medical waste

Addressing Medical Waste as Part of the Global Response to the COVID-19 Pandemic

On February 1, 2022, the WHO released a report on the challenges posed by additional medical waste as the world responds to the COVID-19 pandemic. See World Health Organization, Global analysis of health care waste in the context of COVID-19, February 2022, https://www.who.int/publications/i/item/9789240039612

The WHO news release describes the issues around medical waste during the pandemic. WHO News Release, Tonnes of COVID-19 health care waste expose urgent need to improve waste management systems, 1 February 2022, https://www.who.int/news/item/01-02-2022-tonnes-of-covid-19-health-care-waste-expose-urgent-need-to-improve-waste-management-systems.

“Tens of thousands of tonnes of extra medical waste from the response to the COVID-19 pandemic has put tremendous strain on health care waste management systems around the world, threatening human and environmental health and exposing a dire need to improve waste management practices, according to a new WHO report.

“The WHO Global analysis of health care waste in the context of COVID-19: status, impacts and recommendations bases its estimates on the approximately 87,000 tonnes of personal protective equipment (PPE) that was procured between March 2020- November 2021 and shipped to support countries’ urgent COVID-19 response needs through a joint UN emergency initiative. Most of this equipment is expected to have ended up as waste.

“The authors note that this just provides an initial indication of the scale of the COVID-19 waste problem. It does not take into account any of the COVID-19 commodities procured outside of the initiative, nor waste generated by the public like disposable medical masks.

“They point out that over 140 million test kits, with a potential to generate 2,600 tonnes of non-infectious waste (mainly plastic) and 731,000 litres of chemical waste (equivalent to one-third of an Olympic-size swimming pool) have been shipped, while over 8 billion doses of vaccine have been administered globally producing 144,000 tonnes of additional waste in the form of syringes, needles, and safety boxes.

“As the UN and countries grappled with the immediate task of securing and quality-assuring supplies of PPE, less attention and resources were devoted to the safe and sustainable management of COVID-19 related health care waste.

“’It is absolutely vital to provide health workers with the right PPE, ‘ said Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme. ‘But it is also vital to ensure that it can be used safely without impacting on the surrounding environment.’

“This means having effective management systems in place, including guidance for health workers on what to do with PPE and health commodities after they have been used.

“Today, 30% of healthcare facilities (60% in the least developed countries) are not equipped to handle existing waste loads, let alone the additional COVID-19 load. This potentially exposes health workers to needle stick injuries, burns and pathogenic microorganisms, while also impacting communities living near poorly managed landfills and waste disposal sites through contaminated air from burning waste, poor water quality or disease carrying pests.

“’COVID-19 has forced the world to reckon with the gaps and neglected aspects of the waste stream and how we produce, use and discard of our health care resources, from cradle to grave,’ said Dr Maria Neira, Director, Environment, Climate Change and Health at WHO.

“’Significant change at all levels, from the global to the hospital floor, in how we manage the health care waste stream is a basic requirement of climate-smart health care systems, which many countries committed to at the recent UN Climate Change Conference, and, of course, a healthy recovery from COVID-19 and preparedness for other health emergencies in the future.’

“The report lays out a set of recommendations for integrating better, safer, and more environmentally sustainable waste practices into the current COVID-19 response and future pandemic preparedness efforts and highlights stories from countries and organizations that have put into practice in the spirit of ‘building back better’.

Recommendations include using eco-friendly packaging and shipping, safe and reusable PPE (e.g., gloves and medical masks), recyclable or biodegradable materials; investment in non-burn waste treatment technologies, such as autoclaves; reverse logistics to support centralized treatment and investments in the recycling sector to ensure materials, like plastics, can have a second life. (Emphasis added)

“The COVID-19 waste challenge and increasing urgency to address environmental sustainability offer an opportunity to strengthen systems to safely and sustainably reduce and manage health care waste. This can be through strong national policies and regulations, regular monitoring and reporting and increased accountability, behaviour change support and workforce development, and increased budgets and financing.

“’A systemic change in how health care manages its waste would include greater and systematic scrutiny and better procurement practices,’” said Dr Anne Woolridge, Chair of the Health Care Waste Working Group, International Solid Waste Association (ISWA).

“’There is growing appreciation that health investments must consider environmental and climate implications, as well as a greater awareness of co-benefits of action. For example, safe and rational use of PPE will not only reduce environmental harm from waste, it will also save money, reduce potential supply shortages and further support infection prevention by changing behaviours.’

“The analysis comes at a time when the health sector is under increasing pressure to reduce its carbon footprint and minimize the amount of waste being sent to landfill — in part because of the great concern about the proliferation of plastic waste and its impacts on water, food systems and human and ecosystem health.”

The importance of the report, which doesn’t account for the vast amount of medical waste from COVID in countries not procuring PPE and other products through the UN system, is reflected in a recent posting on the World Economic Forum’s webpage. See World Economic Forum, COVID-19 has caused a surge in medical waste. Here’s what needs to be done, February 17, 2022, https://www.weforum.org/agenda/2022/02/medical-waste-plastic-environment-covid/.

Role for Other Multilateral Organizations and Private Sector

While the WHO obviously has a central role in working with countries to help them improve their healthcare systems including best practices in medical waste disposal, it is clear that more can and should be done to address the current situation and minimize challenges going forward from other pandemics and everyday health care needs.

For example, the IMF, World Bank, WTO and WHO meet to jointly explore ways to improve vaccination and other health care responses to the COVID-19 pandemic. See MULTILATERAL LEADERS TASK FORCE ON COVID-19 VACCINES, THERAPEUTICS, AND DIAGNOSTICS, https://www.covid19taskforce.com/en/programs/task-force-on-covid-19-vaccines. Resources from the IMF and World Bank as well as from governments and the private sector are needed to improve in-country capabilities for medical waste handling. It is not clear that the four are working jointly on funding for improved medical waste treatment as part of the Multilateral Leaders Task Force. If not they should be. Such efforts should be happening now as resources are being spent to ramp up in-country vaccination capabilities so that additional vaccinations are coupled with proper medical waste handling. In addition, those institutions and some governments have been working to increase regional production of vaccines, but there has been no discussion of similar efforts on PPE or other items where local manufacture could reduce environmental and health challenges.

Similarly, the WTO has been exploring the trade response to the pandemic (and to future pandemics). Separately, there are several plurilateral negotiations on environmental issues, including one of plastics in the oceans. The WHO report raises the question of whether the WTO trade and health discussions need to consider what, if any, additional elements could be added to help Members address medical waste. Members should also be exploring whether the plurilaterals should be expanded to take on additional aspects of the medical waste challenge.

There is much that the private sector should be doing to find solutions to the problems of growing medical waste through redesign of products to use less plastic, increase reusability of PPE products and address other aspects of the WHO recommendations.

Time will tell whether the gaps in the health care system pertaining to medical waste are addressed meaningfully or not. Let’s hope this is an area where there will be global focus and coordination.