‘our staff would be very keen to be vaccinated’.”
Both Labour and the vaccine minister Nadim Zahawi had said in February that they believed key workers should be given priority for vaccinations, but the JCVI guidance issued later that month did not give them any special status on the basis that most key workers did not have a higher risk of contracting Covid due to their profession.
Some clinics have ended up throwing away supplies. A woman in her 30s told the Observer how she had been turned away after a friend working at a clinic in East Anglia said that they needed to find people for five leftover Pfizer doses. “When I got there I said, quite straightforwardly, that I’d been told there were some doses left over. The woman looked at me and said ‘how’s that going to look on social media?’ It was as if it was quite unethical for me to even be there.
“But afterwards my friend told me those five doses were wasted. I completely understand that I’m not in a high priority group. I wouldn’t want to push my way in front of anybody. But I do think I’m worth more than a bin.”
NHS England told GPs in January to draw up reserve lists of patients who could attend clinics at short notice, and there has been remarkably little wastage. A freedom of information request revealed that of 156,262 Pfizer doses used before 8 January, only 1,055 shots were wasted.
But with the restriction on supplies of AstraZeneca vaccine in April and no permission yet to go beyond cohort nine, GPs are now wondering how to deal with further leftover doses.
“We’re not allowed to go into cohort 10,” GP running a vaccination centre said. “We have actually had to stop running clinics. If another practice needs a few vials, we can help. But to run a viable clinic, I need more than 300 patients.
“When we first started, the slots were booked in two hours. Now we’re sending them out and we haven’t got enough. If we could go into cohort 10, there are lots of people waiting. It’s quite frustrating.”