On Wednesday, people stood in a long line outside the DoubleTree Hotel in Danvers, with the cold tugging at their faces and with likely one thing on their minds: Will I get the COVID-19 vaccine today?
The mad dash to the state’s mass vaccination site — bred in confusion and strong desires to receive one of the sought-after shots — was spurred by fast-traveling word that “extra” doses of the vaccine may be available to just about anyone. If they moved quick enough, perhaps they could snag one.
Curative, the company that operates the site, later made clear that workers were offering those additional doses to patients who initially had already-scheduled appointments later in the week.
However, the question remains: Is there a way to get one of those extra shots? And is it worth it to try?
The answer seems to depend on where you go — and it’s not so simple.
“It’s a really important issue. I think nobody wants to waste a vaccine dose in a time of such scarcity,” Dr. Karl Laskowski, associate chief medical officer at Brigham and Women’s Hospital who has helped plan vaccine clinics across the Mass General Brigham health care system, told Boston.com on Friday.
Clinic workers are mindful, even passionate, about making sure doses aren’t thrown away, given that so many people are in need of one or are anxious to get one as soon as possible, he said.
“We have to balance that against the goals of equitable distribution and fairness and so that we’re not kind of randomly giving it out,” Laskowski said. “Certainly nobody wants to give it out to friends and family, that would be like a disaster. You want to give it to the people who are most at need.”
Hospitals and health care systems have formulated their own strategies to off load their vaccines within state parameters of who is eligible to be vaccinated.
At the moment, much of that focus is on Massachusetts’s senior, 75-years-old-and-older population, although health care workers and first responders are also eligible to receive their shots.
Under a new state policy, individuals who accompany a senior to their vaccination appointment at a state-run mass site can also be vaccinated if they schedule an appointment for the same day.
Still, as The Boston Globe noted, clinics can give away extra doses from vials that cannot be frozen again after being opened (vaccines must be used within six hours after a vial is entered by a syringe) to any person they choose.
“In the rare instance where you have COVID-19 vaccine that will expire and you have no one in the current priority groups to be vaccinated, you can use your clinical judgement to administer the vaccine to a person in another priority group who is closest to the current priority group being targeted for vaccination to avoid vaccine waste,” the state’s website advises. “It is important that you also ensure that this individual is now included in your reminder recall systems for the second dose.”
Pharmacies and even different operators of state-sanctioned mass vaccination locations have their own protocols about what to do with surplus doses, according to the newspaper.
Hospitals and clinics
At Tufts Medical Center in Boston, health care workers begin doing the math about an hour or an hour-and-a-half before closing time at the vaccine clinic.
They look for how many appointments are left for the day and how many vaccines have been drawn already, according to Dr. Gabriela Andujar Vazquez, an infectious disease physician and associate hospital epidemiologist.
“That has worked very well for us in terms of like, at … around that time, when we’re almost closing, we’re sort of drawing vial by vial so we can make sure we don’t, at the end, end up wasting any dose,” she said in an interview.
If there are no other appointments scheduled but extra doses remain, Tufts calls on several local organizations to try to find eligible arms, she said. If unsuccessful in that effort, the hospital then works to vaccinate qualifying inpatients before moving on to outpatients in its night clinics, Andujar Vazquez said.
Notably, the medical center has limited its vaccines to its patients and employees by appointment only, although Andujar Vazquez said the hospital is working to open another location to expand to vaccinating the general public.
“Hospitals are using a variety of approaches to ensure that every single dose is administered by the end of each day,” Valerie Fleishman, senior vice president and chief innovation officer for the Massachusetts Health & Hospital Association, said in a statement. “At a time when supply is still very limited, providers have become adept at scheduling appointments that precisely align with the amount of vaccine they have on hand.”
Throughout Mass General Brigham’s clinic system, employees have devised clinic-specific waitlists of employees and patients over the age of 75 still in need of the vaccine, according to Laskowski.
So far, the health care system hasn’t really needed to expand its reach beyond those demographics given the demand, he said.
But, there is a backup plan for how to handle extra doses, which prioritizes hospitalized inpatients who meet the age requirement, and then individuals over the age of 65 with two or more comorbidities or who reside in vulnerable communities, Laskowski said.
“We thought that those were reasonable groups where we’re not going to be kind of giving it to a healthy 23-year-old, which doesn’t feel right,” he said. “But if that’s the choice between throwing into the trash and, you know, I think that’s a really hard situation, which we really just didn’t want to be in because it’s almost impossible for the folks on the ground to make that call at the time.”
And so far, there’s little waste. Mass General Brigham usually ends up with only one or two extra doses a day “after doing thousands of vaccinations,” he said.
On Thursday, hospitals across the commonwealth indicated the state informed them their vaccine deliveries will be curtailed so more doses can be fed to state-administered vaccination sites.
In light of that, Laskowski said Mass General Brigham has put a hold on scheduling any new appointments for patients or employees seeking the first dose of the two-dose vaccine. Those who have already scheduled appointments and are waiting for their second dose will receive them, he said.
“Over time, this will constrain our ability to kind of give as many vaccines as we were, and it will mean that there will be fewer extra doses as a result of that,” he said.
Meanwhile, at CareWell Urgent Care’s 16 vaccination sites in the Bay State, patients who do not qualify under the state’s protocols can receive one of the extra shots, the Globe reports.
“As part of efforts to ensure every coronavirus vaccine dose is used, there have been some cases where we have provided leftover vaccine doses to consumers who would not otherwise qualify,” Shaun Ginter, chief executive officer, told the newspaper in a statement.
“We currently have a waiting list with consumers, listed in order of priority, that we call whenever somebody cancels or doesn’t show up for their appointment,” he said.
Pharmacies and mass vaccination sites
So far, there are four state-operated mass vaccination sites in Massachusetts, with two more — in Natick and Dartmouth — slated to open in the next two weeks.
Cambridge-based CIC Health currently runs sites at Fenway Park and Gillette Stadium and uses a system to log open vials, appointments, and missed appointments, among other factors, to make sure vials are fully used, Rodrigo Martinez, the company’s chief marketing officer, told the Globe.
In the event there are leftovers available, the company has found someone to administer the vaccine to in those instances, whether it’s a site worker or a person who accompanied a patient to their appointment, even if they are not in an eligible demographic, according to the newspaper.
“We haven’t wasted one single dose since we opened and have done over 50,000 vaccinations since we opened” in January, he said.
At CVS, which was set to begin offering doses at 30 locations in Massachusetts on Friday, store employees are tasked with evaluating “on a case-by-case basis how to most efficiently vaccinate eligible individuals with remaining doses,” Joe Goode, a company spokesman, told the Globe.
“This may include local ‘wait lists’ of eligible individuals if appropriate,” he said.
Patient profiles at each pharmacy can assist in identifying eligible people, Goode said.
“Bottom line, we’re taking steps to help ensure that these valuable doses will be put to the best use,” he said.
What Gov. Charlie Baker has said
On Thursday, Gov. Charlie Baker said facilities should follow the state’s dose and eligibility requirements when handling extra shots, according to WCVB.
“We don’t believe that there should be, sort of, a cattle call at the end of the day,” he said. “People need to manage their dosing and manage their vaccine.
“Nobody wants to waste doses, let’s face it, ” Baker added. “But at the same time, people have got to manage the dosing that they’ve got to the appointments that they have.”
A request for comment from the Massachusetts COVID-19 Command Center was not returned Friday.
Laskowski advises the public should be patient with the vaccine rollout. Many doctors and physicians have been loaded up with calls about the vaccine and appointments from patients, he said.
If someone is high-risk for the virus, they should be speaking with their health care provider about what to do, he said.
For other, lower risk and healthy individuals, Laskowski has other advice.
“I would tell people, probably don’t call your doctor’s office because you can end up on hold, and they’re not going to be able to help you,” he said. “And if you’re under 65, and healthy, do not go get on a waitlist, don’t hang around the pharmacy, don’t go there. Just don’t do it.”
Waiting a couple more weeks for the vaccine is “not going to make a huge difference in the grand scheme of things,” Laskowski said.
“I desperately want to get everybody (the) vaccine as fast as possible,” he said. “But I think everybody is doing as much as they can.”
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