In the first leg of the race to vaccinate Yukoners against COVID-19 — the most urgent vaccine rollout of our times — immunizers had to juggle shake-it-and-you-break-it doses and their hours-long shelf life, among other considerations.
In the end, relatively few doses was thrown out and, in a twist, the Yukon government gained hundreds more than expected.
The government primarily used the Moderna COVID-19 in the first four months of the rollout.
Careful planning was essential.
"Once it's at room temperature, there's no going back," Marija Pavkovic, manager of the Yukon Immunization Program, which is part of the health department, said in a phone interview on June 15.
Vials, which are supposed to provide 10 doses' worth of vaccine each, take about one hour before the vaccine goes from its frozen state to a liquid state.
If kept in a fridge after that, it has a 30-day shelf life, Pavkovic said.
Once at room temperature, the vial's shelf life is 12 hours if not punctured, then six hours once a dose is extracted.
The vaccines cannot be refrozen for later use.
Of the 48,791 doses of COVID-19 vaccines administered or meant to be administered in Yukon between January and April, 137 were wasted — 0.28 per cent.
The numbers, obtained via a public-records request, are from the Department of Health and Social Services.
Of the doses thrown out, 116 doses were not used in time, 12 were unused due to needle contamination, five due to needle malfunction, and no reasons were provided for the remaining four.
According to the data, the COVID-19 vaccine from Oxford University-AstraZeneca was administered at the Whitehorse Health Centre one day in April, and nine of those doses were wasted.
The Yukon government did not reveal the exact number of doses administered that day — only that there were between one and five — because, as it claims in its response to the access request, "disclosure would be an unreasonable invasion of third parties' privacy."
The rest of the numbers are doses of Moderna's vaccine.
People didn't show up, doses wasted
One reason why the 116 doses weren't used is because people didn't make their appointment, and there were no other people around to give them to at the time, Pavkovic said.
"If clients don't show up for their appointment, it's very difficult to predict how much vaccine you need to thaw," she said, adding that she wants people to be mindful of the work that goes into offering this time-sensitive service, along with the ripple effects of not showing up.
Pavkovic recommends people reschedule appointments if they can't make it.
The other reason for unused doses has to do a bit with chance.
Immunizers must thaw a 10-dose vial, even for just one dose. So if only one person is around to get a dose, nine may be wasted.
If there was another clinic in the same community the next day, some people were asked if they could come back then to avoid these situations, Pavkovic said.
When the timing worked out, immunizers brought those leftover room-temperature vials for use at other clinics on the same day. That includes vials opened in Carcross, Carmacks, and Haines Junction that were later made available to people in Whitehorse, where most Yukoners live.
They had to move the open vials with care, following specific storage and handling guidance.
"This vaccine is, like, quite sensitive in the fact that if you shake it ... it's not effective," Pavkovic said.
The health department also had to contend with the logistical challenges of setting up mobile clinics in different rural communities, most of which have populations in the hundreds, including the usually fly-in-only community of Old Crow.
As for that aforementioned twist: It was in the vial all along.
While each vial is only promised to provide 10 doses each, immunizers have been able to sometimes get 11.
"You have to be experienced and your technique has to be good," Pavkovic said. "Some vials are easier to extract that extra dose from than others."
In total, immunizers were able to get 873 extra doses this way over that four-month period.
Of the 137 wasted doses, 54 were the extra doses.
That's far below the five per cent maximum wastage guidance Pavkovic said was provided by the Public Health Agency of Canada.
With fewer people now left to vaccinate, Pavkovic said she expects perhaps slightly more wasted doses, due to the 10-dose-per-vial issue.
However, she added, as of June 9, the shelf life of the Moderna vaccine has been extended to 24 hours at room temperature before being punctured, and another 24 after that happens, which might balance things off.