Here’s how Maharashtra administered 359K more vax doses in May-July

According to the Union Ministry of Health and Family Welfare, the state’s overall vaccine wastage has dropped to zero

Maharashtra administered 359,000 extra vaccine doses from the vials allotted to the state between 1 May and 13 July, according to the Union Ministry of Health and Family Welfare. The state’s overall vaccine wastage has dropped to zero, but three districts – Pune (1.64% wastage), Aurangabad (0.86%), and Parbhani (0.29%) – continue to report wastages.

Many other states such as Karnataka, Kerala, Tamil Nadu, Goa and Rajasthan have also managed to achieve zero wastage and administer extra doses between 1 May and July 13. (HT File)

One vial is meant for administering 10 doses. How did Maharashtra extract more doses from the vials then?

“One can draw about 11 doses and sometimes even 12 from a vial,” Dr Pradeep Vyas, additional chief secretary (health) told HT. He said that with good training of staff and care, one can draw extra doses and ensure zero wastage.

Each glass vial of Covishield or Covaxin is officially labelled with 5 millilitres (ml) of the vaccine. The dose administered to a beneficiary is 0.5ml. Thus, one vial is meant for 10 doses. However, manufacturers commonly overfill the vials to ensure that the accurate number of labelled doses is delivered and slight spillage or wastage is covered.

“When you have trained staff, and the process is done carefully, there is no question of spillage,” said Dr Prince Surana, chief executive of Mumbai’s Surana Group of Hospitals, which has administered over 300,000 doses at their centres and through tie-ups with corporates and other organisations.

“The manufacturers bill us for 10 doses only, but with proper planning, we ensure that every bit of the vaccine is utilised,” said Dr Surana, adding that some wastage is inadvertent, but it gets covered with the extra doses.

According to the World Health Organization, overfill for a 10-dose vial can be from about 16%-24% (or 0.58ml-0.62ml volume for a 0.5ml dose). This makes it possible to withdraw 11-12 doses of 0.5ml from a 10-dose vial when a low dead space syringe is used. The dead space in syringes refers to the volume of vaccine retained in it after administration.

“For Covid-19 vaccines, we use the auto-disable syringes which hardly have any dead space and it allows us to extract and administer accurate 0.5ml doses,” said Dr Surana.

In May, Maharashtra’s overall vaccine wastage stood at 0.22%. Some districts such as Gadchiroli and Beed, among a few others, were reporting high wastages.

“The geography of districts such as Gadchiroli and Beed is sparse, which resulted in high vaccine wastage at times,” said Maharashtra’s immunisation officer Dr Dilip Patil.

“But 10% wastage is within the permissible range. All our districts are now recording negative wastage, barring three districts – Pune, Aurangabad and Parbhani – that have wastage under 10%,” he said.

The state had sent warnings to some districts that had recorded very high wastage in May. Regular reviews were undertaken. Gadchiroli and Beed are now among zero-wastage districts. For instance, on Friday, Gadchiroli had administered nine extra doses. However, this status is dynamic and changes with more doses that are administered.

Once opened, a vial has to be used within four hours. As per protocol, if centres do not exhaust it within this period, the remaining content has to be discarded.

“In our centres, there is so much demand that we always have more people than vaccine doses,” said Dr Bhupendra Patil, medical officer of health in Mumbai’s M-West ward that covers Chembur and Tilak Nagar areas.

The most common reasons for wastage are less than 10 people for an opened vial, breaking of vials, and spillage while handling. The M-West ward, for instance, has zero-wastage status, but they have reported accidental breakage of two unopened vials and one half-used vial.

“Some wastage like this is unavoidable despite our staff taking care of the vaccines like their precious belongings,” said Dr Patil.

Many other states such as Karnataka, Kerala, Tamil Nadu, Goa and Rajasthan have also managed to achieve zero wastage and administer extra doses between 1 May and July 13. The health ministry said that a total of 249,000 doses were wasted and 4.1 million extra doses were administered across the country during the same period. This data was shared by the ministry in reply to Lok Sabha last week.