Dear Sir,

A recent headline on one of Bermuda’s news websites shouted, “Over 850 vaccines discarded since January.” This is unfortunate and maddening as it should rightfully have stated: “Only 850 vaccines discarded since January”.

As with the handling of the COVID-19 pandemic in general, Bermuda’s vaccination roll-out has been an outstanding success, anti-vaxxers and hesitancy notwithstanding. It is, therefore, unfortunate and disingenuous to suggest that our Covid-19 vaccine wastage has been excessive. Let me explain.

The journey undertaken by every Covid vaccine from production facility to injection site is long and complicated. Some vaccines require an unbroken “cold chain” which for one vaccine, the Pfizer/BioNtech, is at -60C. The perils of transport are myriad and include mishandling, thawing, breakage and loss. However, when I speak here of “wastage”, I am referring to vaccine doses that never end up in an arm once they have entered the receiving country. Bermuda’s wastage for the period January 10, 2021 – June 12, 2021 is just slightly over one per cent. This is outstanding news and something the Department of Health should rightfully be very proud of.

Consider the following. The French Directorate General of Health recently stated that it assumes a 30 per cent wastage rate for its vaccine roll-out. The WHO has operated on the assumption of 50 per cent wastage for previous vaccines.

It is also important to note that the Pfizer/BioNtech vaccine is delivered in vials of six doses (the sixth dose made possible by the use of certain needle/syringe combinations which minimize dead-space volume loss per dose) and the Oxford/AstraZeneca vials contain eight or ten doses. It is well known that wastage rates tend to increase with the size of multi-dose vials and typical assumed wastage rates start at five per cent for single-dose vials and are as high as 15 per cent to 25 per cent for ten-dose vials.

Vaccines spoil; a multi-dose vial once opened has a limited shelf life. Vaccination administrators must carefully estimate the number of vials to be thawed/reconstituted for a specific vaccination session based on the expected number of recipients for that session. This task is easier at the beginning of a vaccination campaign when demand and enthusiasm is highest and vaccines are by appointment. The job becomes more difficult at the tail-end when walk-ins are welcomed. Having a list of short-notice call-ups has also prevented a large amount of open-vial wastage. Alberta, Canada, managed to keep its wastage rate down to 0.3 per cent by consistently overbooking vaccination clinics, an unpleasant tactic perhaps borrowed from the airline industry.

The vaccination staff scrutinise each and every vial as per manufacturer specifications and must discard any vial that shows an imperfection either in the vial itself or in the vaccine fluid within. Reasons for discarding a vial include defective stoppers, cracked vials or particles/opacities in the vaccination fluid. All of these discarded vials count as wasted doses.

Bermuda’s Covid vaccine usage rate for the specified time period has been 98.84% and our wastage rate 1.16 per cent. Kudos to the DOH administrators, clinical leads, vaccinators, volunteers, EMTs and clerical staff for a job well done. The vaccination campaign is not yet over but Bermuda can be proud of what we have accomplished thus far.

JOSEPH FRONCIONI

Pembroke