Every drop is like ‘liquid gold’: B.C. maximizing COVID-19 vaccine doses during first stage of rollout

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It is no small trick to squeeze an extra dose of COVID-19 vaccine out of a vial, but care and precision has allowed more than 1,800 individuals in B.C. – so far – to be vaccinated earlier than expected.

The B.C. government’s COVID-19 vaccination team will provide more details this week about how and when residents can expect to get their turn for a shot. The vaccine will be a rare commodity for months yet, and with uncertain supply – underscored on Friday when Pfizer announced it was delaying shipments to Canada while it expands production – there can be no guarantees about timing.

The first shipments of the vaccine in B.C. arrived in mid-December, and so far, additional deliveries are coming in at a trickle. While millions of British Columbians await their turn, public-health officials desperately want to avoid any wastage of the available vaccines.

“We’re treating it like liquid gold,” said Dr. Patricia Daly, Chief Medical Health Officer for Vancouver Coastal Health. Dr. Daly has joined public-health nurses in her region to deliver COVID-19 vaccines into arms and says the process has been intense. “That’s the feeling I had – very laser-focused on trying to get the six doses out of the vial. ... You don’t want to be dropping anything.”

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The Pfizer vaccine is shipped in a vial with a small amount of the vaccine, with space left for a saline solution to dilute it when the shot is ready to be administered. Officially, the diluted solution provides five doses, but with a margin for error that just happens to equal one extra dose.

“If you’re drawing up the doses, and you go even a little bit over the 0.3 milliliters, you won’t have enough for that sixth dose at the end,” Dr. Daly said. It is easier to be precise with a one-millilitre syringe, but there is a shortage of those, so B.C.’s nurses are mostly making do with three-millilitre syringes instead. “It takes much more time to very precisely draw it up, but we’re all trying to do that because we want to maximize the doses. ... That’s not always possible.”

Health Canada has also said it had no objections to health care professionals “drawing up an additional dose or two from each vial, where possible.” If a full extra dose can’t be extracted, the remainder must be scrapped.

That makes booking vaccine clinics challenging. There have been instances of opportunistic queue-jumping, and those stories can undermine public trust in the system. At this stage in the distribution, the vaccine is only meant to be offered to priority groups. With no certainty of exactly how many doses will be produced, it means that at the end of the day, there may or may not be extra shots available. (Once the vaccine is thawed and prepared, it must be used up within six hours.) Sometimes, people are sent home disappointed.

“At each clinic, we make sure we have sufficient vaccine to vaccinate everyone we anticipate being there, and we keep having people come in until we run out of vaccines,” Dr. Daly said. “If there are any leftover doses, we make sure they go to other priority populations.” That means calling, for example, acute-care health workers at the last moment and offering them a vaccine. “They don’t know when they come to work that day that there might be extra vaccine.”

In some ways, this stage of the vaccination process is the easy one. The list of who is in the first phase of distribution is clearly meant to capture those who are most vulnerable to serious illness or death owing to the virus. It is expected that all long-term care residents and most staff will be vaccinated very soon – and after hundreds of deaths in the province’s long-term care homes, that will be a significant milestone.

But the next stage will be more complex. The province has identified front-line health care workers and elderly British Columbians who still reside at home among the next priority groups. Those experiencing homelessness and people in provincial correctional facilities are also in that line. The provincial government has not yet said which essential workers are next, before the vaccine is available to the general population. By September, the province says, all of B.C.’s 4.3 million adults will have the opportunity to be vaccinated.

To date, B.C. has based its plans on Ottawa’s expectations for delivery of the Pfizer-BioNTech and Moderna vaccines, the two currently approved by Health Canada. Other manufacturers are expected to be approved soon, which could change the timeline.

The order of priority, and the potential for delays, will test public goodwill. A clear plan and transparent accounting is needed to assure British Columbians that the rollout will be fair.

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