CVS, Walgreens Wasted More COVID-19 Vaccine Doses Than Most States

CVS and Walgreens, two retail pharmacy chains, wasted more COVID-19 vaccine doses than states, territories, and federal agencies combined, according to a Kaiser Health News analysis.

The Centers for Disease Control and Prevention (CDC) reports that there have been about 182,874 wasted doses in the United States as of late March, with CVS and Walgreens accounting for nearly 128,500 of those shots.

Pharmacies play a crucial role in vaccine rollout, making the shots more accessible to the public. But experts say tracking this waste is still an important tool for understanding vaccine supply and demand, and how to best streamline the process.

The data from the CDC is incomplete—with some states not included—meaning vaccine waste across the country may be underreported.

Factors Contributing to Vaccine Wastage

Vaccine wastage can occur in both opened and unopened vials, and there are plenty of factors that come into play.

"Waste happens when a vaccine dose cannot be used on a person and has to be discarded,” Johan Bester, MBChB, PhD, MPhil, HEC-C, interim assistant dean for biomedical science education and director of bioethics at the University of Nevada, Las Vegas, tells Verywell. “Sometimes vaccines are wasted because of completely unavoidable events: a vial breaks, a needle bends, that kind of thing. It appears there were a number of logistical issues in the pharmacy chains' rollout of COVID vaccinations that resulted in doses being discarded for a variety of these reasons.”

Arjun Venkatesh, MD, emergency medicine physician at Yale Medicine and associate professor at the Yale School of Medicine, tells Verywell that wasted vaccine doses can also mean that the vaccine provider didn’t have the ability or supplies to get the last or extra dose in a vial.

Following CVS and Walgreens, Texas reported the highest recorded number of wasted doses. Different states reported various incidents, which included:

• Broken vials
• Broken syringes or bent needles
• Storage errors, like freezer malfunction or leaving doses at room temperature for too long
• Leftover doses from opened vials
• Accidents, like spilling a vial
• No-shows at vaccine appointments

“Vaccines have to be stored and transported in a specific way that ensures their quality and effectiveness,” Bester says. “If for some reason a vaccine was stored inappropriately, it must be discarded and cannot be used.”

The Pfizer-BioNTech and Moderna mRNA vaccines need to be kept at freezing temperatures. Once they are removed from their dedicated freezers, they need to be administered within a certain time frame, otherwise the vaccine doses will need to be discarded.

According to the World Health Organization, "wastage in unopened vials is avoidable and should be treated as unacceptable,” no matter the circumstances.

Why Tracking Wasted Vaccine Doses Is Necessary

Knowing how many vaccine doses are being wasted is a valuable part of the quality control of the vaccine delivery system, Bester says. 

“If waste is too high, it means that something is amiss in the system, and steps need to be taken to address the problem,” he adds. “Furthermore, we want to be cost-effective. Vaccines wasted results in money wasted, which has an impact on our society overall.”

Monitoring vaccine usage—and wastage—also helps in calculating current vaccine needs.

“Keeping track of wasted doses is less about immediate waste," Venkatesh says, "but rather a tool policymakers and providers can use to allocate scarce vaccinator kits with special syringes, determine subsequent vaccine allotments, target education to reduce waste and cost, and perhaps most importantly, to ethically lead vaccine stewardship at a time of tragedy due to vaccine shortages outside the U.S. in the developing world.”

How to Minimize Vaccine Wastage

It’s crucial to limit avoidable vaccine waste as much as possible, Bester says. Some incidents may not be completely preventable, but properly maintaining and adhering to the vaccine cold chain requirements and improving vaccine scheduling systems can reduce the likelihood of vaccine wastage to an extent.

According to William Moss, MD, executive director of the International Vaccine Access Center at the Johns Hopkins Bloomberg School of Public Health, several measures should be put in place to curb COVID-19 vaccine wastage, such as:

• Matching supply and demand better by anticipating vaccine needs and requesting only what is necessary
• Developing flexibility in the vaccine supply chain to divert doses to states where they are needed
• Establishing strategies to donate excess vaccine doses to countries with the greatest disease burden or through the COVAX facility to low-income countries
• Improving existing vaccines to have a longer shelf life and have less strict cold chain requirements

There is also a shortage of the low-dead-space syringes designed to maximize all the doses inside COVID-19 vials, which contributes to the number of wasted shots. Venkatesh urges federal and state governments to maximize the production of these special syringe kits to ensure that every dose in each vial can be administered.

“Vaccinators must have a ‘plan B’ to maximize access once a vial is opened and at risk of being unfinished,” Venkatesh says. “This can include having a call-in list, end of day walk-in vaccination appointments, or even mobile clinics that take extra doses to homebound individuals.”

Will Waste Increase in the Coming Months?

Vaccine demand is beginning to slow in the U.S. If providers don’t adjust accordingly and open fewer vials, they may experience more difficulty finding people at the end of the day to administer excess doses to, leading to wasted doses.

However, the Food and Drug Administration (FDA) recently expanded the emergency use authorization (EUA) of the Pfizer-BioNTech vaccine to include children aged 12 to 15. This latest development may lead to an increase in appointments.

Either way, it’s crucial for the entire vaccine supply chain to implement strategies that will mitigate vaccine wastage every step of the way.

“Continued public health messaging should convince some who are skeptical to get vaccinated,” Moss says. “The United States needs to be a leader in the global fight against the pandemic and has an ethical obligation not to waste vaccine doses when these are in such demand across the world."

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