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Leftover COVID-19 vaccines are raising ethical quandaries for Hawaii hospitals as they race to get as many shots in arms as possible to bring a long-awaited end to the year-old coronavirus pandemic.

The Moderna and Pfizer vaccines have to be stored at a certain temperature, and at the end of each day, vaccination sites sometimes have a handful of extra doses from open vials that must be used or go to waste. with what to do with leftover doses, sometimes giving them to whomever happens to be nearby.

Hawaii hospitals and pharmacies are developing their own strategies for dealing with the rare leftover doses to avoid hopeful patients lining up outside.

Two hospitals on the Big Island — Hilo Medical Center and Kona Community Hospital — are giving extra doses to family members of hospital employees, with officials saying it’s the most efficient way to ensure all the vaccine is distributed.

The hospitals aren’t breaking any rules. State Department of Health spokesman Brooks Baehr said he doesn’t know of any state guidance on how those leftover vaccines should be used.

“We do not want any wasted,” he told Civil Beat in a text message. “We have been pleased with the fact that vaccination providers have been using every last drop whenever they can.”

But some patients who don’t meet current vaccine eligibility guidelines and are desperate to make appointments have expressed frustration at what they say is an unfair advantage for people who have found a way to get a shot based on who they know, rather than where they fall in the state’s priority list.

The state has so far limited vaccination appointments to residents

On Monday, Hawaii plans to lower the age of vaccine eligibility to 65 and begin opening appointments to people with certain illnesses, such as diabetes, and broaden eligible occupations.

That still won’t include Belinda Cole-Schwartz, a Hilo resident who is 64 years old and has ongoing health problems including lupus. On Wednesday, she accompanied her 74-year-old husband to get his first COVID-19 vaccination shot at a distribution site set up by .

She returned at the end of the day hoping she might get an extra vaccine but was told that the hospital was working off a list of people who are related to staff members.

“It just seemed grossly unfair,” Cole-Schwartz said in a phone interview, adding the people she saw receiving vaccines that day appeared to be in their 30’s and 40’s. Cole-Schwartz, a yoga instructor who lost her job during the pandemic, said as a Black woman, the strategy “reeked of privilege.”

“These are federally funded vaccines,” she said. “I thought this was based on age.”

Kris Wilson, assistant hospital administrator at Hilo Medical Center, said the hospital implemented a sign-up sheet where employees could write down the names of their family members who would be able to get to the vaccination site quickly at the end of the day if called and randomly calls people based off that spreadsheet when there are leftover doses.

“Our goal is shots in arms,” she said. “In this pandemic, there really isn’t a manual.” 

Why Family Members?

Wilson said that up until March, Hilo Medical Center had a list of Department of Education employees who would get called if extra vaccines were available. The hospital switched strategies after more teachers got vaccinated and after hearing that was prioritizing family members of staffers.

A key motivator is avoiding paying out lots of overtime to staff who might have to wait for people to show up for vaccines at the end of the day. The only requirement is that staff family members be at least 16 years old and be nearby. 

“I’m not completely sure what 1,000-plus members of our staff are doing but we recommend they try to keep it immediate family members who live by the hospital,” Wilson said.

Another factor is avoiding a line of people seeking vaccines at the end of the day, which would raise concerns about social distancing and crowd control.

“We do upwards of 300 doses at that clinic so if the public rushes the clinic with hopes of getting one to three doses then that’s just not going to be in the clinic’s best interest in terms of recipient flow,” said Elena Cabatu, Hilo Medical Center’s director of marketing.

Judy Donovan at Kona Community Hospital said efficiency was key in establishing their system of giving shots to employees’ family members in January.

“We did not open to the public because it’s extremely difficult to control a wide open list like that,” she said.

The only criteria is that those on the waitlist be immediate family members who can get to the clinic within 20 minutes. Donovan said the hospital has been overwhelmed with calls and visits from people asking for the vaccine.

“What we wanted was to create a manageable callback list for a potential limited number of doses and we needed that list to not create an additional process because our staff is already inundated with calls and emails,” she said. “We have to manage potential extra doses and we don’t have the manpower or the bandwidth to handle an influx of calls for people wanting to be on a call list.”

Both Donovan and Cabatu said their staff has been working hard to ensure that thousands of vaccinations are administered and that they hope the public can be patient.

“We ask people to just sit tight and we will get to you hopefully sooner or later,” Cabatu said.

Other Strategies

Monica Prinzing, a spokeswoman for CVS, which owns Longs Drugs, said that the company gives leftover vaccines to eligible patients and employees, and otherwise leaves it up to individual pharmacists to decide how to distribute those extra doses.

“In the rare event of unused doses in our pharmacies, our pharmacy teams will use their best judgment for how best to efficiently manage extra doses,” she said Friday in an email.

The Queen’s Medical Center has given out more than 85,000 doses of the coronavirus vaccine in Hawaii and its chief operating officer Jason Chang said the hospital prioritizes giving extra doses to its employees who haven’t yet been vaccinated.

“In addition, we also have an essential critical infrastructure worker wait list on hand to call those who are in the priority groups being vaccinated in accordance with the Department of Health’s vaccination plan,” he said in an email. “If necessary, we may approach those who may be waiting at the vaccination sites and go down the priority list (1a and 1b) to administer any remaining doses.”

Melinda Ashton, Hawaii Pacific Health executive vice president and chief quality officer, said the company only has at most five extra doses at the end of the day. She said at the Honolulu Pier 2 vaccination site, where about 2,000 people are vaccinated per day, extra doses are given to health care workers and a list of home-bound seniors.

“For now we have a process that works very well for us,” she said. “And we have not wasted a single dose.”

Civil Beat reporter Brittany Lyte contributed to this story.