Malick Kone gets his first dose of the COVID-19 vaccine from Elaina Smith at the Islamic Center of Maine in Orono on April 14, 2021. Credit: Linda Coan O'Kresik / BDN

AUGUSTA, Maine — Maine has virtually stopped ordering new coronavirus vaccine doses with nearly 200,000 in circulation as the number of people seeking first shots has slowed to a crawl.

In the early vaccination effort, health care providers clamored for vaccines and burned through doses almost as quickly as they could get more. Doses were rarely in danger of not being used. If they were, the state reshuffled them quickly, leading 60 percent of Mainers to be fully vaccinated, the third-highest share among states, according to Bloomberg News.

But the state has gotten few doses in since May 17 as it works to use a stockpile of 187,000 doses, the Maine Center for Disease Control and Prevention said. Maine CDC Director Nirav Shah said any orders since have been “quite small” as administration has plummeted from a peak of nearly 80,000 newly vaccinated people in early April to 7,100 last week. While Maine has one of the nation’s best vaccination rates, 450,000 people have not been vaccinated.

The slowdown has presented challenges for health officials as they try to prevent doses from going to waste. While the state and providers are trying to prevent expired or wasted doses, they are risking some waste to get as many people as possible vaccinated. Providers are also cutting back on new orders and pursuing smaller clinics to make sure shots are used.

“We have to get as many people immunized as possible,” said Theresa Knowles, the chief quality officer at Penobscot Community Health Center, a Bangor-based center that serves low-income people or those who struggle with health care access. “The idea that we could get one or two more people vaccinated makes [some waste] worthwhile.”

Nationally, the amount of doses wasted was believed to be around 1 percent in early May, with the majority of that waste coming from CVS and Walgreens, Kaiser Health News reported. Maine has not released a similar figure, while state CDC spokesperson Robert Long said the state’s focus on communicating with providers and moving doses around if they will not be used has prevented any expired doses and a “miniscule” amount of waste.

He pointed to a mid-May document from the U.S. CDC noting waste might increase as more small providers receive vaccines and that vials can be opened without every dose being used. The federal government halted new orders of the one-shot Johnson & Johnson vaccine in early June in an attempt to clear a backlog of doses, then extended the vaccines’ shelf life for six weeks as many were set to expire.

Doses coming into the state have decreased steadily in the last two months. Maine saw its biggest shipment of weekly doses in mid-April. One month later, it had dropped to 89,000. Long said the state has been continuing to order Pfizer doses periodically since then but is focusing on spending down its available supply. As of Tuesday, half of the available doses were Pfizer vaccine, 40 percent were Moderna doses and the rest were Johnson & Johnson shots.

At Penobscot Community Health Center, Knowles said two or three doses are typically being wasted in a day as it gives between 200 and 300 doses per week and has not ordered new ones in three weeks. If a walk-in vaccine seeker comes in late in the day, the clinic sometimes offers home visits to delay opening a vial then, she said.

The slowdown can make it hard for providers to gauge what they might need on hand. Charlie Ouellette, who runs the St. John Valley Pharmacy in Fort Kent, said he has not ordered any new doses since April as he works through roughly 150 doses.

He expects demand might pick up before the school year, particularly if the Pfizer vaccine is approved for kids between ages 5 and 11, but the vaccine’s large trays make timing difficult. He has also fielded calls from many Canadians who want vaccines and thinks there could be a press from the north as Aroostook County lags in vaccinations.

Dr. Dora Mills, the chief health improvement officer at Portland-based MaineHealth and the sister of Gov. Janet Mills, said the state’s largest health provider also has not ordered doses in three weeks. The system has maintained a stock of Pfizer and Johnson & Johnson vaccines but has also occasionally distributed doses to other providers when needed.

With the slowdown, vaccine clinics have become much smaller. Using one-dose shots, MaineHealth has held them at flea markets and concerts and holding school clinics. Primary care providers are also giving more doses and can easily access more if needed, Mills said.

The small amount of waste is worth it, she said, as the more contagious delta variant threatens to become the dominant strain in the country. She said such instances are rare because an open vial is often able to be used at an emergency room. But with no doses expected to expire soon, Mills said there is still time to be judicious.

“We have to strike a balance between not wasting doses and not wasting arms,” she said.