Explained: What Causes Vaccine Wastage? How Can States Curb It?

The WHO describes vaccine wastage to be the “sum of vaccines discarded, lost, damaged or destroyed.”

What exactly causes vaccine wastage and how can it be reduced?

(Photo: The Quint/Arnica Kala)

On one hand, India’s COVID-19 vaccine shortage is impeding the success of the ongoing immunisation drive. On the other, there are reports of vaccine wastage.

According to the latest figures, Jharkhand with 37.3 percent and Chhattisgarh with 30.2 percent recorded the highest vaccine wastage in the country. Certain states like Kerala with -6.3 percent and West Bengal with -5.4 percent recorded a negative wastage.

The Centre has previously rebuked states over vaccine wastage in review meetings.

Since the latest data was released, the Opposition-ruled states of Jharkhand and Chhattisgarh contested the Centre’s data.

Jharkhand Chief Minister Hemant Soren asked, “How can one imagine that Jharkhand will allow its suraksha kavach (protective gear) to go waste?”

The Jharkhand CMO claimed that data couldn’t be uploaded on the CoWin portal due to technical glitches – and that the wastage was much lower at 4.65 percent.

Even Madhya Pradesh, a BJP-ruled state that reported 10 percent vaccine wastage, disputed the Centre’s data.

But what exactly causes vaccine wastage and how can it be reduced?

What is Vaccine Wastage?

The World Health Organization describes vaccine wastage to be the “sum of vaccines discarded, lost, damaged or destroyed.”

“Accurately calculating the wastage rate is essential for reducing stock-outs and over-stock, choosing the most appropriate vaccine presentation and immunisation session size, as well as sizing supply chain infrastructure at country level,” it says.

All vaccination drives do account for some amount of wastage but keeping it to a minimum is imperative, especially in a crisis like the COVID pandemic where it is necessary for the government to immunise the whole country on an urgent basis.

How Does Vaccine Wastage Happen?

Several factors can lead to vaccine wastage in both opened and sealed vials.

Logistical issues such as a weak cold chain, breakage during transportation, unused doses crossing the expiry date, or missing inventory can lead to vaccine wastage.

Alternately, wastage in opened vials can happen because of immunisation workers’ practices. Discarding opened vials without optimal use of the doses, suspected contamination, health workers not being able to draw the number of doses indicated on the label of a vial, can all lead to wastage.

Vaccine usage is calculated as the proportion of vaccines administered out of the total vaccines allotted.

Therefore, the percentage of vaccines not administered at all is called the ‘rate of vaccine wastage’. The vaccine wastage rate is defined as ‘100 minus the vaccine usage rate’, as per the WHO definition.

(Courtesy: World Health Organisation)

Epidemiologist and public health expert Dr Chandrakant Lahariya says, “The most common problem seen especially in the COVID vaccination drive is incorrect planning. Sometimes the vial is opened but there are only a few beneficiaries, so the remaining doses in the vial go to waste. Another factor is that once opened the vial should be used within four hours, so if the number of people who turn up for vaccination is low, there will be vaccine wastage.”

“If incorrect doses are taken from a vial, for example, if the amount of a single dose should be 0.5 ml, but the amount drawn is more than that, then too it can result in less number of doses being taken,” he says.

Will Vaccine Wastage Affect Allocation to States, as Centre Has Warned?

Since the central government has taken back the responsibility of allotting vaccine doses to states to immunise everybody above 18 years of age, it has said that COVID vaccine allocation to states may be negatively affected by high wastage rates.

The Centre already keeps scope for “programmatic wastage” while allotting vaccines and the ‘Wastage Multiplication Factor’ helps estimate how many vaccines are required to immunise a target population.

According to MoHFW guidelines, at least 10 percent of vaccines acquired by the Centre may face “programmatic wastage”.

WMF = Wastage Multiplication Factor = 1.11 for COVID-19 vaccine, assuming an allowable programmatic wastage of 10 percent

[WMF = 100/(100 - wastage) = 100/(100-10) = 100/90 = 1.11].

Therefore, India’s vaccine requirement in 1 month is:

(Total population to be covered in the relevant catchment area (state/district/block/sector) X % of the population to be covered in this catchment area/number of months of the campaign) x 2 doses x WMF.

How Can Vaccine Wastage Be Reduced?

As we stare at an impending third wave of COVID in the country, vaccination has become one of the crucial weapons to battle the pandemic and reduce possibilities of transmission or newer variants.

In its statement released on 11 June, the Centre has made it clear that it expects states to reduce their wastage to 1 percent. Responding to criticisms about its expectations, the Centre pointed out that some states were able to achieve negative wastage.

“Several states have organised COVID-19 vaccination in such a way that not only there is no wastage but they are able to extract more doses from the vial and thus show a negative wastage. Hence, the expectation that vaccine wastage should be 1 percent or less is not at all unreasonable. It is reasonable, desirable and achievable,” the Centre said.

Since there is already a shortage of doses in Phase 3, a thorough planning and proper training of health workers can reduce vaccine wastage.

Careful transportation and maintaining proper temperatures are needed to reduce vaccine wastage. Planning vaccine sessions carefully where health workers open a vial only after a certain amount of beneficiaries are available to ensure full usage of the all the doses available in a vial can also bring down wastage.

“Traditional immunisation programmes allow for a 10 percent vaccine wastage. And in this vaccination programme where vaccines are a precious commodity and really valuable, a target of 1 percent wastage is realistic and possible.”

Dr Chandrakant Lahariya, Epidemiologist and Public Health Expert

States like Kerala and West Bengal, which reported negative wastage, made use of the extra doses available in the vials.

“I think what we are hearing about negative wastage in Kerala is definitely a good sign, because we know that vaccine vials have one extra dose. So, with really efficient and meticulous planning that is possible. Vaccine vials are designed and filled in a way to account for wastage and still achieve 100 percent,” Dr Lahariya says.