States are sitting on millions of surplus Covid-19 vaccine doses as expiration dates approach

Millions of unused Covid-19 vaccines are set to go to waste as demand dwindles across the United States and doses likely expire this summer, according to public health officials.

Several state health departments told STAT they have repeatedly asked the federal government to redistribute their supply to other countries, many of which are facing a third wave of the Covid-19 pandemic. Officials in Washington have rejected those requests, citing legal and logistical challenges.

“We’re drowning in this stuff,” said Robert Ator, a retired colonel in the Arkansas Air National Guard who is leading that state’s Covid-19 vaccine distribution drive. “It’s starting to get a bit silly and we want to make sure we’re being good stewards.”

Some of the wastage could be forestalled if U.S. health officials extend the shelf life of the vaccine developed by Pfizer, but such expiration dates can only be extended so far.

Currently, states have administered 52.36 million fewer doses than have been distributed to them, according to federal data.

Part of that vaccine gap can be attributed to reporting delays and everyday wastage, while some unused vaccine includes second doses that haven’t been administered yet. Still, even a conservative estimate suggests at least half is likely excess vaccine, said Jennifer Kates, director of global health at the Kaiser Family Foundation. That would leave 26.2 million unused doses at the state level — enough to protect at least 13.1 million people.

A significant tranche of Pfizer doses is expected to expire in August. “We’re staring down the barrel, we know it’s happening,” said Jenny Ottenhoff, senior policy director of global health and education at the ONE Campaign, the nonprofit seeking to end extreme poverty and preventable disease. Given waning domestic vaccine demand, those doses are unlikely to be fully used before they must be tossed.

“We’re seeing demand falling off across all the states,” said Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials. “It’s not like, if Connecticut doesn’t need theirs, it can go to Alabama. There just isn’t the demand.”

In North Carolina, 119,756 doses from all three vaccines authorized by the Food and Drug Administration will expire in July; an additional 854,548 is set to expire in August, and hundreds of thousands more will expire in the fall. Arkansas hasn’t accepted new orders since April, when it had 500,000 doses, and has since worked its way down to 380,000, some 100,000 of which will expire at the end of July. “We’re still chopping away at it,” said Ator. “I don’t want to waste a thing.” Delaware said 25,768 vaccines will expire in August, while Colorado has 352,533 doses that will expire in the next two months.

Meanwhile, stockpiles of vaccines continue to build at the federal level. The U.S. has bought 1.41 billion doses in total, and has so far distributed around 390 million across the country. An additional 562 million Moderna, Pfizer, and Johnson & Johnson vaccines are expected to arrive in the U.S. from July 2021 until the end of the year, according to Airfinity, a life sciences analytics firm. The White House announced plans to share 80 million doses of its supply last month, and purchased an additional 500 million vaccines for low- and middle-income countries.

The federal government previously extended the shelf life of J&J vaccine that was set to expire as new stability data emerged, and several state health departments hope that the “Pfizer cliff,” as it’s called, will also be pushed back.

Vaccines already distributed to U.S. states are especially valuable from an international perspective, as they’re ready to use immediately. “They’re real doses sitting on shelves and not waiting to be manufactured. That could change the game in terms of speed,” said the ONE Campaign’s Ottenhoff. “Right now, the most important thing in terms of sharing doses internationally is sharing it fast.”

Many states started seeking federal assistance in redistributing excess vaccine internationally in April, Plescia said, with the Covid-19 crisis flaring in India. Some wealthier states, such as New York and California, have the financial capability to arrange international transportation themselves, said Plescia. And there are plenty of vaccines close to the border, where it would be easy for providers to give supply to those in Canada or Mexico. The federal government owns these vaccines, however, and does not permit states to redistribute them.

“We would prefer to waste zero doses. If we have it, let’s get it in somebody’s arm,” said Chris Kopach, Covid incident commander at the University of Arizona, which has capacity to store 1.6 million vaccines in ultra-cold freezers. The center is currently holding 100,000 doses, with large quantities of Pfizer vaccine set to expire in August. Kopach asked in May if mobile clinics could help take the doses over the border to Mexico. “It’s a great opportunity to partner with our neighbors,” he said. “Could we just give it to Mexico? In reality, it’s not for me to give.”

Kody Kinsley, operations lead for North Carolina’s Covid-19 response, said he was also told he didn’t have the rights to arrange redistribution: “It was a U.S. government-funded product, and it was given to us. We can’t just give it away.”

The U.S. Department of Health and Human Services said it has looked into redistributing vaccines currently held at state level, but said moving doses from 80,000 providers has so far been too legally and logistically complex. “Overall, the federal government has done a very efficient job of managing vaccine supply, and we are doing everything we can to help states use the supply they ordered and still have in their inventory,” said spokesperson Kirsten Allen. “We are doing everything we can to help states administer all of their doses and avoid any wastage and maximize getting shots in arms.”

States are permitted to donate vaccines that have been allocated to them but not yet distributed to the federal pool, which could potentially be sent elsewhere. The federal government also responded to state health department concerns by allowing them to request only specific quantities of vaccine rather than receiving a set amount determined by population.

For now, there’s still hope something can be done. Public health experts believe doses could be returned to the federal government to then be centrally redistributed. Doing so would be a challenge and take resources, they said, but would be worthwhile given the global need.

“It might take some extraordinary effort. We’ve seen extraordinary effort throughout this pandemic,” said Ottenhoff. “That’s why we have enough vaccines for Americans who want them. I’m hoping we can see that extraordinary effort expand beyond Americans for those who need them internationally.”

Kates, from Kaiser Family Foundation, agreed: “This is an unprecedented situation,” she said. “This is urgent. What happens elsewhere affects us, and vice versa. This truly is a global phenomenon and challenge.”