Best Practices for Dealing with Canceled Appointments/Unused Vaccine Doses in the U.S.

Practices around the effective reminder for second doses of the COVID-19 vaccine and how to redirect unused vaccines have been identified as two best practices for dealing with canceled appointments/unused vaccine doses in the U.S.

1. Second Dose Reminders Should be Considered to be Critical

  • To minimize canceled COVID-19 vaccination appointments, health organizations must treat reminders for the second dose of the vaccine critically.
  • This has been identified as a best practice towards avoiding wasting of thawed vaccines because once the vial of the vaccine is thawed, it is not to be refrozen, hence, it must be administered or it is wasted. However, multi-dose vials can be stored for up to 30 days to first use at refrigerator temperatures of 2 to 8 degrees Celsius (36 to 46 degrees Fahrenheit).
  • Once the vial of the vaccine is punctured, it must be administered within 6 hours.
  • Therefore, health organizations need to have a proper action plan before initiating vaccination. It is a best practice to have a waiting list of people to be vaccinated, with certainty on those that “may be able to come at short notice to get vaccinated” should some persons on the waiting list fail to meet up with the appointment.
  • The Minnesota Department of Health pointed out the following practices to ensure that people in the state comply with their vaccine dosing intervals:
    • Health organizations should schedule the appointment for the second dose immediately after the first dose or at the same time with the first dose appointment.
    • Take the COVID-19 vaccination record card of each person after the first dose is administered. The record card should include information such as vaccine manufacturer, lot number, date of the first dose, and the due date for the second dose. They should be encouraged to keep their record for future references.
    • They should be encouraged to set reminders on their electronic calendars if they have a smartphone for the due date for the second dose.
    • Such persons should be encouraged to enroll in VaxText, a “free text messaging to receive COVID-19 vaccine second dose reminders”.
    • The Minnesota Immunization Information Connection (MIIC) will then pull a “lists of people that need to complete the COVID-19 vaccine series using the MIIC client follow-up functionality in MIIC”.
    • From the list, those that are due for the second dose of vaccination are reminded via electronic means such as text messaging, phone calls, email, and others.
  • Second dose reminder is also practiced by the New York State Department of Health.

2. Redirecting Unused Vaccines

  • The CDC provided the following recommendations as best practices toward successfully managing the administration of the COVID-19 vaccine in the US:
    • Vaccine administrators/providers should have a steady and predictable amount of vaccines at each site to enable them efficiently plan and manage vaccination schedules.
    • Providers should be able to estimate the number of people that would require a second dose of the vaccine based on the number of people that took the first dose every week.
    • They should prioritize people scheduled for the second dose at each moment.
    • For each week, providers are to review missed vaccination appointments and the reason why they missed the appointment.
  • However, the CDC noted that to ensure that thawed vaccines are not wasted, giving that thawed vaccines are not to be refrozen, it is a best practice that providers endeavor that unused second doses are repurposed for use as first doses.
  • The CDC opines that second doses are not to be “held or saved for patients who have not returned after 42 days following their first dose; these should be used as first doses.”
  • With reports that states such as New York, Florida, Ohio, and others are canceling vaccination appointments due to shortages of vaccine supplies, excess vaccines allotted to some states can be redirected to other states that have shortages.
  • There are reports that about 32 states and cities in the U.S. such as Illinois, Mississippi, and Maine are “clawing back thousands of extra doses of Covid-19 vaccine that were meant to be used by CVS and Walgreens to immunize residents of nursing homes through a federal partnership set up by the Trump administration.”
  • The Minnesota Department of Health advises that where there are doses of the vaccine left in the vial after thawing, and there is no one immediately available to give them to, health organizations should try their best to redirect the remaining vaccines to priority groups to avoid wasting.
Glenn is the Lead Operations Research Analyst at The Digital Momentum with experience in research, statistical data analysis and interview techniques. A holder of degree in Economics. A true specialist in quantitative and qualitative research.

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