Even as India continues its struggling efforts to vaccinate the large population, two states have shown an outstanding performance in terms of minimising the wastage of COVID-19 vaccines. According to a report, Kerala and West Bengal have shown negative vaccine wastage, with Kerala recording -6.3 per cent and West Bengal reporting -5.4 per cent.
As per the Times of India report, other states had reported a higher percentage of wastage: Madhya Pradesh at 7.3 per cent and Punjab at 7 per cent — far from the Centre’s direction to keep the wastage below 1 per cent.
What is negative wastage?
In simple terms, negative wastage happens, when vaccine administrators manage to extract and administer more vaccine doses than the amount that was supplied in the vials.
According to the World Health Organisation (WHO), generally in multi-dose vials — where more than one dose can be extracted — there might be a difference between the number of doses “that can be withdrawn” and the number of doses which are stated on the label of the vial.
The availability of the doses will also depend on several factors including “vial overfill volume, technique and accuracy of doses withdrawn and delivered and syringe dead space”. In the cases of Kerala and West Bengal, the vaccine administratorS reportedly managed to extract an ‘extra dose’, which is generally available in a vial as a wastage factor.
While administering a large number of people every day, especially in a large-scale COVID-19 vaccination drive, it is very hard to keep an accurate track of vials extracted. So, there is a chance of a minuscule amount getting wasted. Hence, the vial contains an extra dose.
If we take the example of the two states, while generally, one vial can vaccinate 10 people, Kerala and West Bengal have used even the extra dose to vaccinate people — i.e. an estimate of 11 for one vial in theory.
The story in numbers
In comparison with the rest of the Indian states, Kerala has been at the forefront of vaccination in the country — at least in terms of minimising vaccine wastage. According to a Right to Information (RTI) report filed by Vivek Pandey, which was reported by NDTV, since the vaccination drive began in January, more than 44 lakh doses were wasted, out of 10 crore available doses, till April 11. Several states, including Kerala and West Bengal, had reported ‘zero’ wastage.
On May 4, Kerala Chief Minister Pinarayi Vijayan made interesting observations in a tweet. The Chief Minister had said that Kerala had managed to administer 74,26,164 doses out of the 73,38,806 doses that they had received from the central government.
The state was again instrumental in squeezing out the extra dose to administer. The Chief Minister had praised his health workers and nurses “who had been super-efficient”.
Kerala has received 73,38,806 doses of vaccine from GoI. We’ve provided 74,26,164 doses, even making use of the extra dose available as wastage factor in each vial. Our health workers, especially nurses have been super efficient and deserve our wholehearted appreciation!
— Pinarayi Vijayan (@vijayanpinarayi) May 4, 2021
Even on May 11, when the Centre released the vaccine wastage data, Kerala had reported -5.26 per cent of wastage. Similarly, West Bengal also has been instrumental in minimising the wastage of vaccines.
As per the May 11 data sheet provided by the Centre, West Bengal had reported a wastage of 3.27 per cent. However, on May 17, a Times of India report said that the state, with a ‘negative wastage record’, managed to save nearly 3.5 lakh doses.
Apart from the logistics and other factors, the efforts of health workers in the states showing either zero or negative wastage, have to commended due to their accuracy and efforts to extract the optimum doses from the vaccine vials.
According to Delhi-based public health expert Dr Vivekanand Jha, to make optimum usage of vaccine doses, the “states need to have plans”.
“First, the logistics have to be sorted out. Logistics includes several things: geographies where the vaccines will go, the manpower to deliver the vaccines, making sure the population knows about it and the usual supply chain issues. That’s what is the need. Those are the lessons that we have from our polio programmes for several decades. It is a logistics and administrative issue and not a medical issue,” Dr Jha told TV9 News.
Dr Jha stressed the need for “education” about the precision of measuring the doses.
“It is important to ensure that education from the point of view of the health workers knowing they should precise in their measurements. When they measure 1 millilitre it should be 1 millilitre and not 1.1 so that they have the expected leftover in the vial,” he added.
Dr CN Manjunath, one of India’s renowned cardiologists and the director of Bengaluru’s Sri Jayadeva Institute of Cardiovascular Sciences Research, said that confidence-building measures should be strengthened.
“Social media is creating a lot of confusion about the vaccine and as far as vaccination is concerned, confidence-building measures should be strengthened. But again, rather than wasting a vaccination, each vaccination centre should be given some discretion to prevent wastage,” Dr Manjunath told TV9 News.