Spain's COVID-19 vaccination program began just after Christmas and has already been going for 50 days. It began with the Pfizer/BioNTech vaccine, but then the Moderna vaccine was added in mid January, and on February 9, 193,800 doses of the vaccine jointly developed by AstraZeneca and Oxford University arrived, so as of February 14, a total of 2,561,608 people had been vaccinated, of which 1,070,091 had received their second dose of the vaccine and have been given immunity. The average daily number of vaccine doses given over 50 days is about 51,232.
Figure 1: Vaccine supply (from each of the 3 companies and the total) in 17 provinces and 2 autonomous cities nationwide from December 27, 2020 to February 14, 2021; number of doses administered; ratio of vaccine doses administered to supply; number of people who received two vaccine doses; and the date of the last report. This includes the newly added vaccine jointly developed by AstraZeneca and Oxford University.
In terms of supply, Spain will receive a total of 77 million doses of vaccine from the three companies mentioned above, which is thought to be almost enough to cover the population from 16 years and up.* In addition to these the EU has finalized contracts with Janssen/J&J, CureVac, and Sanofi Pasteur/GSK, and is in negotiation with Novavax and others, so there will be vaccines available from a number of pharmaceutical companies, and it seems there will be no problem with supply. However, when you take a look around the rest of the world, more than 130 countries are yet to receive any vaccine, while Spain makes efficient use of this precious resource and continues efforts to make it available around the world. * The total population of Spain is 47.45 million.
Reflecting this efficient use of vaccine, Juan Francisco Navarro, Director of the Department of Preventive Medicine at Elche University General Hospital and President of Valencia’s Society of Preventive Medicine and Public Health, commented, "Seven doses (from one vial) is absolutely possible.”
“Es totalmente posible la séptima dosis”, comenta Juan Francisco Navarro, presidente de la Sociedad Valenciana de Medicina Preventiva y Salud Pública y jefe de Sección de Medicina Preventiva del Hospital General Universitario de Elche.
In the same article, however, José Antonio Forcada, President of the Spanish National Association of Nursing and Vaccines (ANENVAC), thinks, "It is possible to make use of the seventh dose if it is done by a skilled nurse or doctor with a 1-ml low dead space syringe, but considering the risk of doses falling to below 0.3ml and the time required to acquire those skills, it is not desirable to implement that strategy to the extent that it delays the current pace of vaccination.”
In any case, the question of how many doses of vaccine can be extracted from one vial was addressed by Pfizer/BioNTech, the company responsible for its development and production, when it changed the specifications from five to six doses before a month had passed after the start of vaccinations. Personally speaking, I am watching in hope that it won’t be impossible for extraction of seven doses to become the standard, with the use of proper syringes and with proficient procedures, in the near future.
Meanwhile, I heard that 370,000 doses (74,000 vials) of the Pfizer/BioNTech vaccine were finally received in Japan on February 12. Each person receives two injections, so that means doses for 185,000 people have arrived. If they could extract six doses from each vial, as the latest specifications indicate, that would mean 222,000 people in total, or an extra 37,000 people, could be vaccinated.
Following the priority vaccination of medical workers that will start tomorrow (February 17), the vaccination of elderly people over 65 years old will start in April, and the plan is to have administered the second and final dose for each person in about three months. Assuming that about 70% of the approximately 36-million elderly people want to be vaccinated, it will take an average of about 550,000 injections a day (including Saturdays, Sundays, and holidays) to vaccinate 25 million people twice and finish administering the total of 50 million doses in 91 days. I hope the vaccine that has been received is used without any wastage.
In the Guide to Vaccination Against COVID-19 Infections, Version 1.2 issued on February 9, the Ministry of Health, Labour and Welfare states that the basic position is to insist on using syringes secured and supplied by the government and extract five doses per vial: “Needles and syringes for COVID-19 vaccination will be secured and supplied by the government.”
"* Although the official decision will be made when pharmaceutical approval is given, and leaving special syringes aside, each vial of the Pfizer vaccine will give five doses using a standard syringe, so this should be kept in mind as preparations move forward.”
At any rate, more than 200 million standard syringes, from which only five doses can be extracted, have already been ordered and purchased in the preparation stage of this vaccination campaign, so I guess they can't waste them by stockpiling them, as they did with the cloth masks that they bought in huge quantities last year.
I am repeating myself here, but the vials prepared with diluted vaccine contain 2.25 ml of vaccine each, and one dose is 0.3 ml, so if you give five doses, you use 0.3 ml times five, or 1.5 ml. If you subtract 1.5 ml from the total amount of 2.25 ml, the remainder is 0.75ml, which means that this is the amount (2.5 doses) that ends up being discarded.
I guess of course that they took into account the amount of vaccine remaining in the vial, the syringe, and the needle, as well as the amount discarded by expelling air from the syringe and they started out by bumping up the estimate and decided on five doses, but depending on the equipment used (syringes and needles) and the care taken with the procedure, it is possible to extract seven doses let alone six, so, as with the endeavor by Spain that I mentioned, my own thought as a non-expert is that maybe they need to think of ways of using these expensive and precious vaccines as effectively as possible.
While most vaccination is being undertaken by wealthy developed countries, and some of those countries have already completed vaccination of medical practitioners, the elderly, and people at high risk of their symptoms worsening and have moved on to vaccinating the general population, at this point more than 130 countries (including Japan*) have not started vaccination yet, so maybe we should recognize just how precious a drop of vaccine is. (* As of February 16)
To eliminate this uneven distribution of vaccines and fight pandemics worldwide, the World Health Organization (WHO) has launched the COVAX Facility with the aim of equalizing the distribution of vaccines. It is a system that distributes vaccines to developing countries using funds contributed by high-income countries. Japan too is participating in this movement and while the movement is calling for equal provision of the vaccine, wasting it is something we want to avoid as much as possible.
As a side note, in Japan, Prime Minister Suga said in his first policy speech after taking office that part of the meaning of holding the Tokyo Olympic and Paralympic Games is “proof that mankind has won against COVID-19.” If they wind up being canceled, that could be taken as “proof that COVID-19 has beaten humanity,” so I really do hope they make effective use of the precious vaccine that has started arriving and by all means, that the Olympics and Paralympics do go ahead.
If you focus on the words the Prime Minister used in his speech, "proof that mankind has won," not "proof that Japan has won," shouldn’t we overcome the uneven distribution of vaccines to create the conditions whereby athletes from all over the world, whether rich or poor, can participate, and not make it an Olympics for just a handful of countries where vaccination programs have been completed?
Like my previous article, this article out of Spain has ended up discussing misgivings about the situation in Japan. Please forgive these concerns about my far off home.
Postscript: In the EU, the brand name for the Pfizer/BioNTech vaccine is Cominarty (or “Komirunati” in Japanese). This name was coined by combining the words “COVID-19” (novel coronavirus infection), “mRNA” (messenger RNA), “community,” and “immunity.” Although the name “Pfizer” has been on center stage in Japan, the name on the trademark registration application filed on July 2 last year with the Patent Office of the Ministry of Economy, Trade and Industry was BioNTech, not Pfizer.