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State, Hospitals Using Vaccine Waitlists In Effort to Limit Waste

COVID vaccine shot
NH National Guard
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With demand for COVID-19 vaccines still far outpacing supply, states and health systems are under enormous pressure to ensure little—or ideally none—expires at day’s end. In New Hampshire, hospitals serving as public vaccination sites, as well as state-run vaccine clinics, are utilizing waitlists to manage last-minute appointments, though the lists themselves aren’t being publicized.

“I didn’t know there was such a thing, and I don't think many other people know there is,” said Frances Gallagher, 92, of Berlin. 

Gallagher learned about a waitlist overseen by Androscoggin Valley Hospital through word of mouth: her sister-in-law called to say they’d been added to the list after calling with a question about scheduling.

“I called the number that my sister-in-law had called, and this person says, ‘Well I’ll put you on the list, and we’ll call you if there’s a place.’ So I’m kind of waiting, at this point, to see how this works out,” Gallagher said.

It isn’t clear if Gallagher, who is scheduled for her first vaccine on April 3, will be one of the lucky ones called for a last-minute shot. North Country Healthcare, which includes three hospitals administering vaccines to the public--Androscoggin, Weeks Medical Center and Upper Connecticut Valley Hospital--is currently managing multiple waitlists totaling hundreds of people.

“Word gets out quickly,” said Ed Laverty, incident commander for North Country Healthcare. 

[Your Guide To Coronavirus Vaccines in New Hampshire]

Both the Pfizer and Moderna COVID-19 vaccines are shipped and stored in freezers before they are pulled out to thaw and prepared for injection. Once they reach room temperature, the vaccines have a six-hour shelf life. At day's end, any unused vials can’t simply go back into the freezer. That creates a tricky balancing act that is further complicated by last-minute cancellations or no-shows, as well as people arriving with or without a spouse at vaccination sites, which are set up to vaccinate both.

Laverty said his facilities haven’t wasted a single dose yet. Employees work the phones until they can find someone on the waitlist who can arrive onsite within, generally, an hour of the call.

“People are like, we gotta get dressed. It’s like, ‘come in your bathrobe, we don’t care. We need access to your arm anyway,’” said Laverty. 

North Country Healthcare hospitals are prioritizing their waitlists for older residents, and those who have been identified by primary care doctors as being at greater risk.

At Hampstead Hospital, another public vaccination site, staff work off of an Excel spreadsheet to contact people who have been previously added to their wait list.

“So on any given day, I’m typically able to pull in anywhere from 18-25 additional folks from our list,” said Kathi Collins, chief operating officer for Hampstead.

Collins said state health officials encouraged hospitals to do everything they could to utilize the vaccines, but there were no written guidelines, so each participating facility came up with its own rules for the waitlist. At Hampstead, anyone requesting to get on the waitlist needs to have already made an appointment in VAMS, and should live within an hour’s drive of the hospital. 

So far, Collins says her facility hasn’t wasted a drop.

“We wanted to be sure we weren’t going to have any extra doses at all, and we would be able to get every dose that we have in an arm,” Collins said.

During a recent press conference, Gov. Chris Sununu said the state-run drive-thru sites, which are being staffed by the N.H. National Guard, are also keeping a waitlist for any end-of-day extra doses.

“They always have a phone list that they can go to, or they can call folks and bring them in, and make sure that none of that gets wasted, or at least a minimal amount gets wasted,” Sununu said.

The state is working backwards, prioritizing those with appointments the furthest out on the calendar, according to DHHS.

The agency declined to release exact figures on how many vaccines have been discarded, but said the number was less than 1% statewide, with broken vials or broken syringes the leading cause of waste.

To date, the CDC hasn’t released national statistics on vaccine wastage. Neighboring Vermont, which has received approximately half as many doses as New Hampshire, based on its population, is reporting just 224 doses have gone to waste out of nearly 150,000 received, a wastage rate of around 0.1%.

The Maine Centers for Disease Control said it “has not received reports of significant amounts of discarded or expired doses.”

In Nashua, the local public health network, which is focused on an equitable rollout of the vaccine across underrepresented minority groups, is coordinating a waitlist with the local state-run site.

Lakes Region General Hospital, which is also administering doses to the public, is reporting zero wasted doses so far. Its waitlist, which has more than 100 names, is prioritizing medically vulnerable people who live within proximity of the hospital.

Like other facilities, LRG said it is turning away people who are showing up without an appointment, and is encouraging people not to wait in the parking lot at the end of the day, as has been reported at other hospitals.

Frances Gallagher, who turns 93 next week, said she is waiting patiently for a call from the local hospital for her vaccine, but isn’t sure if or when it may come before her already scheduled April 3 appointment.

“You have to use what you’ve got,” Gallagher said. “It isn’t something that you can put aside and use it later.”

Todd started as a news correspondent with NHPR in 2009. He spent nearly a decade in the non-profit world, working with international development agencies and anti-poverty groups. He holds a master’s degree in public administration from Columbia University.

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