Overflow lists and creative solutions: How provinces are using up leftover vaccines

Despite strict protocols surrounding the distribution of precious COVID-19 vaccines, sometimes there are vials left over at the end of the day.

The reasons for the surplus vary — as do the strategies being used to avoid waste. Oftentimes, unfilled appointments and last-minute cancellations come up against vaccine expiry dates, leading to the leftovers.

Regardless of the reason, “it’s wrong to proceed on this without a plan,” said Kerry Bowman, a professor of bioethics and global health at the University of Toronto, and it’s “not acceptable to take just anyone.”

“There’s a lot of people that seem to be winging it,” he said. “We have to calibrate this carefully.”

Here’s how some provinces are handling leftover doses:

Even as COVID-19 cases climb in Ontario, thousands of vaccine appointments remain unclaimed.

In Toronto, there are almost 30,000 appointments available over the coming week. The city has repeatedly pleaded with eligible groups to sign up to get vaccinated, ultimately deciding to slightly expand its eligibility age group to get more shots in arms.

With weak demand, some hospitals are finding themselves with leftover doses. The province’s health ministry has instructed vaccination clinics to figure out a process to fulfill last-minute or leftover doses, but how they do it is up to them.

1:33 COVID-19: What happens to vaccines left over at the end of the day?

Michael Garron Hospital and the Toronto East Health Network opened up a vaccination standby list over the weekend for those who are part of the province’s Phase 2 populations.

It received such a huge response that the website crashed soon after.

A Toronto-area woman lucky enough to snag a spot on the list said she received a call about a leftover shot. She tweeted her experience while sitting in a waiting room, saying everyone in the room “seems to have been called to come ASAP.”

As it stands, the hospitals are prioritizing anyone who is part of the Phase 2 vaccination plan, which will roll out widely in April. This phase includes adults above the age of 50 in high-risk communities and hotspot communities, as well as many types of essential workers and a wide range of people with health conditions of varying seriousness.

With more than 60,000 submissions, the hospitals are still figuring out how to move forward with the standby list.

Raywat Deonandan, an epidemiologist with the University of Ottawa, said this is where robust databases are vital.

He said there are a lot of variables in vaccine priority groups and without proper data, it’ll be hard to whittle away at who should get the first call on a standby list.

“Location is everything, as is the recognition that the first three people on the list might not be available,” Deonandan said.

“The more this is automated, the better. For example, a database can be created of eligible recipients and their addresses, as well as whether they are available for last-minute doses.”

Ottawa, for example, seems to be keeping it simpler for now. The city said vaccination clinics with leftover doses are allowed to offer them to eligible health care workers who have signed up on a last-minute appointment list.

“If there is excess, it needs to be drawn from the community that fits within the criteria in that phase, at that time,” Bowman said.

2:57 Health Matters: What should Canada do with leftover COVID-19 vaccine doses?

In Quebec, officials say it’s so far been rare to have leftover vaccines, but there are backup plans just in case.

“We have a board by age group. If we have leftovers, we call from the oldest person we have on the list to come and get their vaccine,” Dalia Toledano, the vaccination director at the West Island Health Authority (CIUSSS), told Global News previously.

A spokesperson for Quebec’s Health Ministry told Global News that vials are prepared each morning based on the exact number of appointments. In the event there are shots leftover at the end of the day, “different means can be used to administer the remaining doses, such as vaccinating staff and attendants,” the statement reads.

Just like Ontario, “it is up to each regional health centre to decide,” the ministry said. In some cases, police officers have been called in to receive a shot.

Pharmacies also have a plan for leftovers. While the hope is that there will be none, Benoit Morin, president of Quebec Pharmacy Owners, told Global News that pharmacists will call people on a waiting list which, at this time, is only prioritizing those aged 65 and older.

The same goes for Alberta. Pharmacists there say they are experiencing cases of people booking appointments at multiple places — hedging their bets in an attempt to get the shot more quickly -— leading to no-show appointments or last-minute cancellations.

To ensure nothing goes wasted, they’ve also turned to a standby list.

Pharmacies may have ironed out the kinks, Bowman said.

“When people register for an appointment at the pharmacy, there’s a box you can tick off that asks whether you’d be willing to come within an hour’s notice,” he said. “Then what happens is people that have already been triaged as acceptable in terms of age and comorbidities, they’re automatically phoned first.”

7:05 Why are vaccine appointments going unclaimed? Doctor answers your COVID-19 questions

With pharmacies being very localized, might not know which region or hospital serves them, Deonandan added. It only emphasizes the importance of consistency in plans for leftover shots and standby lists.

“You can foresee a situation where some people assume things work a certain way simply because their relative who lives several blocks away told them about it. Then they are surprised when their own region is somewhat different,” he said.

“It just adds additional confusion to a public health communications soup that has been nothing short of confusing from day one.”

The handout of leftover vaccines hasn’t been well documented around the world.

Back when vaccines were freshly approved, Americans flocked to pharmacies and clinics as word about spare doses spread like wildfire online.

Pictures from L.A. and other big cities showed dozens of people queuing up, equipped with sleeping bags and fold-up chairs, hoping they’ll be the lucky recipient.

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Since then, many Americans have taken to social media groups and websites, like Vaccine Hunter, to share tips about how to snag a surplus shot. Others have relied on family practitioners and pharmacies to notify them of an opening.

In Israel, which has one of the highest vaccination rates in the world, there have been reports of young people lining up outside inoculation sites hoping for a dose. Israelis have also discussed the best way to find spare shots in Facebook and WhatsApp groups.

But in Canada, COVID-19 vaccines are simply harder to come by at this point.

Shipment and production delays have hampered the country’s national rollout. Only now is it on the cusp of shifting into high gear, with 3.3 million vaccine doses expected to funnel into Canada this week alone.

“When we see people lining up by the hundreds for doses, then excess becomes less of an issue,” said Deonandan. “As supply becomes less of an issue, we might care less about vaccine wastage months down the road.”

But, even once the scarcity of vaccines improves, Bowman isn’t a fan of handing out leftover vaccines to just anyone.

He acknowledged the importance of avoiding wastage and spoilage but said there’s no excuse for vaccines to not go to the current, provincially-designated priority groups.

The ethical dilemma behind doing anything otherwise can’t be ignored, he said.

“If you have professional teams that aren’t following the priorities, what kind of message is that?”

— with files from the Associated Press, Canadian Press, and Global News’ Elizabeth Zogalis, Kamil Karamali, Sarah Ryan