Behind Alaska's low 'wasted' vaccine numbers, a combination of diligence and last-minute random calls

Feb. 20—Mark Huber and Cindy Mittlestadt got the call around 5:30 p.m. last Saturday. A friend heard there were some "end-of-the-day excess shots" at the Anchorage School District's COVID-19 vaccine clinic.

Huber and Mittlestadt were already vaccinated as caregivers of their 34-year-old daughter Tricia, who has cerebral palsy and other developmental disorders and is in a wheelchair, leaving her more susceptible to the virus and reliant on multiple caregivers from outside the home.

Under Alaska's vaccine rollout, Tricia was too young to get vaccinated despite her health issues.

Huber said the family jumped at the chance Saturday. They got to the school district clinic 20 minutes later. Tricia got her first dose.

Huber called the decision a "no brainer" that gave him no pause even though his daughter technically wasn't yet eligible.

"The vaccine would go to waste otherwise and that would be the real shame," he said.

As Alaska's vaccination program expands, stories like this are popping up: random last-minute connections that deliver precious doses otherwise wasted, or rewards for waiting at a clinic door as the day ends, despite the state policy that only eligible people should be receiving vaccine.

Similar narratives are emerging around the country of leftover vaccines going to "random people" to avoid throwing them away. The two vaccines currently being used need to be administered within six hours after vials are taken out of cold storage and opened. If the vaccines are not used within that period, they need to be tossed.

Here, the situation is part of a larger strategy that seems to be working, if the state's numbers are any indication. As of Thursday, the Alaska Department of Health and Social Services reported fewer than 100 wasted doses and more than 137,000 people with at least one shot in their arms.

It's hard to tell how that roughly 0.07% rate compares nationally. Not all states are reporting vaccine wastage, according to a report last month by ProPublica that describes doses lost after a health care facility in Washington couldn't find eligible recipients and Maryland workers who threw away thawed vaccine.

In Alaska, top health officials say the wasted doses include situations where a vial broke or needle malfunctioned. The first 20 doses of the Pfizer vaccine shipped to Ketchikan in December were tossed after arriving outside the recommended temperature range.

Alaska holds the top spot among states for number of people vaccinated in the United States, with nearly 20% of the population receiving one dose as of Saturday, and nearly 10% receiving a second dose. A separate federal Indian Health Service allocation for tribal members has led to broad distribution of the vaccine across Alaska, including anyone over 16 in some villages.

State health officials say they're monitoring wasted doses on a weekly basis and taking extra care to hold vaccine in Anchorage until it's needed before transporting it around the nation's biggest state.

But without a consolidated place where eligible people can sign up for last-minute shots, the process isn't always organized or necessarily fair.

State and municipal officials this week said they're working to create a more centralized system to distribute last-minute or extra doses — what one described as a version of a "vaccine Craigslist" marketplace where providers maintain a list of eligible people. Right now, that connection is happening via email.

"We are trying to make sure that we are connecting all of our providers so they can share those doses with each other," Tessa Walker Linderman, the state co-lead on Alaska's vaccine task force, said during a media briefing Thursday. "We're trying to put that together. It is definitely a little mismatched right now."

Anchorage health officials say they are working with state health officials on a sign-up for people who want to get called for last-minute vaccine availability at the state's COVID-19 hotline at 907-646-3322.

The call center will keep an "interested" list of vaccine-eligible people when no appointments are available for them, municipal health officials say. Call takers will collect contact information that can be given to a provider with extra late-day doses, with the understanding that any vaccine opportunity will almost always be very last minute.

Officials want to emphasize the last-minute list does not replace a waitlist, and offers no assurance of a call or appointment. People need to make sure they keep checking the state vaccine website for available appointments.

But the list does provide one place for different clinics to turn to when those hard questions start at the end of the day.

In recent weeks after the initial rush to book appointments waned, vaccine clinic workers sometimes scrambled to find fill-ins for appointments. Time is of the essence with vaccines that only remain viable for a few hours after they're drawn out of a vial.

Often, especially early on, workers at big clinics would get the extras.

Health officials say that, while not an ideal situation, anything is better then letting vaccine go to waste.

"There's a point where we have to say, 'Find an arm,' " said Christy Lawton, Anchorage's public health division manager, who adds that the priority is people within eligible tiers. "It's that or waste it. We are not going to waste any vaccine."

Lawton personally recalls a few episodes at the Alaska Airlines Center clinic where she scrambled to find people to grab slots after a standing vaccine waitlist was exhausted and it was getting late.

Unfortunately, those last-minute calls reflect the larger challenge of vaccine equity in general, said Dr. Janet Johnston, the municipal health department epidemiologist.

"You need somebody who can show up on the drop of a dime. The question is, how do you pull those lists together?" Johnston said. "It's people who have transportation, people who have flexible jobs or child care. Unfortunately, I don't think we have a solution yet but we really are thinking through those issues. How do you make that work?"

The situation shifts somewhat outside the large-scale clinics and urban providers of Anchorage.

In the Interior, the Tanana Chiefs Conference is providing vaccinations to 26 villages spanning a region the size of Texas, most not reachable by road.

Avoiding waste involves a combination of complicated logistics and pre-planning, said Jacoline Bergstrom, executive director of health services. The health organization does everything by appointment, setting up spots in advance of flying to villages and coordinate with village leadership to ensure everyone shows up.

"Because of that, we have not had a lot of waste at all," Bergstrom said.

At its urban vaccine clinics, the organization relies on appointments but also keeps a broad call list that includes employees from the Fairbanks Native Association and the conference's for-profit counterpart, Doyon, as well as frontline workers at the soup kitchen, family members of TCC employees, construction workers working on a health center expansion and educators in the community.

Dan Nelson, director of pharmacy at TCC, described one tactic that seems to work: Near the end of the day, clinicians call patients and let them know if they show up more than 10 minutes late, their vaccine may go to someone else.

"We've been tremendously successful using that technique," Nelson said.

In Mat-Su, public health officials refer to a standing waitlist for big clinics at the Alaska State Fairgrounds.

"We always have a waitlist to call, and usually have no problem finding qualified people to give them to," said public health nurse Rene Dillow, who added that people with second-dose appointments need to prioritize keeping them. "We have no way of transferring second doses to different days or other providers when appointments are missed."

Since January, Anchorage School District officials say they've given nearly 15,500 vaccine doses at busy clinics.

Asked about reports from Huber and others called to rush in for last-minute shots, district spokesman Alan Brown in an email said determining eligibility "depends largely on the honor system. There are certain things we can verify on site like age. But to confirm whether someone is a frontline worker or if they have a high-risk medical condition, we have to rely on a person's own integrity."

Generally, Brown said, the district doesn't have a waitlist because "we haven't needed one" and word of mouth spreads quickly about open vaccine appointments as the day goes on.

Vaccine doses stored in batches of six are delivered to nurses as needed during clinics, he said. Health workers track the number of prepared doses versus appointments already through the building and the number remaining.

That's led to "very few" doses remaining at the end of each clinic, he said. "Most often we've only had one or two, and the clinic staff has always had enough eligible recipients waiting at the door in hopes of receiving the dose."

ADN reporter Annie Berman contributed to this report.

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