How the world is (not) handling surplus doses and expiring vaccinesBMJ 2021; 374 doi: https://doi.org/10.1136/bmj.n2127 (Published 27 August 2021) Cite this as: BMJ 2021;374:n2127
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I read with interest your article ‘How the world is (not) handling surplus doses and expiring vaccines’ [BMJ 2021;374:n2062]
Unfortunately, this problem is not limited to COVID-19 vaccines, as they are just the tip of the iceberg concerning, not just expired vaccines, but other medicines as well.
I run a small, independent travel clinic and as a result of the pandemic and decrease in travel, we had stocks of vaccines that eventually had to be destroyed. Notwithstanding the £16,000 value of these products, the most galling part was the fact we could have vaccinated over 250 children against rabies (the worlds most dangerous disease), let alone a number of other pathogens. We contacted various countries/charities to see if they could make use of them, but to no avail and, unfortunately, this situation was not unique to our clinic or our situation. Ask any clinician at the forefront of primary care in the UK and they will tell the same story: pharmaceutical waste is a multi-million pound problem.
There is an understandable ethical and moral dilemma when discussing the passing of expired medicines onto low/middle income countries. However, if my son or daughter required treatment for a disease such as rabies (one death every 10-minutes with a 100% fatality rate), and the only option open to me was nothing, or a stable but recently expired vaccine, I know what decision I would make.
Let's be clear, if stored correctly, most medicines are incredibly stable, especially vaccines that have been lyophilised (for which there is good stability date, particularly for rabies). A systematic review of drug stability by Zilker et al in 2019 suggested it would be reasonable to extend safe usage time far beyond five years of expiry.
This issue is complex, requiring the acquiescence of pharmaceutical companies (who do not wish to obtain/use this data as it would naturally affect profitability), and an open discussion on the ethics of countries requiring medicines, but who need to maintain and uphold a complex moral, ethical and clinical standpoint with their populations. Whilst this standpoint is wholly reasonable and justifiable, the absence of data that would reduce waste and save lives is not, as highlighted by Kenyan physician Dr Gikonyo in 2019.
Perhaps what is required is a globally recognised independent organisation that would investigate the stability of a wide range of post-expired medicines, and create an expiry index. This multi-national, intergovernmental organisation could then distribute well researched, safe but expired medicines to those most in need. At least in this situation, everyone has a chance of benefiting, particularly those who at dire need of benefiting the most.
International Diploma in Expedition and Wilderness Medicine
Zilker M, Sorgel F, Holzgrabe U. A systematic review of the stability of finished pharmaceutical products and drug substances beyond their labeled expiry dates. Journal of Pharmaceutical and Biomedical Analysis 2019 J Pharm Biomed Anal. 2019 Mar 20;166:222-235
Gikonyo D, Gikonyo A, Luvayo D, Ponoth P. Drug expiry debate: the myth and the reality. Afr Health Sci. 2019;19(3):2737-2739.
Competing interests: No competing interests