Toronto pharmacist Kyro Maseh faced a difficult task on Tuesday. He had to toss 330 doses of the Moderna vaccine that expired before he could get enough people to sign up for a shot.
“It feels sinful to throw these out,” he said. “This shouldn’t be happening. It hurts.”
In the early days of Canada’s COVID-19 vaccination campaign, the main hurdle was having enough vaccines to meet demand. But now that a majority of Canadians have received their shots, pharmacists and health-care providers face a new challenge: getting enough people to sign up for a dose before their available supply expires.
“It’s a whole different situation now,” said Regina-based infectious disease physician Dr. Alexander Wong, whose clinic tossed eight expired Moderna doses last week.
“Now we’re dealing with everybody that’s left — [those with] questions, [the] hesitant … It’s going to require outside-the-box thinking to better engage these people.”
Limited shelf life
Eighty per cent of Canadians eligible to get vaccinated have received at least one dose, and close to 64 per cent are fully vaccinated. That still leaves more than 6.5 million people who have yet to get a single shot — at a time when COVID-19 infections are ticking upward in Canada.
In the past two months, Canada received millions of Moderna doses from the U.S., but not all of them will be put to use before they expire.
The Ontario Pharmacists Association said pharmacists in the province will likely have to throw out thousands of expired Moderna doses over the course of this week and the next due to declining demand.
Vials of Moderna can be stored in the freezer for up to six months. But they arrive in a thawed state at pharmacies, and can only last in the fridge for 30 days, said the association’s CEO Justin Bates. And once a vial is punctured to withdraw a dose, the remaining doses — typically around 13 — expire in 24 hours.
Bates said another hurdle is that some people who got the Pfizer-BioNTech vaccine for their first shot are refusing to get Moderna for their second dose, because some countries — including the United States — don’t recognize people with mixed doses as being fully vaccinated.
“There’s still a significant hesitancy related to Moderna, and mixing in general, which has led to the potential of wastage,” he said.
Bates said Ontario pharmacists are doing their best to use up expiring Moderna doses, including sending some to pharmacies with higher demand and educating customers on the benefits of vaccination.
“No health-care provider wants to be put in this position where they have to contemplate disposal of vaccines,” said Bates. “It’s a terrible situation to be in and we’ve done everything we can to avoid wastage.”
Ontario’s Middlesex-London Health Unit (MLHU) is also scrambling to avoid discarding doses. It has around 15,000 Moderna doses set to expire on Aug. 12 — just six days away.
MLHU says it received a big Moderna shipment in July, but didn’t have enough room to store it in the freezer. And because demand was high at the time, the health unit expected the vaccines would be used up quickly.
Now that demand has waned, the MLHU is hoping to drum up interest by accepting walk-ins and setting up pop-up clinics.
“We right now are doing everything possible to make vaccination as simple and as accessible as we can,” said Dr. Chris Mackie, MLHU’s medical officer of health.
What about donating doses?
Maseh, the Toronto pharmacist, said he would like to see Canada donate unwanted doses to developing countries that urgently need them.
“We’re just [going to] toss this in the trash while other people die,” he said. “This is not fair.”
But shipping soon-to-expire vaccine doses to other countries poses challenges of its own given their limited shelf life.
Global Affairs Canada, which is involved in the vaccination effort, told CBC News it’s aware that a “small number” of vaccine doses in Canada will soon expire and said it may not be possible to redistribute them.
However, the federal department said the rate of COVID-19 vaccine waste in Canada is low — at a rate of less than 1 per cent.
“Careful planning, training and sharing of best practices across provinces and territories has helped to minimize avoidable wastage,” spokesperson Ciara Trudeau said in an email. “Canada is determined to use our vaccine supply efficiently and effectively.”
What about offering third doses?
News of vaccine doses going unused has prompted some Canadians who received different vaccines for their first and second shots to question why they can’t receive a third shot, given some countries have refused to recognise mixed doses as complete vaccination.
“Why let those doses go to waste?” said Louise Jacob of Ottawa, who got a mix of AstraZeneca and Moderna vaccines.
Jacob booked a Caribbean cruise with Norwegian Cruise Line departing from Florida in January. She said she’ll have to cancel in early October — when full payment is due — if the cruise line maintains its policy of refusing to recognize people with mixed doses as being fully vaccinated.
To alleviate those concerns, Jacob said she’s willing to sign up for a third dose of Moderna if no one else wanted it.
“Why doesn’t the government offer it to people like me?” she asked.
Last month, the Quebec government said it is offering a third vaccine dose to people who have an essential trip planned to a country that doesn’t recognize their vaccination status.
The Ontario government has said it has no plans to follow suit, and the federal government isn’t recommending a third shot at this time.
“We don’t really know the exact impact of adding another dose,” said Chief Public Health Officer Dr. Theresa Tam at a news conference on Thursday.