COVID vaccine clinics around Charlotte don’t waste many doses. Here’s how they do it.

Only a small sliver of precious coronavirus vaccine doses have not gone into arms across North Carolina since distribution began three months ago.

The number of “unusable” doses equates to only 0.1% of the more than 2.3 million doses the state received as of Feb. 28, according to North Carolina Department of Health and Human Services spokeswoman Catie Armstrong. No “significant batches” have been lost, she said.

That success comes even as health care providers contend with complex storage requirements and rapidly changing vaccine eligibility designed to safeguard the limited supply.

If vaccines were administered perfectly — with zero doses spoiled or contaminated, and no vials or syringes broken — at least an additional 2,571 North Carolinians could have received some measure of protection against COVID-19 vaccine by now.

Charlotte-area counties are faring remarkably well in making use of every potential shot, even as health departments repeatedly revamp their vaccination strategies due to new priority groups and weekly allocations now including Pfizer, Moderna and Johnson & Johnson shipments. And at vaccine clinics, it’s a race against the clock.

When the Pfizer vaccine is removed from a freezer and mixed with a sodium chloride diluent, it can be kept at room temperature for six hours. After that timeframe, leftover doses should be discarded, according to the Centers for Disease Control and Prevention. The Moderna vaccine operates under a similar tight timeline and cannot be refrozen.

In Mecklenburg, no viable doses have been “wasted” due to human error, Deputy Public Health Director Raynard Washington told the Observer this week. But at least 44 doses were deemed “not suitable for use” due to issues like defective syringes or vials, DHHS data show.

“Basically we have not wasted any doses, and we don’t have any intention to — so we will find someone’s arm to put it in,” Washington said. “It’s not wise to waste doses.”

The result: Occasional late-night injections at Bojangles Coliseum, the county’s mass vaccination site, or at the health department’s southeast clinic with only a matter of hours to spare on open vials, Washington said.

County staff will be called, and so will first responders, to see if they are nearby and want the shot. Sometimes, if there’s extra doses floating around during late-afternoon slots, spouses or companions will unexpectedly get immunized at Bojangles alongside their loved ones who arrive for appointments, Washington said.

Vaccine doses aren’t wasted

State health officials support the practice of administering doses to people not yet eligible for vaccinations if opened vials are in jeopardy.

If people from Group 4 or 5 just happen to be at the right place, at the right time, they could get vaccinated today — and not wait weeks to become eligible to book an appointment, officials acknowledge.

”We recognize on-the-ground realities require us to be flexible,” Armstrong said in a statement. “Our current guidance is that if there are extra doses in a vial at the end of a vaccination event, no doses should be wasted.”

That’s the trend throughout the Charlotte region, as only several dozen vaccines never made it into residents’ arms:

▪ In Cabarrus County, 21 doses were not suitable, the most recent DHHS data show. Cabarrus Health Alliance says those were wasted “very early on” — before it established a waitlist, spokeswoman Marcella Beam said in a statement.

▪ Catawba County Public Health has not wasted any doses, spokeswoman Emily Killian said.

▪ Union County Public Health has wasted 60 total doses — mostly due to dropped vials or syringes, as well as cracked or broken vials, spokeswoman Liz Cooper said.

“Over the course of any large-scale vaccination effort, a small number of doses may be lost inadvertently...” Armstrong said. “However, data on wasted vaccine is an essential metric for state and federal health agencies storage and handling procedures to maintain COVID-19 vaccine cold chain and minimize the likelihood of vaccine loss or damage during shipment.”

‘Careful coordination’

”Vaccine shopping” is on the rise, with adults looking for appointments across healthcare systems, pharmacies and county boundaries to secure an appointment, plus multiple back-up options. Health departments encourage residents to get vaccinated in their home counties, though that’s not mandatory.

But people are forgetting to cancel appointments that they no longer need.

Beam estimates Cabarrus Health Alliance’ no-show rate is somewhere between 5% to 10% lately. Union County Public Health is logging, on average, 50 to 60 no-shows each week, with a higher volume at large vaccination events, Cooper said.

Anecdotally, no-shows and cancellations are increasing in Catawba and Mecklenburg counties too, though specific numbers are not tracked, officials say.

Health departments rely on several time-sensitive tactics to keep the vaccination momentum and scheduling going. DHHS encourages counties to maintain active waitlists as vaccine coordinators anticipate handing extra doses, Armstrong said.

”As soon as we see an appointment has been canceled or we have increased vaccine availability, we’re quickly going from our waitlist to fill those,” Dr. Meg Sullivan, Mecklenburg’s medical director, said in a news briefing last month, urging people to not hold onto duplicate slots.

Mecklenburg’s waitlist includes roughly 800 people in Group 3, as of Wednesday — all of whom have been contacted by phone or email, Washington said. There’s also about 700 people in Group 4 who are not yet eligible for the coronavirus vaccine.

At the Bojangles Coliseum mass vaccination clinic, Washington said Public Health’s inventory nurses monitor no-show appointments to decide whether or not to draw more doses, particularly later in the day. There’s an extra calculation for the Pfizer vaccine, which must be thawed due its storage in ultra-cold temperatures.

“Our inventory nurses are very, very stringent,” Washington said. “They thaw and draw based on what’s needed.”

At Cabarrus Health Alliance’s clinics, there’s a critical end-of-day strategy as well: Nurses start sharing open vials among different vaccine stations, instead of opening new ones, as appointments wind down, Beam said.

”This allows us to keep a close count on (the) number of doses left to ensure no waste,” Beam said.

Catawba County Public Health also draws doses in “very limited quantities” — just one vial at a time near the end of the day, Killian said. Pfizer vials contain about six doses, and Moderna vials contain 10 doses, according to the CDC.

”All of this requires careful attention to detail and clear, frequent communication and coordination between check-in and administration staff,” Killian said.