MEMO: Strategies to Limit Unused Doses and Expanded Third Dose Eligibility

TO: Pharmacy and Health Care Professionals in the Niagara Region

FROM: Pandemic Response Division, Niagara Region Public Health

REFERENCE: Strategies to Limit Unused Doses and Expanded Third Dose Eligibility

DATE: Sept. 21, 2021

As of September 20, over 687,000 doses of COVID-19 vaccine have been administered to Niagara residents and as of September 20, over 77% of the eligible population in Niagara are fully vaccinated against COVID-19. Although the COVID-19 vaccination program in Niagara has been a great success, it is important to continue to strive to achieve higher coverage, especially in the context of the surging Delta variant.

Several factors around our current vaccine products contribute to unused dosages including vaccine packaging in multi-dose vials, strict storage and handling requirements and limited post-puncture time for product use.

Early in the vaccination roll-out, vaccine was in short supply with a huge number of people seeking vaccinations, but unable yet to get it. Every wasted dose was a lost opportunity to vaccinate someone eagerly seeking vaccination. The priority therefore was not to waste a dose, as every wasted dose slowed our vaccine rollout.

Now we are in a position of having more vaccine supply than demand to be vaccinated. The priority now is to convince hesitant and complacent persons to get vaccinated. Any person deferred for vaccination out of fear of wasting a vial is potentially squandering an opportunity to vaccinate someone we may not be able to engage again. Therefore, opening a vial to vaccinate one or a small number of individuals will be necessary to maximize vaccination uptake.

Notwithstanding this, the goal in Ontario remains to optimize the use of COVID-19 vaccines and limit the number of unused doses through effective storage, handling, and program and clinic strategies. However, this should not be at the expense of missed opportunities to vaccinate.

Strategies to Limit Unused Doses

Take every opportunity to vaccinate, especially for those who may be vaccine hesitant and for those who may be less likely to return for their vaccine, either first or second doses.
- Visit our website for information and resources on addressing vaccine hesitancy. Please see our new resource titled “Vaccine hesitancy – 2A quick reference tool” which aims to build confidence and reduce barriers to COVID-19 vaccination.
Do not cancel booked appointments or turn people away due to the possibility of wastage
Continue locating individuals for vaccination (e.g., from waitlists) wherever possible
Continue hosting dedicated vaccination clinics whenever possible to ensure most doses can be administered
Limit expiry of closed vials through proper inventory management, storage and handling, fridge monitoring (e.g., temperature logs), stock rotation based on expiry and “must use by” dating, and recommended packing and transport per product specifications

Expanded Third Dose Eligibility

On September 14, the province announced that additional vulnerable populations are eligible to receive a third dose of COVID-19 vaccine. The expanded eligibility for a third dose aligns with the National Advisory Committee on Immunization (NACI) recommendation on providing additional doses of COVID-19 vaccine in immunocompromised individuals.

In addition to the individuals listed in our August 31 Memo, the following individuals are eligible to receive a third dose of COVID-19 vaccine

Those undergoing active treatment for solid tumors;
Those who are in receipt of chimeric antigen receptor (CAR)-T-cell;
Those with moderate or severe primary immunodeficiency (e.g., DiGeorge syndrome, Wiskott-Aldrich syndrome);
Stage 3 or advanced untreated HIV infection and those with acquired immunodeficiency syndrome; and
Those undergoing active treatment with the following categories of immunosuppressive therapies:
- anti-B cell therapies (monoclonal antibodies targeting CD19, CD20 and CD22),
- high-dose systemic corticosteroids,
- alkylating agents,
- antimetabolites, or
- tumor-necrosis factor (TNF) inhibitors and other biologic agents that are significantly immunosuppressive.

These individuals can receive their third dose at a recommended interval of eight weeks following their second dose, though as early as 28 days is acceptable.

Process for Vaccinating Eligible Individuals

The process for vaccinating eligible individuals with a third dose remains the same as to what was outlined in our August 31 Memo.

As a reminder, patients referred to a vaccination clinic for their third dose must be provided with a medical letter to present at the clinic that states the condition that makes them eligible for a third dose of COVID-19 vaccine. A medical letter from the patient’s pharmacist specifying the medication that makes them eligible to receive a third dose is also acceptable at Niagara Region Public Health clinics. The medical letter must include

Date and be on letterhead
Contact information for the clinic, physician, specialist or medical practice of individual completing the form
Patient’s name (typed/generic letters will not be accepted)
Patient’s eligible condition (or medication) for third dose

If you are administering the COVID-19 vaccine at your office, you may also provide third doses to your eligible patients. Eligible patients should not be given a third dose, or referred to a vaccination clinic, until they meet the time interval for a third dose as specified above.

More Information

Call the COVID-19 Primary Care Info-Line at 905-688-8248 (press 7, then 1 for physicians). The info-line is open Monday to Friday, 8:30 a.m. to 4:15 p.m.