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Saturday, April 17, 2021

Explained: Understanding Covid-19 vaccine wastage in India

A concern flagged by Prime Minister Narendra Modi, vaccine wastage is an expected part of any large inoculation drive. How is vaccine wastage quantified, why does it happen, and what are the ways in which it can be reduced?

Written by Kaunain Sheriff M | Kolkata |
Updated: March 27, 2021 12:48:45 pm
Vials of Covishield at a store in Pune earlier this year, ahead of distribution to various vaccination centres. (Arul Horizon/File photo)

At a meeting with Chief Ministers on Wednesday, Prime Minister Narendra Modi raised concerns on vaccine wastage emerging from the Covid-19 inoculation drive. What are the concerns, and how is wastage determined?

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What is vaccine wastage?

Vaccine wastage is an expected component of any large vaccination drive, and a vaccine is procured from the maker with an estimated wastage. For each vaccine type, the wastage has to be within recommended limits.

In general, high vaccine wastage inflates vaccine demand and increases unnecessary vaccine procurement and supply chain costs.

Vaccine wastage is directly linked to vaccine usage, which is the proportion of vaccines administered against vaccines issued to a vaccination site. The vaccine wastage rate is defined as 100 minus the vaccine usage rate. And the wastage rate directly determines the “wastage factor” that needs to be established for each vaccine in the immunisation schedule to accurately plan vaccine needs.

The states

How is wastage factor calculated? How much is it in the ongoing programme?

Wastage Multiple Factor (WMF) is calculated from the formula WMF = 100/(100 – wastage). In the Centre’s operational guidelines on Covid-19 vaccination, WMF has been calculated at 1.11 after assuming an allowable programmatic wastage of 10%, so that WMF = 100/(100 – 10) = 1.11.

Vaccine wastage is one of the key factors to be considered for vaccine forecasting and need estimation. The number of Covid-19 vaccines required in a month in a catchment area (state/ district/ block/ sector) for a month is calculated from the formula:

Requirement = (Total population to be covered in the catchment area) × (% of the population to be covered in this catchment area/no. of months of the campaign) × 2 doses × WMF.  

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How does vaccine wastage happen?

It is broadly divided into two categories: wastage in unopened vials, and in opened vials.

Wastage in unopened vials can occur due to six broad reasons: if the expiry date has been reached; if the vaccine is exposed to heat; if the vaccine has been frozen; breakage; missing inventory and theft; and while discarding unused vials returned from the vaccination site.

Wastage in opened vials can occur due to five broad reasons: while discarding remaining doses at the end of the session; not being able to draw the number of doses in a vial; submergence of opened vials in the water; suspected contamination; and poor vaccine administration practices.

At what stages can wastage occur?

Wastage occurs at three levels: during transportation; during cold chain point; and at a vaccination site — both at service and delivery levels.

At the cold chain point, the operational guidelines state: Issue of vaccine doses should match the registered list of beneficiaries (rounded off to the nearest higher whole number of vials) without any adjustment made for vaccine wastage in terms of the WMF, and vaccine vials with earlier manufacturing dates should be prioritised for issue first.

At the district vaccine stores, the guidelines state: Vaccine doses issued should be equal to the number of registered beneficiaries for each cold chain point (rounded off to the nearest higher number of vaccine vials) without adjustment for vaccine wastage in terms of the WMF. The issue quantity will depend on the supply frequency (e.g. weekly estimate of registered beneficiaries at cold chain points in the district), and vaccine batches with earlier manufacturing dates should be prioritised for issue first.

At the vaccination session site, the operation guidelines state: Each vaccination session will be expected to cater to a maximum of 100 beneficiaries; however, in the case of remote and sparsely populated areas, the state could organise sessions for a lower number of beneficiaries ensuring that there is no vaccine wastage. If the number of beneficiaries at a session is low, then that session site will be clubbed with other sessions.

Why are certain states showing a higher vaccine wastage?

At the vaccination site, the wastage of vaccines has a direct relationship with session size — the number of beneficiaries per session — and vial size.

The first reason identified by the Centre is inadequate planning of sessions. For instance, if the vial contains doses for 10 people and only six turn up, four doses can go waste. The Centre has advised the states to mobilise people and not to open the vials if they don’t have 10 people. “We have advised the states to ask beneficiaries to wait for half an hour or so; if no one comes, then we have asked the states to give the beneficiary an option to come the next day, where they will be given the first slots. All this comes down to granular planning at vaccination centre level. That is the kind of planning that is required,” a senior Health Ministry official said.

The second reason identified by the Centre is inadequate training. Officials said vaccinators are ending up drawing, maybe, only nine doses against ten doses. “We are seeing that those who are trained vaccinators know how to draw a vaccine. These trained vaccinators will tell you that even in a vial of ten doses, you can actually take out 11. This is a crucial aspect to reduce vaccine wastage,” the official said.

Also, open vial policy guidelines have to be strictly followed to minimise vaccine wastage. In the Covid-19 vaccination drive, the Health Ministry fact sheet sent to the states mandates that both Covishield and Covaxin have to be discarded after four hours of opening.

What are the concerns raised by the PM, and his suggestions to the states?

Modi specifically pointed out that vaccine wastage in Telangana, Andhra Pradesh and Uttar Pradesh is to the tune of 10%. “The states have to examine why the vaccine is being wasted and there has to be a mechanism where every evening this is being monitored. Because by wasting the doses of the vaccine, we are denying another beneficiary’s right to get vaccinated. The states have to immediately correct the drawbacks of planning and governance at the local level to reduce vaccine wastage. The states have to target zero per cent wastage,” he said.

Modi asked the states to increase vaccination centres and stay vigilant about the vaccine expiry date. “… We have to increase the number of vaccination centres, both in private and government facilities. If we the Centre work proactively there will be a reduction in wastage of vaccine. There is also the issue of vaccine expiry date: the doses that have arrived first should be used be first; however, if the states use doses that have arrived later, then again there could be a situation of wastage,” he said.

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