Ukraine has started mass vaccination against Covid-19. So far – Ukrainians get vaccinated with the Indian vaccine Covishield. However, in the future, the authorities plan to receive more effective drugs under the Covax aid program for poor countries. In particular, there are expectations to receive 117,000 doses of Pfizer. However, one aspect of vaccination with Pfizer has been overlooked by the authorities. If Ukraine does not purchase special syringes, the drug will go to the scrap as it will be enough to vaccinate 10,000 people. And this is against the background of a total shortage of high-quality vaccines in Ukraine.
In addition, so far nothing is known about the procurement of even ordinary syringes required for other vaccines, and for Covishield in particular. Problems with mass vaccinations can also arise due to the lack of other ancillary medical equipment.
Free dose and panic
Japan recently announced that it would have to throw away millions of doses of Pfizer simply because there were no "special" syringes in stock. And the point, in this case, is not in the miscalculation of the Japanese but in the unexpected overflow of the vials by the manufacturer of the vaccine.
When using the vaccine, it turned out that many vials contained not 5, but as many as 6, but in some places even 7 doses of the drug. The "free dose" proved to be a real boon at a time when the coronavirus vaccine is such a scarce commodity.
Later, Pfizer researchers and independent pharmacists from the US Food and Drug Administration confirmed that there was enough vaccine in each vial for an additional injection. The US Food and Drug Administration (FDA) immediately advised hospitals to use these additional doses.
However, Pfizer said that it is not allowed to mix "residual" doses from several vials. This means that the last portion of the vaccine must be withdrawn from the bottle "to the last drop."
Hence the problem. Pfizer does not provide syringes for "residual" doses. In addition, in order for the vaccine to last for the sixth dose, and it simply does not settle on the walls of the syringe, an ordinary needle does not fit. We have to think about special "economical" syringes with a reduced space between the needle and the plunger when it is fully depressed.
Finding them in large quantities is not easy. Manufacturers did not anticipate that the demand for these syringes would grow, because until recently they were a niche product. This means that the reserves were insignificant. For example, in a batch of vaccination syringes prepared by the American manufacturer Becton Dickinson, only every 7 syringes had a low dead space.
Now manufacturers of medical equipment around the world are massively reorienting themselves to new needs. British company Vernacare said it plans to produce more than 1 billion special syringes in a year, South Korean company Poonglim – about 10 million syringes every month.
And what about Ukraine? Officials have not heard of a request for such syringes. Chief sanitary doctor of Ukraine Viktor Lyashko said that Ukraine would receive vaccines immediately along with needles, without specifying anything about syringes with "small dead space."
The international organization Crown Agents will provide syringes for mass vaccination instead of the Medical Procurement State Enterprise, which the Ministry of Health was dissatisfied with. We contacted the company's representatives with a question about the procurement of syringes but did not receive an answer.
Based on the complete absence of relevant data in the Ukrainian information space, there is a great risk that when receiving the Pfizer vaccine, the sixth doses will simply be "drained" due to the short-sightedness of officials. Taking into account the fact that Ukraine is preparing to receive 117,000 doses of the vaccine, this is at least 19,500 lost doses or 10 thousand people who may be left without a vaccine with an efficiency of 96% (according to the epidemiological department of the Israeli Ministry of Health).
Although the Pfizer vaccine is free of charge within the framework of the Covax program to help poor countries, such an irrational use of the drug against the background of numerous statements by the Ukrainian authorities about the vaccine deficiency is unacceptable.
In theory, if Ukraine does use Pfizer, doctors could try to "get out" the last doses with one-millimeter syringes. Although at the same time there is a great risk that part of the drug will still go to waste if the doctors cannot collect the vaccine with pinpoint accuracy.
Lack of ordinary syringe?
One-millimeter syringes have already fallen into the scarce category. Some European hospitals even ask veterinary clinics about the availability of such syringes. As for Ukraine, the situation cannot be called critical due to the low rates of vaccination.
The delay in purchases can be explained by the fact that the officials did not have an understanding of how many and what syringes we needed.
Indeed, some vaccines are supplied not in ampoules, but in packages ready for administration (syringe-tube). If in an ampoule, then an additional syringe is needed for its introduction. According to information from COVAX, in the first phase, we expect 117,000 doses from Pfizer and 2.2 to 3.7 million doses of AstraZeneca/Oxford vaccine for the next phases of the campaign. They both involve the use of disposable syringes.
In neighboring Georgia, in the meantime, even before the vaccine was received, they purchased 50,000 Pfizer syringes for vaccinations. New Zealand also reported receiving “enough” specialized syringes. Regarding Ukraine, it is only known that it buys syringes along with vaccines.
According to the director of the Medtekhnika chain of stores, Oleksiy Davydenko, Ukraine may experience a shortage of needles when it receives at least about 10 million doses of vaccine. This is in case the syringes are not purchased in sufficient quantities.
In case of a shortage of syringes, we can only hope for assurances from head of the UNICEF office in Ukraine Laura Bill. Commenting on the provision of the vaccine under the COVAX program, she assured: if the country needs additional syringes, she will be able to apply for them. But whether this promise will change the global needle shortage remains to be seen.
Germany has already strengthened its own production: 64 syringes are produced there every 13 seconds and supplied to more than 140 countries of the world. Theoretically, it would be possible to produce syringes (and with "small dead space" in particular) at domestic facilities.
Ukraine has several large factories. The main ones in terms of market share in Ukraine (about 3/4 according to delo.ua) are Hemoplast (Odesa region) and Tyumen-Mediko-Smela (Cherkasy region). Also in Ukraine, syringes are produced in smaller volumes by Yuria-Pharm LLC (Cherkassy).
Almost 2 months ago, Oleksiy Davydenko announced the possibilities of replenishing the demand for Ukrainian capacities. According to him, no one in the Ukrainian government has contracted Ukrainian manufacturers of syringes for a year in advance. At the moment, according to the expert, nothing has changed. According to him, Ukrainian factories have not signed a single contract with Ukraine as a state.
Ukrainian syringes for export
The press services of the main Ukrainian companies supplying syringes do not comment on negotiations on cooperation with the state. Based on Prozorro's data, these companies did not have centralized procurement of syringes.
According to the Youcontrol portal, the last contracts with Hemoplast were signed in December. The company bought only one-millimeter syringes in small batches: the Kyiv medical center of the Ministry of Internal Affairs, the KNP Regional Medical Center for Reproduction, the Kiliya District Veterinary Hospital, and the Ukrainian State Chemical-Technological University.
The syringe story is reminiscent of the 2020 "oxygen battles." At the last moment, it turned out that the country lacks oxygen concentrators, although the problem had been known for a long time. And because of the delay of officials, there could be no question of installing more efficient and economical oxygen points in hospitals. With only one difference: there is not a single plant in Ukraine that produces concentrators. There is the capacity for the production of syringes.
Moreover, Davidenko reports with reference to his sources that Ukrainian factories are export-oriented.
A little over a year ago, the Association of Operators of the Market of Medical Devices commented that our manufacturers are not able to meet the needs of the domestic market on their own, especially “in conditions of increased demand”. And, according to the testimony of the employees of PJSC "Hemoplast", this enterprise has imported syringes for further resale in Ukraine over the past three years. However, this does not mean that the needs of Ukraine could not be met at the expense of other domestic producers, at least partially.
One way or another, Crown Agents has not yet officially confirmed the refusal to cooperate with Ukrainian companies.
Refrigerators and vials
In addition to the supply of vaccines and syringes to Ukraine, the planning of mass vaccination has other problems. Not only syringes are questionable, but also the availability of boxes for their disposal. And also – alcohol and cotton wool for processing the skin, the required amount of adhesive plaster.
Recently, vaccine manufacturers have stated that there is a problem with the containers into which the vaccine is dispensed. This is a global problem, which Ukraine, unfortunately, has not even come up with yet. As far as it is known from open sources, Ukraine has not only not purchased but has not even calculated the exact number of vials required for vaccination points.
Initially, there was a problem with special refrigerators required for storing vaccines, requiring a special temperature regime (the same Pfizer). Although, in the end, the Ministry of Health explained that the vaccine can be stored in a thawed state for about a week without losing its properties.
It is assumed that refrigerated vehicles will deliver a batch of vaccines to a special "freezing farm", and from there, on an ad-hoc basis, they will be brought to vaccination points. So there is no serious need for refrigerators for transportation. In addition, business reports that there is no shortage of refrigerators in Ukraine: they are imported into the country in batches. If the state has such a need, most likely, businesses will be able to provide it.
But there remains the question of the readiness of vaccination points: are there enough refrigerators today, how reliable will the process of storing vaccines that are demanding to the temperature regime be (will there be temperature differences during a power outage).