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COVID-19 vaccine wastage in the midst of vaccine inequity: causes, types and practical steps
  1. Jeffrey V Lazarus1,2,
  2. Salim S Abdool Karim3,4,
  3. Lena van Selm1,
  4. Jason Doran1,5,
  5. Carolina Batista1,6,7,
  6. Yanis Ben Amor8,
  7. Margaret Hellard9,10,11,12,
  8. Booyuel Kim13,
  9. Christopher J Kopka14,
  10. Prashant Yadav15,16,17
  1. 1Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, Barcelona, Spain
  2. 2Faculty of Medicine, University of Barcelona, Barcelona, Spain
  3. 3Department of Epidemiology, Columbia University, New York, New York, USA
  4. 4Center for the AIDS programme of Research in South Africa (CAPRISA), Durban, South Africa
  5. 5UK Health Security Agency, London, UK
  6. 6Médecins Sans Frontières, Geneva, Switzerland
  7. 7Baraka Impact Finance, Geneva, Switzerland
  8. 8Center for Sustainable Development, Columbia University, New York, New York, USA
  9. 9Burnet Institute, Melbourne, Victoria, Australia
  10. 10Department of Infectious Diseases, The Alfred Hospital, Melbourne, Victoria, Australia
  11. 11Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  12. 12Department of Infectious Diseases and School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  13. 13Department of Environmental Planning, Graduate School of Environmental Studies, Seoul National University, Seoul, South Korea
  14. 14Independant Researcher Salida, Colorado, USA
  15. 15Center for Global Development, Washington, District of Columbia, USA
  16. 16Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  17. 17INSEAD Business School, Fontainebleau, France
  1. Correspondence to Prof Jeffrey V Lazarus; jeffrey.lazarus{at}

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Summary box

  • There has been open and closed vial COVID-19 vaccine wastage in low-income, middle-income and high-income countries, with wastage rates of up to 30%.

  • Plans to monitor, forecast and ultimately reduce vaccine wastage are urgently needed in every country.

  • Open vial wastage should be reduced by strategies increasing overall vaccination rates, such as overbooking appointments and appointment-free vaccination, as well as through technologies maximising the number of doses being extracted from the vial.

  • Closed vial wastage should be reduced by timely, well-organised surplus donations and reallocations, as well as supporting effective supply chain management in recipient countries.


Vaccination is the cornerstone of current strategies to mitigate the COVID-19 pandemic, through reductions in transmission, morbidity and mortality.1 To optimise the impact of vaccination, an approach for equitable global distribution which minimises vaccine wastage is essential. Yet, after more than a year of distributing COVID-19 vaccines, unnecessary vaccine wastage continues, with wastage rates as high as 30%.2

Globally, highly inequitable distribution of COVID-19 vaccines persists, despite the approval and mass manufacturing of COVID-19 vaccines in high-income countries (HIC), and agreements with initiatives such as COVAX—the vaccines pillar of the Access to COVID-19 Tools Accelerator—to support vaccination in low- and middle-income countries (LMIC). To date, HIC have administered over 2.3 billion doses (79% of the population) and have procured over 7 billion doses,3,4 some of which may go to waste as vaccination rates are stagnating, while in low-income countries only 15% of the population has been vaccinated.5 Of equal importance, effective supply chain management for the distribution of COVID-19 vaccines in LMIC should be improved to overcome the ineffective practice of HIC donating ‘about-to-expire’ vaccine doses to LMIC, which exacerbates the issue of overall wastage. Such ‘late-date donations’ create the false impression that HIC are ‘doing their bit’ while LMIC …

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