BIRMINGHAM, Ala. (WBRC) – In a “quiet zone” at UAB Hospital, a team of nurses prepares Pfizer’s COVID-19 vaccine for patients.
“Not everyone can do reconstitution because if those people don’t get it right, then the patient is not going to get the right volume of vaccine,” explained Roseann Trimble, R.N., Manager, Employee Health, UAB Medicine.
“There’s no chit-chat. It’s all business when you sit down at that table.”
There’s no room for error when dealing with a precious resource, said Trimble, and early on these nurses found a way to make the most of every last drop.
“People started saying, ‘I think I can get another one out here!’ And that’s exactly how that happened. It was, ‘Not uh, there’s too much in here for me to throw away,’ and so once we realized that we could get that sixth dose, we were hot on that!”
Trimble said UAB has been pulling six doses of vaccine from the five-dose vials since December by using low dead space syringes. “Dead space” is the area between the syringe hub and the needle where vaccine gets trapped. It’s usually only a few drops, but in this case, enough to make a difference.
“A .3 mL is a tiny little dose. If you look at that syringe, it is a very, very small dose. And so, if you think about a drop or two being held in that needle, that’s going to take up your 6th dose,” said Trimble.
Providers get vaccine from the federal government and the supplies necessary to administer them. Trimble said UAB received the low dead space syringes from the beginning, but not enough.
The supply kits, shipped by the U.S. Department of Health and Human Services (HHS), contained enough syringes for five doses per vial.
“We realized we were going to run out of syringes really quick, but that was OK because then we substituted some of the syringes that we had on hand,” said Trimble.
The Food and Drug Administration (FDA) updated Pfizer’s Emergency Use Authorization (EUA) in January to recommend six doses can be pulled from the vials using the right syringe.
The updated guidance said, “Low dead-volume syringes and/or needles can be used to extract six doses from a single vial. If standard syringes and needles are used, there may not be sufficient volume to extract a sixth dose from a single vial.”
Trimble said after the EUA was changed, UAB started receiving enough syringes to get six doses of vaccine from each vial.
“It didn’t take long before they fixed that problem,” said Trimble.
Supply problems exist for other providers as these specialty syringes are in short supply. And, like the FDA and Trimble said, they’re necessary to get the sixth dose of vaccine.
WBRC Fox6 reached out to HHS about the issue and was told: “All COVID-19 vaccines are being shipped with the appropriate number of ancillary supplies per the recommendations under the FDA’s authorization for emergency use. The actual number of doses that can be extracted from each vial depends on which syringes are in the kit, their amount of dead space, and the experience of the person administering the vaccine. States that experience issues with vaccines are encouraged to contact CDC as the national vaccine distribution lead.
As soon as possible after the FDA updated the Pfizer EUA to recommend that a sixth dose be pulled from the Pfizer vaccines, we began sending reconfigured supply kits to support 1,170 doses per Pfizer shipment, plus a 5% overage of all materials to account for damage or wastage, that include a majority of Low Dead Volume (LDV) syringes which we have confirmed will enable the six-dose draw. The larger supply kits will arrive concurrently with Pfizer vaccine allocations.
We are committed to maximizing use of every vaccine dose available and we work with our vaccine distribution partners to ensure that this is possible.”
The Alabama Department of Public Health said it is aware of a “few” cases where providers were unable to get the sixth dose of Pfizer out of a vial. The Centers of Disease Control and Prevention said it is working to be able to share nationwide data of how many doses of vaccine are unused or wasted, once it has more complete data.