The Perfect Enemy | COVID, the flu and RSV: We’re not out of the woods
November 6, 2023

While the political leaders of the world, America included, argued about the ground-zero source of COVID-19, the virus spread like wildfire. Mandates on the medical community to develop a vaccine within a few months made as much sense as ordering an expectant mother to cut her pregnancy time in half. Governors all across America had totally inconsistent crisis management policies. 

Moderna and Pfizer did an outstanding job leading the way in expedited vaccine development. Even then, a major misunderstanding contributed to the problem. Unlike polio and smallpox vaccines, no COVID vaccine prevents contracting of the virus. COVID vaccines are proven to be effective only in restricting the negative impacts of the virus. COVID has the potential to flare up again. 

Even though we are not out of the dark with COVID, evaluations of what happened — what went right and what went wrong — must be completed and refined as we progress through this medical crisis. Corrective actions must immediately be implemented. 

Nations hoarding the vaccines were part of the problem. In the future, all nations must recognize their citizens are no more important than those of another country. Likewise, the vaccines need to be pushed out into the most remote parts of the world. 

An emergency stockpile and the means to quickly develop more vaccine distribution strategies, and unity of messaging, are not options but commonsense mandates. Had common sense been applied, massive waste of vaccine serum would not have occurred. Unfortunately, this problem came from several equally incompetent sources. 

While research and development were being worked within the pharmaceutical laboratories, insufficient effort was ongoing to develop enough syringes to inoculate the global community. The world was under attack by a virus. The serum was a weapon developed to defeat that deadly enemy. No weapon is ever effective without an adequate delivery system. Yet the syringe problem continues to this day. 

Early in the vaccine process it was realized that vials coming from the manufacturers contained more serum that the federal government issued syringes could extract. The intent of the vial size was to get more vaccines out to areas in critical need. This discrepancy averaged a 15 to 29 percent waste of critically needed vaccine per vial. The problem continues to be no better in Canada.

Across the nation, the Centers for Disease Control and Prevention’s requirement for administering organizations to report unused vaccines being discarded for various valid and invalid reasons was ignored. No one knows how many vaccines were lost.   

Proper management and low-waste syringes could have spared waste with estimates up to as high as 40 percent. In the United States alone, that comes out to 75 million people who could have received inoculation protection within the first six months after Moderna and Pfizer broke the codes and started shipping out the medicines. 

The most important step that needs to be taken to maximize the number of doses of any injectable medication is to utilize ultra-low-waste space syringes. This step can increase the national stock supply, new drugs and vaccines by up to 40 percent without any increase in the manufacturing process. Either save more lives or increase supply and reduce costs. 

Medical professionals and scientists who worked their way through the Spanish flu epidemic of 1918 left behind a wealth of information that was used by their successors when COVID first hit in 2019. When monkeypox surged in 2022, the Biden administration’s failure to immediately apply lessons learned from the COVID epidemic was without reasoning. 

Fortunately, not all of America’s leaders are in denial. On Aug. 23, 2022, Sen. Patty Murray (D-Wash.), the chair of the Senate Committee on Health, Education, Labor and Pensions, sent a detailed letter to the Biden administration calling for resolutions to address the monkeypox surge.

Over seven months ago, Murray introduced the Prevent Pandemics Act. As stated in its summary, the bill “sets out programs and activities primarily to address public health preparedness and response.” To date, this bill remains stuck at the committee introduction level. From a public health perspective, this bill should be addressed immediately because we are still not out of the woods. With new COVID variants emerging and our population under the triple threat of the COVID, influenza and RSV viruses, we need to be prepared to deal with the worst-case scenario in the next few months.

The medical community got off to a rough start at the beginning of COVID. Across the world, they continue working together to create and adapt solutions. Governments need to learn from them. This includes getting vaccines into the field and making sure we eliminate waste, to include proper storage, accounting, unified and scientific messaging, and proper use of the low-waste syringes.

Rather than being in denial about COVID, delaying a response over monkeypox, our leaders need to follow the example of Sen. Murray and lead from the front to prevent pandemics.    

Dr. Rashid Chotani, MD, MPH, established the Global Infectious Disease Surveillance and Alert System (GIDSA) at Johns Hopkins University. A public health physician and infectious disease epidemiologist, he has extensive experience on viruses, especially SARS-CoV-2. The opinions expressed are his own. Follow him on Twitter @drchotani.