| The rapid development of Covid-19 vaccines is one of medicine's greatest achievements, but distribution hasn't been easy. Vials full of doses often must be kept in extreme cold, and once opened have to be used quickly, sometimes prompting health workers to run out into the street looking for someone to take the leftovers. Now vaccination campaigns in the U.S. and some other countries are moving from mass demand to more targeted efforts to reach the hesitant—and doctors want easier ways to deliver shots. The ideal in many instances would be a pre-filled syringe, simple to store with no excess to worry about. But drugmakers haven't made that a priority yet, and other measures to deliver vaccines to smaller, farther-flung populations are coming along slowly, presenting achallenge in the next phase of the immunization effort.  A pre-filled syringe. Photographer: Mikael Sjoberg/Bloomberg Doctors' offices and clinics "need to reach people in their persuadable moment," Kentucky Public Health Commissioner Steven Stack said April 21 at a briefing hosted by the Association of State and Territorial Health Officials. "And it's difficult to do that when these products are shipped in 10-dose vials, or even sometimes five-dose vials." Large shipments of vials filled to the brim suit the needs of a campaign aimed at eventually vaccinating most of the world's population. More than 1 billion shots have been administered globally, according to Bloomberg's vaccination tracker, and more than a fifth of them in the U.S. alone. Large lots remain a priority globally, even as the U.S. campaign enters a new, more targeted stage. Almost a third of Americans are fully immunized, but getting to a level at which vaccines will keep the virus largely at bay will increasingly require reaching residents who have misgivings about the shots. Those are most likely to be given at locations like primary-care doctor's offices and clinics, where fewer doses might be needed each day, experts said. Yet the pre-filled syringes aren't a major focus for vaccine manufacturers that have been racing to get shots developed, cleared and distributed. Pfizer, whose Covid vaccine developed with partner BioNTech was the first authorized in the U.S., isn't currently developing a pre-filled version, a spokesman said. Coming up with slightly more convenient packaging hasn't been the first priority for Moderna either, according to a spokesperson. Schott and Catalent Pharma Solutions, which make pre-filled syringes, say they're in discussions with companies now on Covid vaccines, but that the shift will take time. Becton Dickinson, one of the top makers of syringes, has said it's investing about $1.2 billion over four years on manufacturing capabilities and technology for pre-fillable syringes and other drug delivery systems that could also be of use for pandemic response. Requests for pre-filled syringes are "probably good news. It means we're far enough in the vaccine process where the modality starts to matter," said Cody Powers, a principal at consulting firm ZS who advises manufacturers of Covid vaccines. "In much of the world, that's a luxury."—Emma Court | 
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