what we know about the “sixth dose” and foresight problems

When on January 8 European Medicines Agency (EMA) allowed that, instead of the five doses provided by Pfizer, six vaccines could be extracted from each vial, was increasing the vaccines available throughout the continent at a stroke of the pen by around 20%.

Some autonomous communities and cities, as Melilla, they took advantage of it quickly and closed last week with 102.1% of doses administered. Others, as we are discovering today, were caught with a changed foot and that is causing us to waste many thousands of vaccines.

Because power extracting six doses from the vaccine vial is not just a matter of will or administrative permission; special needles and syringes are needed to optimize the liquid contained in the vials. According to the Cadena SerMost of the communities say they are taking advantage of the entire road; Basque Country and Castilla y León have not given data; and Andalusia, Madrid and, to a lesser extent, Catalonia would be having problems getting that sixth dose of the vaccine extracted (or, directly, they would be letting it lose).

What is the problem with the sixth dose?

dead space

For the preparation of the vaccine, the content of the original vial (0.45 ml) must be diluted with 1.8 ml of a sodium chloride solution. As each dose is 0.3 mL, it is enough to make a simple calculation to realize that in the diluted vial (2.25 ml) there are more than seven doses (2.1 ml) of vaccine. The problem is that the syringes have, between the plunger and the needle, a small space in which they remain small amounts of fluid that end up being wasted. This is what is called “dead space (or volume)”.

The “dead space” problem is so real that with standard material only five doses can be withdrawn from each vial. With syringes and space needles it is relatively easy to extract the sixth. On the other hand, the seventh requires more expertise and, although there are places where it is being used, today it seems difficult to generalize its use.

In this sense, yes, Spain is wasting doses of the vaccine. In Andalucia, if we do cases of the official data, 34,855 extra vaccines could have been used so far this season (some less if we only count since January 8). There is no doubt that at the time of putting it into practice some of them would have been lost, but the figures give us an idea of ​​the size of the problem.

Why are some communities unprepared?

hospital clinic

That’s the big question. From the Junta de Andalucía, for example, They emphasize In the approval of the EMA it arrived on January 8 so, although they have requested special material, it is still available. However, the debate over low dead space syringes is not new.

La European Biosafety NetworK hizo a general recommendation in July 2020 explaining that “standard syringes and needles were not designed for large-scale immunization campaigns, where maximizing the use of vaccines is critical “and estimated, together with the WHO, that the waste caused by the ‘dead space’ of the standard models could reach 20%.

The 15th of July various information echoed a report from the Spanish Medicines Agency that would serve as the basis for planning the vaccination campaign and the problem was discussed. According to the Ministry of Health, in summer the communities had already been informed of the need to acquire this type of material. However, at the time of publication of this article we have not had access to the communication to confirm it.

Be that as it may, it seems clear that some autonomous communities prepared better than others Faced with a vaccination campaign that at the time of preparation (in summer) was still unknown and that has already taken its toll on us as thousands of doses of vaccine have been wasted due to lack of foresight.

Image | CLinic Hospital


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