Covid-19 vaccines are wasted as special syringes run short

Vaccine administrators say they aren’t receiving enough special syringes needed to extract every last dose of Covid-19 shots from vials, a problem at risk of worsening because manufacturers project that domestic production won’t improve until the second half of this year.Eight states and multiple local health departments and healthcare providers say that kits they receive from the federal government to administer vaccines contain an insufficient number of so-called low-dead-space syringes designed to minimize wasted doses.The kits contain needles, gauze pads and other supplies for vaccinators, including varying combinations of special syringes and regular ones. Sometimes administrators run out of the special syringes and have to use the standard, less-efficient alternatives, leaving doses to go to waste.“We worry about it all the time,” said Erin Fox, a drug-shortage expert and pharmacist who is helping administer shots at the University of Utah. The site discarded 10 doses on a recent day, because staff couldn’t get the last drops out of vials. “You open that up and you don’t know what kind of syringes you’re going to get,” she said.A Department of Health and Human Services spokeswoman acknowledged that there was limited supply of the special syringes. The shortages are less acute for the supply of special syringes used to administer the Pfizer Inc. PFE 1.00% shots, given that the federal government boosted device supplies earlier this year. The federal government will provide more special syringes for Moderna MRNA 1.65% shots to states in the coming weeks, she said. Until then, vaccinators shouldn’t plan to extract all the additional doses of Moderna Inc. vaccine, the HHS spokeswoman said.The shortage means that in some cases up to 17% of the vaccine in Pfizer vials and up to 13% percent of the vaccine in Moderna vials is wasted. With nearly one-third of the U.S. population fully vaccinated, the syringe shortage may be eased as production of vaccines continues to rise in the U.S. and demand for vaccines slows. But every dose is still highly sought after globally as most countries are still in early stages of the vaccine rollout.As more U.S. adults get their Covid-19 vaccines, a variety of side effects are emerging. WSJ’s Daniela Hernandez speaks with an infectious disease specialist on what is common, what isn’t and when to seek medical attention. Low-dead-space syringes minimize the area between the bottom of the plunger and the top of the needle. A small amount of fluid typically is trapped in this area after a shot is administered. By using special syringes with a smaller dead space, health officials say, less vaccine goes to waste.The syringes were in limited supply before the pandemic, because they are mostly used for niche applications such as for expensive specialty drugs and to prevent the spread of bloodborne illnesses in low-income countries, say supply-chain experts.Trump administration officials didn’t secure many low-dead-space syringes early in the pandemic because it wasn’t apparent that the devices would be needed, according to people familiar with the matter.After the shots were authorized in December, vaccine administrators quickly realized there were more doses in the vials than the label indicated, because manufacturers had erred on the side of caution and overfilled the vials.By using the special syringes, administrators could extract the extra doses and increase supply. The U.S. Food and Drug Administration has since authorized new labels to account for extra doses: Up to six for the vaccine from Pfizer [PFE] and BioNTech SE [BNTX] 9.35% and up to 11 or 15 depending on the vials for the vaccine from Moderna [MRNA], if proper syringes are used.So far, health officials say they haven’t observed overfilling with vials of Johnson & Johnson [JNJ] vaccine, the third one authorized in the U.S.HHS distributes both vaccines and kits for Moderna. Pfizer ships its own vaccines, but the government distributes kits for those shots. State and federal officials say that about 80% of the syringes in the government kits for Pfizer vaccines are now of the low-dead-space variety, after regulators added more of them to kits in January. State officials say that many of the government kits that they receive for Moderna shots currently have few or none of the special syringes. Using available supplies, the federal government says it plans to increase the percentage of special syringes in Moderna kits starting in May, with the aim of hitting 50%.Domestic manufacturers say a major expansion in the production capacity of special syringes, which they say is likely to ease the shortages, isn’t expected to occur in the U.S. until the second half of the year.“Right now there is a shortage,” said JehanZeb Noor, chief executive of Smiths Medical Inc., a manufacturer based in Minneapolis that is expanding its capacity for special syringes. “Unfortunately, the low-dead-space capacity is not going to increase in the next 2-to-3 months.”The U.S. government last July signed three contracts worth a total of $115 million with syringe manufacturers including Smiths Medical, Retractable Technologies Inc. RVP 0.51% and Becton, Dickinson BDX -0.59% & Co., to expand production capacity of syringes.Becton, Dickinson said it doesn’t currently have plans to produce more of the special syringes for the U.S. The company said additional capacity expected to come online this summer will be for traditional syringes and needles, not low-dead-space ones.Retractable said it was using funds from its federal contract to expand its Texas plant and produce more low-dead-space syringes. That project won’t be finished until July, it says. Company officials declined to say when the new production lines would begin operation. Before the pandemic, the company made more than 80% of its syringes in China.HHS said it has been working with Retractable to boost the number of the low-dead-space syringes. In addition to providing funds to expand production, the federal government gave Retractable an order for $94 million of low-dead-space syringes in May 2020. Since February, it has agreed to purchase an additional $77.5 million of the special syringes, deliverable through September, company filings show.Separately, since last August, the U.S. government has placed $229 million worth of orders with seven companies, purchasing what it estimates is more than 1 billion syringes. These orders included some quantity of the low-dead-space variety, an HHS spokeswoman said.Public-health departments such as Denver Health say they are securing syringes on their own from suppliers outside of the HHS supply chain. They are tapping medical distributors who typically get syringes from a combination of domestic and international sources.“It would be unacceptable for a patient to show up for a visit and be told a 22-cent piece of plastic was out of stock and we couldn’t give them their vaccine,” said supply-chain chief Andrew Miller of Denver Health. The health system procured some 50,000 special syringes in February through private distributors at twice its usual cost, he said.Source: WSJ