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[...]due to concerns about vaccine wastage, there is a risk of a vaccine not being administered to someone who needs it if the entire vial cannot be used. [...]depending on the demand at the vaccine delivery point, fewer vaccine doses per vial could reduce vaccine wastage while ensuring access for those in need of a vaccine. Despite the lack of exact numbers, many striking examples of COVID-19 vaccine wastage have been reported worldwide (table 1), highlighting the urgent need to better report, identify the root cause of wastage and, ultimately, reduce vaccine wastage rates globally.Table 1 Global examples of vaccine waste including reasons Country/territory/region Number of vaccines wasted Reason Date Hong Kong Up to 2 million Vaccine hesitancy, below 20% of the population had been vaccinated and this low up-take led to a potential wastage of up to 2 million vaccines May 2021 African countries, include Malawi, South Sudan, Liberia, Mauritania, Gambia, Sierra Leone, Guinea, Comoros, and the Democratic Republic of Congo. 450 000 Expired due to delays in shipment of vaccine doses and therefore no time to roll-out before expiration date July 2021 The Netherlands 39 000–200 000 Since they are surplus and about to expire and the Dutch law states that medicines that have been delivered to doctors for their patient cannot be traded, even if it is for charity and free of charge July 2021 Ireland (Republic of) 220 000 Vaccine expiration of boosters August 2021 Catalonia, Spain 69 129 Too many vaccines defrosted due to miscalculation and declining vaccination rates September 2021 Australia Up to 7 million Expiration and unwanted October 2021 Madrid, Spain 117 977 Expired November 2021 UK 600 000 Vaccine expiration November 2021 South Korea 938 630 Expiration—913 817 (97.4%) Temperature excursions—21 260 (2.3%) November 2021 While accurate data on the difference in wastage between COVID-19 vaccines are not yet available, based on the characteristics of the various vaccines, differences in wastage are expected (table 2). [...]the optimal COVID-19 vaccine to minimise vaccine wastage rates is context dependent. [...]public trust in vaccines plays an important role, and this trust is highly influenced by communication and the spread of misinformation.15 16 For example, the media’s sensationalisation of possible risks related to the AstraZeneca vaccine, starting in March 2021, led several countries to temporarily stop using the vaccine, which likely led to increased levels of vaccine wastage.17 Further, although initially questioned due to adapting the practice of heterologous dosing (eg, dosing with an adenovirus-based vaccine, followed by an mRNA vaccine) with a weak evidence base, it has now shown advantageous immunogenicity outcomes and could provide additional flexibility in using vaccines that might otherwise be wasted.18Table 2 COVID-19 vaccine characteristics Vaccine WHO EUL holder Doses/vial Shelf-life Storage COMIRNATY COVD-19 mRNA vaccine (nucleoside modified) BioNTech Manufacturing GmbH 6 9 months after date of manufacture for undiluted vaccine at storage temperature −90°C to −60°C −80°C to −60°C in ULT freezer −90°C to −60°C in thermal shipper as temporary storage for up to 30 days from delivery (should be re-iced every 5 days if opened up to two times a day, less than 3 min at a time) Up to 1 month (31 days) prior to dilution for undiluted thawed vaccine at +2°C to +8°C up to 2 hours for undiluted thawed vaccine at temperatures up to +30°C VAXZEVRIA COVID-19 vaccine (ChAdOx1-S (recombinant)) AstraZeneca AB/SK Bioscience Co. Ltd AstraZeneca AB 10 6 months for unopened vials stored at 2–8°C 2–8°C Opened vials can be stored at 2–25°C for use within 6 hours Up to 25°C for 2 hours COVISHIELD COVID-19 vaccine (ChAdOx1-S (recombinant)) Serum Institute of India Pvt. Ltd 10 Unopened vials can be stored at 2–8°C for 6 months or up to 25°C for 2 hours Opened vials can be stored at 2–25°C for use within 6 hours 2–8°C COVID-19 vaccine (Ad26.COV2-S (recombinant)) Janssen–Cilag International NV 5 Unopened vials −25°C to 15°C for 2 years Unopened vials 2–8°C for 4.5 months of printed expiration date Up to 25°C for 2 hours 2–8°C Or −20°C if kept unthawed in shipping conditions SPIKEVAX COVID-19 mRNA vaccine (nucleoside modified) Moderna Biotech ModernaTX, Inc 10, 15 9 months at storage temperature: 20°C±5°C 20°C Do not store on dry ice or below

Current treatment of metabolic dysfunction-associated steatotic liver disease focuses on adjusting patients’ lifestyles, including promoting weight loss and physical activity. Here, we suggest adopting a holistic preventive hepatology approach encompassing social nutrition, social prescribing and broader societal changes to facilitate individuals’ engagement with behavioural modifications. Ivancovsky-Wajcman et al. outline the need for a holistic preventive hepatology approach, involving social nutrition and social prescribing, to address the public health threat of metabolic dysfunction-associated steatotic liver disease (MASLD). They argue that this will facilitate individuals’ engagement in behavioural modifications to treat MASLD.

The US Food and Drug Administration (FDA) has approved the first drug, resmetirom, for metabolic dysfunction-associated steatohepatitis (MASH), but much work remains for the industry, practitioners and health systems so that this approval will benefit all patients.

Around 5.3% of adults worldwide are living with metabolic dysfunction-associated steatohepatitis (MASH). As liver fibrosis develops, their incidence of cirrhosis, hepatocellular carcinoma, cardiovascular complications, and non-liver cancer increases. We analyse MAESTRO-NASH resmetirom data and discuss real-world implications following approval. US-based patients now have a novel treatment and expert use recommendations. We anticipate that the UK and EU will approve resmetirom; however, questions remain regarding patient selection and implementation practice.