Doses of the COVID-19 vaccine were poised to expire at the Berkshire Community College clinic, and no one was around to receive them.
As appointment slots went empty last week and over the weekend, local officials and lawmakers lobbied the state to move on within Phase Two, or at least to give the Berkshires special permission to do so. On Wednesday, the state announced it would open up eligibility.
But this was Tuesday. With no word from Boston, few eligible recipients signed up and over 100 refrigerated Pfizer doses nearing the end of their lifespan, clinic coordinators made their own call.
“That’s when we reached out to people,” said Leslie Drager, lead public health nurse with the Berkshire Public Health Alliance. “We said, ‘Do you know anybody over 65 that can come get a dose? Do you know anybody that has comorbidities?’”
Clinic coordinators say the issue was a “fluke” that arose, in part, from the county’s overwhelmingly successful vaccine push. Berkshire County has given first doses to more than 18,000 people, the highest per capita rate in the Commonwealth, according to an update from Gov. Charlie Baker on Wednesday.
But, as the Berkshires sped ahead of the rest of the state, drawing praise day after day during Baker’s press briefings, the leaders of the Berkshire Vaccine Collaborative found themselves with more vaccines than unvaccinated people age 75 and up who could get to a clinic.
One late afternoon last week, vaccinators sat around the BCC field house as just a trickle of eligible recipients came in for shots. Around 500 out of 700 appointment slots had gone unfilled that day. Then on Friday, vaccine coordinators opened up another batch of vaccines to bring to the college for a Saturday clinic. Once again, appointments went unused.
At that point, state representatives were on the phone with the governor’s office, urging the state to open up eligibility to people 65 and older and those with two or more comorbidities. Despite pressure from across the state, however, eligibility remained fixed.
By Tuesday, about 100 doses remained from the previous BCC clinic, and they were set to expire, coordinators said. The vaccines had been moved from ultracold storage to a refrigerator on Friday for a mandated thawing period. Pfizer doses last just five days at ordinary fridge temperatures – far longer than punctured vials survive, but not a lot of wiggle room.
“We’ve always had clinics Tuesday, Thursday, Saturday,” said Drager. “So we’ve never had any extra vaccine that might sit in the refrigerator for five days.”
This time, however, they had not planned another first-dose Pfizer clinic because the eligible pool seemed to have dried up.
Still, they had to get the doses out – including a handful left over from a North Adams clinic. So they set up one more BCC clinic that Tuesday. When too few people 75 and up registered to fill all the slots, they began calling people who were not yet eligible but fell into the next subset of Phase Two. Clinic staff reached out to people they knew who came close to the qualifications and asked vaccine recipients from that day’s clinic if they knew anyone.
“There were people that had come to get shots, who came up to me and said, ‘Hey my brother is 73, can he get on the list?’” said Drager. “So it wasn’t just people connected to the clinic.”
Coordinators described walking a fine line with invitations. They had to make sure all the doses were used before they expired, without letting word spread so far that people would show up only to find there were no doses left.
They stressed that the situation was unusual. Clinic organizers always keep lists of eligible people to call in case of “extra” shots at the end of a clinic – for example, the few remaining doses at the bottom of a Pfizer vial – but this time they had run themselves out of eligible recipients.
“This isn’t something that could happen on a regular basis,” said Laura Kittross, director of the Berkshire County Boards of Health. “It could happen again at the very end of the [next eligible group], but it’s definitely not going to happen before then.”
The state has urged providers to make “every effort” to prevent wasted vaccines, a sentiment echoed across the country. In a situation where doses from a single, punctured vial are set to expire, the state’s website recommends giving the remaining doses “to a person in another priority group who is closest to the current priority group being targeted for vaccination to avoid vaccine waste.”
Clinics with extra vaccine left over, however, are urged by the state to vaccinate eligible individuals or redistribute doses to another site.
For Carmel Shachar, executive director of the Petrie-Flom Center for Health Law Policy, Biotechnology, and Bioethics at Harvard Law School, getting the doses into arms was the right call. Still, the incident suggests that Massachusetts, like almost every other state, does not have effective systems to report real-time data back to the people planning the rollout.
“This says there’s a need for constant communication between the administrators of the vaccine and the state governments that are planning where vaccines get sent,” she said. “They can say, ‘Maybe it’s time to open up to the next priority.’ Or, ‘We feel like this area of the state has been well-covered, maybe we should ship some of those doses to areas struggling to keep up with demand.’”
But she added that small numbers of doses administered outside standard procedures are to be expected. The risk only increases when eligibility criteria are strictly limited, a central feature of the Massachusetts rollout so far.
“When we’re talking about just a few doses, that’s not worth kind of redoing an entire system over,” she said. “The only question is, when does it become a tipping point and a loophole for people to game the system?”