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In the month after the first COVID-19 vaccinations had rolled out to prioritized populations across the U.S. in mid-December 2020, claims about vaccine fluid being thrown in the garbage were widely circulated on the internet. An overarching look at the wasted vaccines was published on Jan. 8, 2021, by The New York Times and was covered by a number of publications, including libertarian-leaning news publication Reason, which ran the story under the headline, Cuomo’s New York is Just Throwing Away Vaccines Rather Than Distributing Them Competently. While there is truth to the claim that some COVID-19 vaccination fluid was thrown out, it is important to note that by and large, these instances were the result of strict distribution rules and in some cases, a lack of guidance, which left some health care providers with more vaccine doses than they could distribute. A look at regulations issued by the New York State Department of Health (NYSDOH) revealed that this claim is partially true. In some cases, vaccine fluid had been thrown out by health care workers, but often for one of two reasons: either because the vial contained more doses than was originally thought — and health care workers did not have regulatory guidance on how extra fluid should be administered — or because of the perishable nature of the vaccines and the conditions under which they must be kept. In a news briefing held on Jan. 12, 2021, Gov. Andrew Cuomo stated that 300,000 doses of the vaccine are given to New York every week from the federal government — an amount he stated did not adequately address the 7 million eligible recipients across the state. Many considered the tossing out of vaccination fluid ironic considering the state had on more than one occasion lamented a vaccine shortage. Our greatest hindrance continues to be federal inaction. We have come too far to be held back in our efforts by the inadequate vaccine supply from the federal government. I encourage New Yorkers to be patient throughout this process and urge our federal government to increase the supply to states, said Cuomo in a Jan. 13 news release. Cuomo’s office did not immediately respond to questions sent by Snopes. But in order to understand why vaccines are being thrown out during a perceived time of shortage, it is important to first understand how they are kept and administered in the first place. Shortly after emergency use authorizations were issued by the U.S. Food and Drug Administration (FDA) in mid-December 2020 for two COVID-19 vaccines, it was made apparent that both the Pfizer/BioNTech and Moderna vaccine vials, which were expected to have five and 10 doses, respectively, contained an extra dose — and in some cases, two. This pushed the total dosage up to six or seven in Pfizer vials and up to 11 in Moderna. According to a report by CBS, the amount of leftover vaccine fluid depended on what type of syringe was used to administer the vaccine because fluid can sometimes stick to the walls of the syringe, requiring more fluid to bridge the gap. CBS also reported that overfill is not uncommon in vaccines. The amount of vaccine remaining in the multidose vial after removal of five doses can vary, depending on the type of needles and syringes used. Vaccinators need to consult their institution's policies for the use of multidose vials, Pfizer told the publication. Snopes contacted the Centers for Disease Control and Prevention (CDC) for further clarification and will update the article accordingly. But it wasn't immediately clear why the syringe would influence how much vaccine is left over if the doses were standardized in the first place. Snopes sent emails to both Pfizer and Moderna asking the companies to clarify, as well as to explain why there was extra fluid. Neither pharmaceutical company provided guidance as to how health care workers might administer these extra doses. In a Dec. 16 Twitter thread, the FDA said that given the public health emergency, it was acceptable for health care providers to administer every dose from each vial until distribution issues had been resolved. But given the precise conditions that the vaccines must be stored under, the agency wrote that it was critical to note that any further remaining product that does not constitute a full dose should not be pooled from multiple vials to create one. Neither of the COVID-19 vaccines contains preservatives, so fluid from one vial cannot be combined with fluid from another. Furthermore, once a vial has been taken out of the cooler, there is a finite amount of time before it denatures and is no longer effective. In short, if someone mixes fluid from separate vials to make one dose, the entire dose may be unsafe or ineffective. So, some vials were tossed out, according to numerous news publications around the country. It is not known how many extra doses were tossed out, but reports of discarded vaccine also came from Ohio, Massachusetts and Wisconsin, to name a few. When it came to full doses in a vial, New York followed the FDA’s guidance. On Dec. 18, 2020, NYSDOH determined that health care workers could withdraw more than the allotted five doses in the Pfizer vaccine so long as any extra fluid could be easily drawn up in a syringe to meet the .3 milliliter amount. And on Dec. 23, NYSDOH set forth similar guidelines for the Moderna vaccine, adding that extra vaccine from a single vial could be drawn up to fulfill the .5 milliliter dose. But these newly issued regulations didn’t solve the entirety of the problem. In many cases, it was found that strict distribution requirements meant that if there weren’t enough eligible recipients to receive the vaccine on a given day, any extra fluid would still be tossed out. In early January 2021, it became apparent that the strict prioritization process behind qualifying vaccine recipients meant that in some cases, there were too few eligible people to receive the first available dose. And if a vial had been taken out of the freezer but not all of its doses had been administered, it would be thrown out. In response, NYSDOH and the Governor’s office expanded criteria for those who were eligible to receive vaccinations across the state to a broader range of health care workers, as well as nursing homes. Guidance issued by the NYSDOH on Jan. 9 established that all available doses of the vaccine must be used as quickly as possible to priority populations. This guidance lays out and clarifies what we have been discussing with hospitals for weeks regarding how to maximize their doses to make sure that no vaccines are wasted. We want no confusion and want to make sure that everyone understands the procedures, said Jill Montag, the public information officer for the NYSDOH, in an email to Snopes. Health care providers were encouraged to plan accordingly to ensure every dose is administered, which meant not only maintaining a list of those planned to receive the vaccination each day but creating a stand by list of eligible individuals who could fill in vacant vaccination times on short notice. At the time of writing, the CDC reported distributing more than 29.3 million doses across the U.S., resulting in the vaccination of 10.2 million people. Snopes contacted both Cuomo’s office and the FDA for further clarification on planned efficiency measures for rolling out more vaccines but did not receive a response by the time of publication.
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