Malawi burns thousands of expired AstraZeneca Covid-19 vaccine doses

Health authorities in Malawi have incinerated 19,610 expired doses of the AstraZeneca coronavirus vaccine, saying it will reassure the public that any vaccines they do get are safe.

It is the first African country to publicly do this.

The World Health Organization initially urged countries not to destroy expired doses but has now changed its advice.

Uptake of the vaccine in Malawi has been low and health workers hope the move will increase public confidence.

Out of a population of about 18 million people, the country has recorded 34,232 confirmed coronavirus cases and 1,153 deaths.

Malawi received 102,000 doses of the AstraZeneca vaccine it acquired from the African Union on 26 March and used almost 80% of them.

But the expiry date on the labels was 13 April so vials were taken out of the cold chain needed to store them.

Malawi's principal health secretary told the BBC that it was unfortunate they had to destroy the vials but the benefits of doing so outweighed the risks.

When news spread that we had out-of-date vaccines, we noticed that people were not coming to our clinics to get immunised," said Dr Charles Mwansambo.

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"If we don't burn them, people we will think that we are using expired vaccines in our facilities and if they don't come, Covid-19 will hit them hard."

Dr Mwansambo explained that one of the reasons health workers didn't use up the vaccines before they expired is that it has proved difficult to persuade adults to get vaccinated.

On the streets of the capital Lilongwe, some people are worried about the safety of the vaccine.

"I would like to get vaccinated but how sure am I if I go to the hospital I won't be given the expired vaccines?" shopkeeper Jack Chitete told the BBC.

"I have heard a lot of stories about people getting blood clots and some even dying after getting immunised. Are those people telling lies? If it is the truth, why are we being given the same vaccines?" asked another shopkeeper, Mphatso Chipenda.

The link between the AstraZeneca vaccine and rare blood clots is not yet proven, and health experts say the risk from Covid-19 is far higher. They advise people to get vaccinated if they can.

Malawi is not the only country in Africa to have expired vaccines. The WHO initially asked affected countries to hold onto the vaccines until it could establish whether they could be still be used.

But it now says vaccines already sent out by the manufacturer with a set expiry date should be destroyed.

"While discarding vaccines is deeply regrettable in the context of any immunisation programme, WHO recommends that these expired doses should be removed from the distribution chain and safely disposed of," it said in a statement on 17 May.

Other vaccines that are currently in use have a shelf life of up to 36 months. The challenge with Covid-19 vaccines is that they have been in use for less than a year and there is no substantive data around their effectiveness after long periods.

Despite many African countries struggling to obtain enough Covid-19 vaccines, some have thousands of expired doses which they have been unable to use.

Some countries are now destroying these vaccines, in line with the latest World Health Organization (WHO) advice.

Which countries have unused vaccines?
Malawi has destroyed almost 20,000 doses of the AstraZeneca vaccine, while South Sudan has 59,000 doses which it also plans to discard.

The vaccines had been donated through the African Union but had not been administered by their expiry date of 13 April.

The WHO had originally asked for the vaccines to be kept while it investigated whether the expiry date could be safely extended.

But it now says vaccines already sent out by the manufacturer and which are expired should be thrown away.

"While discarding vaccines is deeply regrettable in the context of any immunisation programme, WHO recommends that these expired doses should be...safely disposed [of]," the WHO says in a statement.

The Democratic Republic of Congo, meanwhile, says it cannot use most of the 1.7 million AstraZeneca doses it received under the global Covax scheme for poorer countries.

Only about 1,000 of the doses had been administered by the end of April.

Most of this batch - with an expiry date of 24 June - is now being sent to other countries, with some already delivered to Ghana and Madagascar.

Why have vaccines not been used?
The AstraZeneca vaccine can be stored safely in refrigerated conditions for up to six months after production.

And the African Union redistributed batches originally delivered to South Africa in February, which had a 13 April expiry date.

The South African government decided not to use them, concerned the vaccine offered insufficient protection from the variant prevalent in the country.

And, in late March, the one million doses it had were sold on to the African Union to give to other African countries.

But some, such as South Sudan, say they were not made aware of the expiry date.

Nigeria, meanwhile, said it would be unable to use all the doses in time. So some were reassigned to neighbouring Togo and Ghana.

And some were even sent to Jamaica.

The WHO says only Togo and The Gambia have confirmed they used all these doses by the expiry date.

And information about what has happened to the rest is currently unavailable.

What caused delays in using vaccines?
Many countries failed to prepare adequately before receiving the vaccines, Phionah Atuhebwe, from the WHO in Africa, says.

"That is one of the reasons we are seeing the slow pace of rollout," she says.

And some countries also faced financial challenges.

Africa Centres for Disease Control head John Nkengasong says countries need more support to increase the numbers of health workers and obtain supplies, such as personal protective equipment.

And those who have vaccines approaching or beyond their expiry date should contact the WHO or Africa CDC.

"The continent as a whole knows how to vaccinate and has been vaccinating for other diseases," he says.

"But the key is how do you scale that up - and... at speed?"