But with appointment cancellations and occasionally overfilled vials, extra vaccine doses have come to be expected, leading local providers to create their own systems for getting these extra shots in the arms of Phase 1a and select 1b eligible community members.

After all, they only have six hours after puncturing a vial of the Moderna vaccine before the doses go bad.

“We kind of jokingly call it liquid gold, so we know we can’t waste a dose,” said Dr. April Alvarez-Corona, Chief Medical Officer of North Country HealthCare, which has created a standby list for its extra doses.

Corona said these extra doses occur, at most, only a few times each day at the Flagstaff clinic, which administers 500 doses a week.

Every day, 10 to 15 people willing to drop into the North Country clinic at a moment’s notice are pulled from larger list of several thousand eligible individuals who asked to be notified of available vaccine appointments. Corona said at one point, this notification list had 11,000 names. Individuals are moved from this list to the standby list in the order they registered and then are called one by one until someone is able to receive the extra dose.

“We’ve found this to be the best utilized pathway because then we don’t have to go hunting for people at the last minute,” Corona said, noting that the practice has yet to waste any doses.

Appointment cancellations are rare, but Corona said there are instances where individuals cannot receive their dose when expected, thus opening up doses for others. Most commonly, doctors ask patients who have had a recent COVID-19 infection to consider delaying their vaccine because of the strong symptomatic reaction likely to be prompted by the shot.

“It’s nice for that patient not to have to have that really intense experience and it’s also nice because you’re giving that dose to somebody who doesn’t have any immune response,” Corona said.

At the Fort Tuthill vaccination site, Coconino County Health and Human Services (CCHHS) has a call-down list of Phase 1a healthcare providers and Phase 1b emergency response staff who can arrive at the vaccine site on short notice.

Trish Lees, CCHHS Public Information Officer, said in many cases, those on this list are scheduled for vaccination at a later time. If they do receive the extra dose, their appointments are canceled and opened for others who are in current eligible priority groups.

“Because the call-down mechanism is only used if vaccine is unused due to cancellations or no-shows and would otherwise go to waste, future vaccine supply is not impacted,” Lees said in an email. “Vaccine supply remains low and Coconino County does not currently have sufficient doses to meet the current demand within eligible groups.”

The county is committed to zero waste of the vaccine, she added, and as it moves through its priority vaccine groups, the individuals who can be added to the call-down list will also change.

Though the county advises its partner organizations not to waste vaccine, it does not manage their vaccination plans. Therefore, smaller local clinics targeting specific groups, such as Flagstaff Family Care Clinic, have set up their own procedures for extra doses.

The clinic is currently offering vaccines only to the 1,100 of its patients who are age 75 and older, said Practice Administrator Cindy Wade, and will eventually move to patients 65 and older.

“We’re not catering to younger people only because they can drive and they can schedule their own appointments, they’re computer savvy, they have technology and they’re not the highest risk,” Wade said. “We’ve got to take care. We could lose an entire generation if we don’t manage this correctly and that would be very sad.”

Although 10 doses per vial is the standard for the Moderna vaccine, Wade said vials in reality can contain anywhere from nine to 11 doses. She has not yet seen a vial with only nine doses, though she said the practice has been informed that if this occurs, Moderna will provide the practice with another vial in replacement.

The clinic’s initial allocation was 100 doses, in which an additional three doses were discovered. Of these 100 appointments, there were no cancellations. This week the team will receive an additional 900 first doses and 100 second doses.

Flagstaff Family Care’s waitlist currently includes about 700 individuals in the Phase 1a and 1b groups who agree to arrive at the clinic within an hour’s notice to receive one of the rare extra doses.

Northern Arizona Healthcare, which opened a community vaccine clinic for eligible groups last week at the Elks Lodge, did not at the time have a specific plan for managing extra doses at the site, which has the capacity to distribute up to 1,000 vaccines a day, pending dose availability.

“If we have an extra vial at the end of the day that we can take back and open up additional appointments for another day, that’s a win,” Susan Huerta, NAH’s interim practice manager for community vaccine clinics, said last week. “If mid-vial we’re like, oh, wow, we have room for five more people, between the volunteers that are working here or whoever, we can get shots in arms. It won’t go to waste.”

Other vaccine providers who have announced having waitlists for eligible community members to receive extra doses include Vera Clinic and Northern Arizona University. Vera Clinic will only vaccinate employees of Coconino County, City of Flagstaff, Mountain Line, Flagstaff Unified School District, Coconino County Accommodation School District, Coconino Community College and Kachina Village Improvement District, while NAU is only offering vaccines to active employees.

According to the latest report from the Arizona Department of Health Services, dated Feb. 6, a total of 23,685 vaccine doses have been administered in Coconino County, or 106% of the county’s allocation. This percent exceeds 100 because pharmacies and retail vaccination sites — such as Safeway and Albertsons stores, which recently opened local vaccine clinics — report their administered vaccines to the state, but do not place all their orders through the state.