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‘Pooled doses’: how a rule change could vaccinate thousands more

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Doctors from across the U.S. have said one rule change could allow thousands more to be vaccinated for the coronavirus each week.

After the final dose is pulled from a vial, there is generally some leftover, and it’s thrown away. I asked local healthcare professionals about the possibility of combining those leftovers to create “pooled doses.”

“In the beginning of the process of vaccinating our patients, there was a shortage of vaccine, and so in the back of our minds, we were always worried about whether we were going to have enough or not,” shared Gregory Fritz, a Pharmacist Supervisor at the Sanford Hospital Pharmacy.

“So, that’s really a tempting idea.”

Fritz says, at this point, there is an ample supply of vaccines in North Dakota. However, that doesn’t mean pooled doses aren’t worth considering.

“I’m not enough of a technical expert to offer an opinion on it, but if it otherwise is going to go to waste, why not try to utilize it?” North Dakota’s Chief Health Strategist Dr. Joshua Wynne added.

Even though the state and the U.S. supply chains are good, Dr. Wynne has repeatedly said we as a country need to be thinking of vaccination on a global scale, or the pandemic will not end.

“The idea that we’re going to be safe in North Dakota, or in America, while the rest of the world is having a pandemic, is not logical,” he explained.

For example, Brazil has the second-most COVID-19-related deaths in the world, behind the U.S., but the country reported just over 2% of the population is vaccinated as of the first of April.

“And until we get more of the world vaccinated, we’re at risk in the United States,” Dr. Wynne said.

That said, there are safety concerns with combining vaccines from different vials.

Fritz explained, “When you are taking vaccines out of a vial, you’re piercing that rubber stopper several times. The more times that you do that, and the longer those vials hang around, the more chance for contamination there is.”

The pharmacist also worries this could cause vaccine vials to be left out and expire. He says other vaccines have been pooled in the past, but with the mass amount of people coming through COVID-19 vaccination sites, the regulation would be much more difficult.

“Some days, we have up to 800 people come through our doors. We are moving fast to try to keep those vaccines drawn up, so we can those patients in and out; it can get really confusing really fast,” Fritz added.

Still, theoretically, if the pooled vaccine vials all came from the same lot number, it would be possible. In fact, Fritz says the Pfizer vaccine sometimes has a full seventh dose left, but it varies.

“We’ve noticed that there’s volume leftover, but we don’t; we don’t go there,” he shared. “Yeah, we’ll take the six, and then we’ll abandon it.”

Right now, that’s required by law. Nothing beyond that sixth dose, 11 for Moderna, and five in a Johnson & Johnson vial can be given out, according to Emergency Use Authorization from the U.S. Food and Drug Administration that allows these vaccines to be administered.

Just last week, the FDA did make two revisions to Moderna. One change brings the maximum extractable doses up to 11, from 10. The second authorizes another type of multi-dose vial, where each contains a maximum of 15 doses.

Fritz says the biggest struggle with vaccinations in North Dakota lately has been getting people to come in to get the readily available shots.

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