'Unused' doses, double booking and other things you need to know about your COVID-19 vaccine

There is a lot of talk about unused vaccine these days. According to the most recent numbers from the Centers for Disease Control and Prevention, more than 20 million doses of distributed vaccine haven’t been administered across the country. 

“This idea that there are unused doses sitting around isn’t quite accurate,” says Danielle Scheurer, M.D., MUSC Health System chief quality officer. “We don’t just have a freezer full of it. We get it, and almost immediately, it goes in the arms of people that are scheduled that week. But with a weekly shipment, we are always going to have more inventory at the beginning of the week than the end.”

The disconnect, Scheurer says – and an important thing to point out to the general public, which might think that hospitals and long-term care facilities are dragging their feet in the area of vaccine administration – is that when the CDC reviews its data can vastly affect the numbers. The CDC has acknowledged that sometimes its data might lag and, in some cases, erroneously count doses more than once, lending to artificially high numbers of unadministered vaccine. 

 

“Our doses usually come in on Monday, so if they review their data that day, or even early in the week, they’re going to see a lot of ‘unused’ doses. That just isn’t very clear to people who aren’t privy to all the things we see on our side.”

A bigger fish to fry, Scheurer thinks, is reducing the amount of data input that needs to be done. According to the CDC, South Carolina is one of only 13 states using the federal government’s vaccine tracking system, known as VAMS – Vaccine Administration Management System. In addition to MUSC Health’s standard vaccine documentation, a system known as SIMON, the South Carolina Department of Health and Environmental Control also requires the use of VAMS. 

“I don’t know that people realize all the documentation that goes into this. Demographics, lot number, expiration of vaccine – it’s a lot. Every time we administer a dose, we have to do the accompanying documentation. As a result, we’re constantly playing catch up. Our goal, eventually, is to be administering 10,000 doses a day. To put things in perspective, if we had enough vaccine to make that happen seven days a week, we would need 200 man-hours a day just to keep up with the documentation. That’s a colossal amount of time – time I’d say that isn’t well spent.” 

With the vaccine landscape changing almost daily, each week we are checking in with Scheurer to ask her the most pertinent questions that are hanging in the balance.

Q. Are people who need the second dose being turned away?

A. Absolutely not. We are guaranteeing second-dose scheduling. If for some reason somebody has a tough time getting a second dose appointment, they can simply reach out to us.

Q. Speaking of scheduling, I’m hearing from several people who are having a tough time with cancellations. Some don’t know where or who to reach out to and some don’t have MyChart accounts. What should they do?

A. First off, I appreciate how conscientious people are. They don’t want to hold appointments from somebody else. Just know we have a feature to see if somebody has double booked a dose, and we’re able to contact them. That said, if anybody has any concerns about double booking or not being able to get a second dose scheduled, they can call 843-876-7227 or visit muschealth.org/get-vaccine. Additionally, I get it if some people don’t want to sign up for a MyChart account just to get a vaccine and there’s a way to bypass it simply by choosing ‘check out as guest.’

Q. If somebody has already gotten COVID-19, should they still get the vaccine?

A. It’s not a perfectly simple answer, but yes, they’re eligible for the vaccine, and there’s no medical reason why they shouldn’t get it. But given the shortage, we’re telling everybody who falls into Phase 1a that it’s OK to wait 90 days post-symptoms to schedule your vaccine because natural immunity lasts at least that long.

Q. Can people with medical conditions such as diabetes or cancer get the vaccine yet?

A. There are so many people who are deserving of getting this vaccine that aren’t able to yet. So I’m sad to say no, they can’t, yet. There are more than 630,000 South Carolinians age 70 and older, and we’re currently only receiving 60,000 doses a week in the entire state, so we just have to be patient. 

Q. When will children be able to get the vaccine?

A. I would venture to say the earliest that could happen is summer, based on the additional clinical trials that need to be completed and published. At the rate we’re vaccinating in the U.S., it will take that long to get all the people over the age of 16 vaccinated anyway. 

Q. Is this a live vaccine?

A. No, and I think it’s important for people to know that. It’s a replica of a small piece of the genetic material that encodes for the spike protein. So it’s not live RNA. It’s RNA that scientists created. There’s nothing live about it. It’s similar to the monoclonal antibody treatments. Those are manufactured, too. Because we know what the anti-COVID-19 antibody looks like, we are able to manufacture it and infuse it into the person as a treatment for COVID-19. 

Q. On the topic of monoclonal antibody treatment, should people who have received it also get the vaccine? 

A. Monoclonal antibody treatment is similar to the vaccine, only instead of giving your body the information it needs to make anti-COVID-19 antibodies, it’s skipping that step and giving you the antibodies. We think that the ones your body makes, via the vaccine, are probably more effective than giving you the antibodies themselves, but they’re still both effective. But again, the short answer is the same as for those who have already contracted COVID-19, we’re telling them to wait 90 days after a monoclonal antibody infusion to schedule their vaccine. 

Q. How did scientists develop this vaccine so quickly? During previous outbreaks of coronaviruses like SARS and MERS, they weren’t able to do it. 

A. It is amazing, isn’t it? We certainly have some smart people on this planet. But the truth is several companies like Pfizer and Moderna were already working on messenger RNA vaccines before the outbreak even started. Messenger RNA is notoriously unstable. So the real breakthrough technology was the lipid nanoparticle that they coated it with. That’s the real miracle. That coating is what allowed it to remain stable long enough to get it inside the human body, and do its job. SARS and MERS burned out so quickly that a vaccine didn’t come into play, but had they endured anywhere near like this, I feel like they would have come up with a vaccine for those just about as quickly. 

**Have a question you'd like answered? Email it to donovanb@musc.edu with the subject line "Vaccine Q."