NASHVILLE, Tenn. (AP) — As millions continue to wait their turn for the COVID-19 vaccine, small but steady amounts of the precious doses have gone to waste across the country.

It’s a heartbreaking reality that experts acknowledged was always likely to occur. Thousands of shots have been wasted in Tennessee, Florida, Ohio and many other states. The reasons vary from shoddy record-keeping to accidentally trashing hundreds of shots. However, pinning down just how many of the life-saving vials have been tossed remains largely unknown despite assurance from many local officials the number remains low.

To be sure, waste is common in global inoculation campaigns, with millions of doses of flu shots trashed each year. By one World Health Organization estimate, as many as half of vaccines in previous campaigns worldwide have been thrown away because they were mishandled, unclaimed or expired.

By comparison, waste of the COVID-19 vaccine appears to be quite small, though the U.S. government has yet to release numbers shedding insight on its extent. Officials have promised that may change soon as more data is collected from the states.

In the interim, state health agencies are much more inclined to tout how fast they’ve administered the shots while keeping mum on the number of doses that end up in the trash.

Ohio’s Department of Health resisted the use of the term “wasted” when asked by The Associated Press for a total number of tossed doses. Instead a spokesperson for the agency said that the state tracks “unusable” vaccines reported by state providers.

“With 3.2 million doses administered as of March 9, 2021, the 3,396 unusable doses reported by state providers make up about 0.1% of the doses administered — less than the CDC expectation of 5% of unusable doses,” Alicia Shoults, an Ohio Department of Health spokesperson, said in an email.

According to a log sheet provided by the department, Ohio providers reported almost 60 incidents where doses were unused. The largest incident occurred earlier this year, when a pharmacy responsible for distributing the vaccine to nursing homes failed to document storage temperatures for leftover shots, resulting in 890 doses being wasted.

In Tennessee, wasted, spoiled or unused doses aren’t publicly disclosed on the state’s online COVID-19 vaccine dashboard. However, after nearly 4,500 of Tennessee’s doses were ruined in February, the state’s Department of Health scrambled to find answers.

It started with nearly 1,000 doses reported missing in eastern Tennessee’s Knox County, where emotional local leaders told reporters that a shipment was accidentally tossed by an employee who believed the box contained dry ice.

Shortly after, a little more than 2,500 doses were reported wasted in Shelby County — which encompasses Memphis. A state investigation concluded the eye-opening spoilage occurred over multiple incidents due to substandard pharmacy practices, a lack of standard operating procedures for storage and handling, disorganized record-keeping and deficient management of soon-to-expire vaccine doses.

A separate 1,000 doses were then reported spoiled in middle Tennessee after a school district reported a storage error.

Despite the recent string of wasted vaccine incidents, the health agency stressed that the number represents just a sliver of the nearly 1.9 million doses the state has received since December.

“We don’t believe there is a systemic issue statewide, but we’re ramping up our efforts for compliance just to be sure,” state Health Commissioner Lisa Piercey told reporters earlier this month.

Piercey said Tennessee will soon conduct a review of the state’s vaccine distribution efforts to prevent future waste, and eventually hire a separate company to conduct the quality checks.

Meanwhile, in Florida, Surgeon General Dr. Scott Rivkees recently called for an audit after more than 1,000 doses of vaccine were reported damaged last month in Palm Beach County. When asked for the review of that audit, the state said this week it would provide those documents through a request for public records — which it was still compiling.

Like other states, Florida doesn’t regularly publish how many doses don’t end up in arms, but a spokesperson for the state health department said 4,435 doses had been reported wasted as of Monday.

In Louisiana, health officials give updated totals of wasted doses to reporters at the governor’s weekly COVID-19 briefing. Out of 1.2 million vaccine doses administered thus far, fewer than 1,500 had been wasted as of Tuesday, said Dr. Joe Kanter, the governor’s chief public health adviser.

Ohio’s health department reported 2,349 doses wasted or spoiled as of February. Officials stress the wasted amount is extremely low compared to the total doses that ended up in arms. However, they note, that doesn’t make the situation any less upsetting.

“Here’s the bottom line: This stuff is gold,” said Julie Willems Van Dijk, deputy secretary of the Wisconsin Department of Health Services. “I think every vaccinator who touches a bottle of Pfizer, Moderna or J&J knows it. … I’ve talked to people with these wasted vaccine and they are heartbroken.”

The federal government has also held off releasing numbers of spoiled or unusable doses, though it says states should report such waste in its vaccine tracker.

“We are working to figure out how to provide this data online in the future when the data is more complete,” Kristen Nordlund, a spokesperson for the Centers of Disease Control and Prevention, said in an email.

Associated Press writers Adrian Sainz in Memphis, Tennessee, Scott Bauer in Madison, Wisconsin, Melinda Deslatte in Baton Rouge, Louisiana, and Andrew Welsh-Higgins in Columbus, Ohio, contributed to this report.