Sunday, 7 Aug 2022

Covid 19 coronavirus Delta outbreak: The Government behind in race to procure less wasteful syringes

The Government is still trying to purchase less wasteful syringes for the Covid-19 Pfizer vaccine.

In July, it put out a request to the market for three million syringes to be delivered by the end of August. None of those syringes have arrived yet – and the Ministry of Health has confirmed that it has not even selected a preferred supplier for that contract.

The problem with the country’s syringe stock goes back to when they were ordered at the beginning of the year, when other countries were already vaccinating their people.

Because of the tight demand for syringes at the time, the Government purchased what it described as the “best available options at the time,” – these syringes appear not to have been thepreferred option – and they appear not to have even been the syringes recommended by Pfizer, the manufacturer of New Zealand’s vaccine.

There is nothing especially wrong with the syringes and needles New Zealand has used – people vaccinated with them get a full dose of the vaccine.

The problem is that evidence from the front line of the rollout suggests that a particular combination of needle and syringe used on the rollout is wasteful, with vaccinators drawing as few as 5 doses from a vial of vaccine, short of the 6 doses the Government hopes to achieve and the 7 doses which is possible.

This is a problem for the Government, which wants to supercharge the vaccine rollout, while ensuring that stocks of vaccine go as far as possible.

The Ministry of Health has tried to address the wastage issue. It stopped using a particular syringe-needle combination which was found to be particularly wasteful and in July it sought a quote for six million more syringes – this time, ones that could hopefully extract as many as seven doses per vial.

But this order has also hit a snag.

In its request to the market in late July, the Ministry said it wanted the first three million of those syringes to arrive by the end of August.

As of the first week of September, the Ministry has not yet finalised a deal with a supplier.

National’s Covid-19 spokesman Chris Bishop said the delay was concerning.

“Why has the ministry still not procured syringes that were apparently urgent and needed to be delivered by August?” Bishop said.

How New Zealand gets its vaccines

The Government has ordered 10 million doses of its chosen vaccine, Pfizer.

One of the complexities of ordering vaccine is that the Government orders and receives the vaccine in different units.

It orders the vaccine by the dose – meaning the Government literally orders 10 million doses of the Covid-19 jab from Pfizer, but the Government receives vaccinations in trays of vials. A vial of Pfizer vaccine could deliver as few as five or as many as seven doses.

The Government keeps tabs on the number of doses of vaccine in stock, which are regularly published. The Ministry of Health confirmed that from the early stages of the pandemic this number was calculated by looking at the number of vials of vaccine in stock and multiplying it by six – reflecting the six doses that were taken, on average, from each vial.

The Ministry of Health reports it has 184,000 doses in stock as of August 29 – or about 30,000 vials of vaccine (the Ministry notes that there is some rounding that goes into producing this figure).

Wastage matters, particularly at the moment when there is constrained supply.

If those vials were to only get five does of vaccine per vial, the Government would go from having 180,000 doses in stock, to just 150,000. If those vials stretched to seven doses, it would have about 210,000 doses in stock.

Ordering syringes

Answers to Written Parliamentary Questions from Bishop sketch out a timeline for how the syringes and needles were ordered.

Covid-19 Minister Chris Hipkins told Bishop the “initial purchase orders” for the vaccine were placed in October 2020, with syringes arriving in February 2021.

Hipkins said at the time the “global supply chain for 1mL syringes and needles was severely constrained at the beginning of the 2021 and options were limited”.

In answer to a different question, Hipkins said that in February 2021 needles and syringes designed for six doses a vial were purchased. These numbered 8.5 million needles and eight million syringes.

These “best available options” were a combination ofBecton Dickinson (BD) syringes with Vernacare low dead space needles”. They were able to get six to seven doses of vaccine per vial – exactly what the Ministry wanted.

But this appeared to change following the exhaustion of BD supplies, when the BD syringes were replaced with Vernacare syringes in June.

Hipkins said that a “combination of Vernacare syringes and low dead space needles were used across a number of vaccination sites”.

This new combination did not work – in fact the Ministry went back to Vernacare and asked them to investigate the syringes. The Ministry has since stopped using the syringes entirely.

No one has a clear idea of how serious or widespread the problem might be, because that level of granular detail is not collected. However, Hipkins said that “most sites were drawing between five and six doses per vial” – fewer than what was hoped for.

Bishop said the timeframe presented by the answers to those questions painted a “confusing picture”.

“But it is pretty clear there has been a stuff up along the way in terms of procurement of syringes and needles,” he said.

Ordering more syringes

The country has enough syringes for the rollout – in fact it has more than enough syringes to go around.

But with supplies of vaccine currently constrained there are questions to be asked about whether procuring better syringes earlier in the rollout might have allowed the country to stretch its limited doses of the Pfizer vaccine a bit further.

That is a question that could be difficult to answer – as granular data on how many doses are being taken from each vial does not exist, although it is possible to extrapolate a rough figure from the number of people who are being vaccinated and the number of vials of vaccine used to vaccinate them.

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