• 2021.02.18
  • Low Dead Space Syringes
In my World Network article published January 22, I informed you about the arrival and first administration of the COVID-19 vaccine in Spain. The vaccine arrived straight after Christmas, on December 26, and the first vaccination was given on Sunday, December 27. On the following day, the 28th, 350,000 doses of the Pfizer-BioNTech vaccine were received and began being administered, then on January 14, vaccination with the Moderna vaccine began in parallel. As for the order of vaccination, top priority was given to the residents of old age homes and their nursing staff and employees. Then came people working in healthcare, people not in old age homes but who need nursing care, and elderly people over 80.

As of January 31, about a month after the first vaccination, a total of 1,609,261 vaccinations had been administered, and of those, 357,892 people had already received the second and final vaccination. You can see the daily progress of these vaccinations on a special government website.

Figure 1

From Figure 1 on this website, you can see the quantities of vaccine supplied (Pfizer-BioNTech, Moderna, and their totals), the numbers of doses administered, the doses administered as a percentage of the supply, the number of people who have received the second dose, and the date of the last report for 17 autonomous communities and two cities across Spain from December 27, 2020 to January 25, 2021.

At first glance, the vaccination report data contain some strange numbers. For the six autonomous communities circled in red, the number of vaccinations listed is greater than the vaccine supplied, which means more than 100% of the total supply has been administered. But then I understood the reasoning behind it when I read Note (1). The yield per vial has increased along the way.
Note (1): The figures for the Pfizer-BioNTech vaccine supply are calculated at five doses per vial. Then there was a change, with the manufacturer adding the possibility of extracting a sixth dose from each vial, depending on the circumstances.

One vial (a glass bottle sealed with a rubber cap) contains 0.45 ml of the concentrated vaccine frozen at 60 to 80 degrees below zero. According to Pfizer-BioNTech's specifications, after the vaccine is thawed, it is diluted with 1.8 ml of saline solution (0.9% sodium chloride) making a total of 2.25 ml before administration.

The dosage is 0.3 ml per person, so by simple calculation, 2.25 ml divided by 0.3 ml makes 7.5 vaccinations per vial. To one measure of the undiluted liquid, you mix in four measures of saline, so it is diluted to five measures, which might be about the same as diluting Calpis, I guess. It’s like mentsuyu (concentrated noodle soup base), whose concentration is five-times, right. But it was probably initially set at five doses to allow extra for loss during handling and the residue in the syringe and needle. Yet, in January of this year, the specifications were changed to six doses per vial.

The shape of the syringe used for vaccinations is an important requirement for implementation of this change. So, they needed a syringe designed for efficient use of liquid medications, and it’s called the low dead space syringe.

(1) a low dead space syringe and (2) a normal syringe, filled with one dose, 0.3 ml.

the syringe plungers are pushed all the way in, so you can see the difference in the residual amounts of vaccine in (1) and (2) that end up in the tips of the syringe cylinders and are discarded.

This special syringe is needed to minimize those residual amounts of vaccine, but it has been reported recently that Spain doesn’t have enough of this type of syringe and large amounts of vaccine are being wasted. It’s easy to imagine the confusion when suddenly the number of doses to be extracted from each vial changed from five to six.
ABC Sociedad newspaper, January 21, 2021
La falta de jeringuillas adecuadas para administrar la vacuna provoca el desperdicio de dosis en toda España.
Pfizer ha confirmado a este diario que para extraer seis dosis de un solo vial se deben utilizar las llamadas jeringas de 《bajo volumen muerto》 las estándar causan que esa sexta dosis no se pueda aprovechar.
A lack of proper syringes for vaccination is causing vaccine to be wasted across Spain.
Pfizer said in a statement to this newspaper, "To extract six doses of vaccine from a single vial, the 'low dead-volume,' type of syringe should be used. Standard syringes do not allow the sixth dose to be used.”


And in the U.S., Reuters reported a shortage of special syringes for the Pfizer-BioNTech vaccine.
“Plan de EEUU de sacar más inyecciones de los viales de Pfizer, obstaculizado por producción de jeringas”
25 ene (Reuters) - El mayor fabricante de jeringas del mundo no tiene la capacidad de aumentar sustancialmente los suministros a Estados Unidos de jeringas especiales para extraer más dosis de los viales de la vacuna COVID-19 de Pfizer Inc en las próximas semanas, dijo un ejecutivo en una entrevista.
“The U.S. plan to get more doses from Pfizer vaccine vials has hit a syringe-production wall.”
Jan 25 (Reuters) - Management at the world's largest syringe maker said in an interview that they do not have at hand the capacity to greatly increase production in the coming weeks of the special syringe that allows more doses to be extracted from a single vial of the U.S. Pfizer COVID19 vaccine.


Incidentally, the Spanish manufacturing facility of Becton Dickinson (BD), the syringe manufacturer mentioned in that article, is located in the city of Fraga, Huesca, Aragón, on the border with France across the Pyrenees, and has already produced and shipped 500 million low dead space syringes.

Syringes with needles for vaccinations manufactured at BD Spain. This type of syringe minimizes the amount of vaccine left in the tip of the syringe, allowing for seven doses per vial of the Pfizer-BioNTech vaccine.

Aerial view of the BD factory in Fraga.

In Japan, the Ministry of Health, Labour and Welfare reached a basic agreement with Pfizer on July 31, 2020, saying that on successful development, 24 million vials will be supplied by the end of June 2021, which is enough for 60 million people (120 million doses), calculated on the basis of five doses per vial.

Then in the official contract concluded with Pfizer on January 20 this year, the amount of vaccine per vial was changed to six doses, so while the number of vials supplied remained the same at 24 million, the number of vaccinations increased by 20% to 144 million doses for 72 million people, and the delivery date was changed from the end of June to the end of this year. The government is quoted in the news as saying, “We had a basic agreement for doses for 60 million people, but that has increased by 12 million,” but it seems they hadn't ordered more, it just meant they could extract six doses instead of five from one vial. However, it seems the price is calculated on the number of vaccinations not the number of vials, so in fact it was a 20% price increase.

Of course, the syringes must be the type that don’t waste the vaccine, a type that can deliver six vaccinations per vial. In Japan, it’s the government that provides not only the vaccines but also the injection needles and syringes for vaccination, and while countries around the world are battling for low dead space syringes, I think in Japan they are doing thorough work on securing these slightly special syringes, and the same for the vaccines.

That’s because, while no vaccine has been approved at the moment (February 2), the new prime minister is in command and has already appointed a Minister of Health, Labour and Welfare, whose role is to protect the health of the people and maintain a sound medical system, and below him, a Minister in charge of Novel Coronavirus Disease Control, and a Minister in charge of Vaccine Coordination. On top of that, the party in government in Japan has also set up its own "Project Team for Vaccine Countermeasures Against the Novel Coronavirus," they are working together, and they seem to be prepared for an all-out battle against the virus.

Meantime in Spain, on January 26, in the middle of the COVID-19 crisis, Salvador Illa, the Minister of Health who had been leading the fight against COVID-19, resigned, quitting central political circles to announce he would be standing for election as president in the February 14 parliamentary elections in the autonomous community of Catalonia, where he is from.

Just on a personal note, I hurriedly bought a 25 gauge 100 unit (1 ml) syringe for administering insulin the other day. It was a low dead space syringe, the type that is in short supply in Spain. But at a unit price of 50 cents (60 yen) and buying only 6 of them, I’m not about to become a reseller, am I.

The six low dead space syringes I had bought but gave up reselling


  • Susumu Yamada
  • JobSpanish and Japanese Translation

It’s been almost 37 years since I received a residence permit and work permit from the Spanish government and paid my first tax and social insurance premiums. Now that I’m at that age where I will soon go and register at the senior human resources center, I’m grateful to have this opportunity to introduce you all to this country that has taken care of me these many years.

View a list of Susumu Yamada's

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