At least five states on Wednesday said that doses of coronavirus vaccines were going to waste as citizens were not showing up to receive their shots, mainly due to worries over possible adverse reactions, the Hindustan Times reported.

India authorised two vaccines this month for emergency use at home, Oxford University-AstraZeneca Covishield vaccine, produced by the Serum Institute of India, and Covaxin, a government-backed, indigenous one from Bharat Biotech, whose efficacy is not known.

In case of Covishield, each vial contains 10 doses, while Covaxin has 20. Both vials need to be used up within four hours once opened. This has led to a wastage of doses in Maharashtra, Tamil Nadu, Haryana, Bihar and Assam, where recipients failed to show up on time, or at all, for their shots.

“On the first day of the vaccination, as we had recorded 100% turnout, we didn’t lose any unit,” Amravati District Health Officer Dilip Ranmale told Hindustan Times. “All the registered 100 health care workers opted for vaccination. However, the next day when only 38 HCWs [healthcare workers] came forward, we lost two doses from the second vial.”

Officials noted that loss of doses was not uniform and more doses of Covaxin had to be thrown away at some locations since they were in vials of 20. “In case of Covaxin, it is difficult to mobilise 20 health care workers at a time, given that hospital functioning should not be interrupted,” said Dr Binod Kumar Singh, superintendent of the Nalanda Medical College Hospital in Patna, Bihar, where 25% of doses were thrown away.

Tamil Nadu’s Health Secretary J Radhakrishnan said some of this problem is inevitable. “Unused doses are inevitable as some session sites will have less beneficiaries while other sites will have more than the prescribed 100 beneficiaries in a day,” he added.

The state’s Director of Public Health and Preventive Medicine TS Selvavinayagam noted the conflict of choice the situation created. “Each vial has 10 doses, and if only five people are coming, either we have to deny vaccination for these five people or waste five doses,” he told the newspaper.

In Uttarakhand, Immunisation officer Kuldeep Singh Martoliya said the state has decided it would open vaccine vials only after around 10 candidates line up for vaccination. “Along with this, there is strict supervision over vaccinators to ensure that doses are not wasted,” he added.

Assam orders probe

Authorities in Assam ordered an investigation after 1,000 doses of Covid-19 vaccine were wasted after they were stored in sub-zero temperatures at the Silchar Medical College and Hospital in Assam’s Cachar district, PTI reported.

A senior doctor of Silchar Medical College and Hospital said that the vaccines were supposed to be stored at a temperature of 2 to 8 degrees Celsius. However, it was found that the vials were kept in sub-zero temperature because of which they froze.

Cachar Deputy Commissioner Keerti Jalli said that 100 vials of Covishield vaccine were spoiled mainly due to lapses in the storage facility and cold store management. “We have, however, initiated an inquiry into the incident to ascertain the exact reason behind the lapses,” Jalli said.

The vaccination drive will not be hampered due to this as “we are prepared with enough stock and error margin was also taken into account during the allocation of doses for the district,” she added.

Assam’s National Health Mission Director S Lakshmana said that show-cause notices were issued to those responsible for storing and supplying the vaccine. The priority now was to ensure scientific disposal of the wasted doses, he added.

In Cachar district, 11,710 healthcare workers are scheduled to be vaccinated in the first phase and there are two session sites in the district – Silchar Medical College Hospital and S M Dev Civil Hospital.

Vaccine hesitancy

India, which has reported the highest number of coronavirus infections after the United States, has so far vaccinated 7,86,842 frontline workers after starting the campaign on Saturday, according to the Union health ministry. This still translates to a cumulative coverage rate of only 55% – every day, 100 people are selected, and invited for shots for each session, and on average roughly 45 of them are not turning up, according to the Hindustan Times.

The government has urged frontline workers not to refuse the vaccines, after almost all states failed to meet their targets in the first few days of the immunisation drive. But many people have declined to take the shots, especially the Bharat Biotech vaccine whose efficacy data from late-stage trials are not known, fearing side-effects.

In a survey conducted by New Delhi-based online platform LocalCircles, 62% of 17,000 respondents were hesitant to get vaccinated immediately, mainly due to worries over possible adverse reactions.

The Madhya Pradesh unit of the Indian Medical Association on Wednesday suggested opening up the access to vaccinate more people if targets are not being met. The doctors’ body said that allowing vaccination of people outside the priority group will help in preventing “wastage” of the medicine.