Thousands of COVID-19 vaccines are set to expire in Canada this week, with pharmacists in Ontario raising concern about wastage amid hesitancy to mix different doses.
In Ontario alone, “several thousand” doses of the Moderna COVID-19 vaccine will expire on Aug. 6, said Justin Bates, CEO of the Ontario Pharmacists Association (OPA).
“It’s an unfortunate set of circumstances,” he said in an interview with Global News on Monday.
The vaccine supplies come in their frozen state each week and once they are delivered to a pharmacy and thawed, there is a 30-day window for the doses to be used — or they have to be disposed of.
Bates said they were looking at transferring some doses to pharmacies in other parts of the health-care system so they don’t have to throw them away.
“We’re going to use every tool we have to avoid wastage, but the reality is that we’re going to see some wastage starting Aug. 6.”
Meanwhile, thousands of expired AstraZeneca vaccine doses have already gone to waste in provinces in Atlantic Canada after demand dried up in June and July.
The government in Newfoundland and Labrador was able to transfer 1,400 doses of AstraZeneca to Ontario in mid-May for use there as they neared their expiry date. However, the province had 2,848 doses of the vaccine expire at the end of June. Nearly 2,900 doses were wasted in July.
Prince Edward Island also disposed of 3,200 expired doses of AstraZeneca, the province announced last month.
But the national wastage rate so far has been “very minimal and far below initial estimates,” according to the Public Health Agency of Canada (PHAC).
As of July 12, less than 0.05 per cent of total doses delivered by the federal government have been wasted, PHAC told Global News.
The boost in vaccine supply coupled with dropping vaccination rates has left unused doses nearing expiration data, said Dr. Gerald Evans, an infectious diseases specialist at Queen’s University in Kingston, Ont.
“We’re now into that smaller group, which … has been a little bit reluctant (to get vaccinated) up until now,” he said.
‘Brand hesitancy’
Bates said there has been a steep decline in demand for the Moderna shots over the last two weeks in Ontario.
“We’ve seen that in public health clinics where people are turning away when they find out it’s Moderna or not showing up,” he said.
Hesitancy around the Moderna vaccine and mixing doses has led to a lot of cancellations and no-shows at pharmacies, said Bates, adding that people demand Pfizer over Moderna.
Since June, several provinces have been mixing COVID-19 vaccines under the recommendation from the National Advisory Committee on Immunization (NACI).
According to NACI, people who have received a first dose of an mRNA vaccine should be offered the same vaccine for their second dose, but mRNA vaccines can be interchangeable if the same product is not readily available for the second dose.
The so-called “brand hesitancy” is also present in Alberta, where an Edmonton pharmacist said that he’s noticed roughly 40 per cent of customers have turned down the Moderna vaccine after a first dose of Pfizer.
“Once they hear that we’re giving Moderna, there’s been a little bit of a pushback,” pharmacist Eddie Wong told Global News in a previous interview.
Evans said while both the mRNA vaccines are equally effective, Pfizer has done a “really good job of branding itself.”
“It’s not so much that Moderna has a bad name, it’s just that Pfizer has really dominated the market in mRNA vaccines.”
As for mixing doses, he said there was evidence in several studies that backed the strategy used by Canada and in Europe, adding it “was not an inferior approach.”
How to prevent wastage?
Amid wastage concerns, Evans said Canada should look towards either donating vaccines to other countries facing financial issues or other constraints.
Selling them to nations like Australia, which has seen a spike in cases recently and is short on vaccine supply, is another option.
“If we have large quantities like that, we should be right now talking to other countries.”
Provinces should also try to send doses that haven’t been thawed yet to other regions where there is a shortage in supply, he said.
Bill Campbell, a spokesperson for the Ontario Ministry of Health, told Global News on Monday that the province was “working with federal partners to explore vaccine donation opportunities in the future”.
According to Bates, one strategy to avoid wastage would be to start offering a third booster dose to seniors, high-risk populations of morbidities and immunocompromised people.
“That’s a scenario that we’re asking the Ministry of Health to explore and move on quickly,” he said.
But some experts are skeptical about the lack of clinical evidence when it comes to booster shots.
Dr. Theresa Tam, the chief public health officer of Canada, told reporters during a virtual news conference on July 30, that even though the evidence is quickly “evolving,” there’s “not enough data” to support it quite yet – despite countries like Israel pushing ahead with a vaccination top-up.
“There’s not enough data to suggest that in Canada we would go into boosting as of yet,” she said. “But it is something that we’re watching very carefully.”
— with files from Global News’ Sean O’Shea, Chris Chacon and the Canadian Press.