# Each Day, Vaccine Workers Solve Tricky Math To Keep Doses From Going To Waste04:01DownloadCopy the code below to embed the WBUR audio player on your site<iframe width="100%" height="124" scrolling="no" frameborder="no" src="https://player.wbur.org/commonhealth/2021/03/09/each-day-vaccine-workers-solve-tricky-math-to-keep-doses-from-going-to-waste"></iframe>

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On the edge of the Reggie Lewis Center’s indoor track turned mass vaccination site, Emily Rice barely seems to notice the hundreds of people getting inoculated in front of her. Instead, she’s focused entirely on the tiny vial between her fingertips. In her other hand, she eases the plunger back on a syringe, drawing 0.3 milliliters of the Pfizer vaccine into its chamber.

Rice is a vaccine preparer for CIC Health, which operates the mass vaccination site at Reggie Lewis. All day, she painstakingly fills syringes with the Pfizer coronavirus vaccine. Each vial is supposed to contain five doses, but most actually have one or two extras.

“Just from this vial, I’m on number seven,” she says. “Seven is the max, and it’s hard to get that.”

Similarly, Moderna vials are billed at 10 doses, but they often contain 11. Once a health worker cracks open a vial, the clock is ticking. Moderna and Pfizer vials have six hours before they need to go in the trash. With Johnson & Johnson, there aren't expected to be extra doses, but the five shots in each vial are good for just two hours at room temperature – six hours with refrigeration.

That leaves clinic managers with a tricky math problem. How to vaccinate every person arriving for an appointment without breaking the seal on too many vials too quickly.

Let’s say the Reggie Lewis Center has 1,200 vaccinations scheduled. If every Pfizer vial contains only five doses, the clinic will need 240 vials to handle all those people. But with extra doses in most vials, opening 240 would leave hundreds of unused doses at the end of the day – and clinicians would be scrambling to find arms to put them in before they expire.

“And that’s something I am super anal about, right? I mean, it’s like – that’s not happening,” says Chris Kaufmann, the lead vaccine coordinate at CIC Health, which runs three mass vaccination sites. “We take this very, very seriously. I treat every single dose as liquid gold. As precious as a life.”

Part of Kaufmann’s job is making sure that the number of doses health workers prepare closely matches the number of patients on any given day. As long as the clinic opens the right number of vials, they should only have to deal with the remainder of a single vial at closing time.

“It sounds like just simple multiplication,” Kaufmann says. “But once you’re actually drawing up 4,000 syringes a day – it’s a formidable task.”

CIC Health keeps two vaccine coordinators on site. Throughout the day, they scribble calculations on sheets of paper – periodically checking to see if the number of doses extracted matches the number of people vaccinated and checking their colleagues’ work.

If everything goes according to the plan, there should be no more than one open vial with a maximum of six doses left at the end of the day. Those last doses go into the arms of clinic staff and volunteers who haven’t yet been vaccinated. If everyone has already been vaccinated, then the staff will call up eligible people on a priority list to receive one of the doses.

A version of this process goes on in every vaccination clinic, but often smaller clinics lack the resources to hire a staff dedicated to tracking doses. Dr. Sheena Sharma runs a community health clinic in Webster. On days when her clinic turns into a local vaccination site, she hustles to make sure doses aren’t wasted.

“I’m like, this is the most stressful part. The rest of the clinic’s easy. It’s the darn doses - the way these vials are made,” she says.

A small brigade of volunteers administer hundreds of COVID-19 vaccinations at her clinic. So, she’s the one running around counting patients and doses.

“38 – 4, 5, 6,” she mutters to herself as she peeks into each vaccine station. “And we just lost the one.”

The "lost" one is a patient who couldn’t get the vaccine because she received a different shot too recently. To make sure they don’t end up with an excess of open vials, Sharma has to keep a running tally of last-minute cancellations and extra doses – almost like she’s counting cards at a blackjack table.

“We’re gonna be off, but we can’t tell how much,” she calls to one of her volunteers. “It’s really hard to tell.”

To keep vaccines from going down the drain, Sharma and other volunteers start calling up patients who are eligible for the vaccine but didn’t get a chance to make an appointment. If they’re free, they come to the parking lot and hope to get a dose from the last vial of the day.

One of those people is Mary Warchal, a teacher and child care worker in Webster, and a friend of one of the doctors volunteering at the vaccination clinic. When she got the call about an extra dose, she says she debated for a second – then jumped in the car.

“The thought of being able to hug my parents – this just gets me closer to that,” she says. “I feel good right now. Excited. Like I might have won the lottery.”

And at the end of the day, all of the extra doses from the very last vial have gone to people who are eligible for the vaccine. The clinic didn't waste a single shot.

This segment aired on March 9, 2021.

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Angus Chen Reporter, CommonHealth
Angus Chen is a reporter for WBUR's CommonHealth.

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