Hello Blog Readers and Podcast Listeners!
In today’s topic, I am going to discuss about a grave issue related to COVID-19 pandemic, that is, the issue of medical waste management and climate crisis. A clear negative externality of the pandemic is the medical waste produced since the inception of the pandemic. Healthcare waste including masks, gloves, gowns, testing kits, personal protective equipment (PPE), vials, syringes, and needles – in millions of tons of medical waste!
The World Health Organization recently released a report conducting global analysis of healthcare waste in the context of COVID-19 pandemic. Globally, the latest data indicates that one-third global healthcare facilities do not safely manage medical waste. This number goes up to 60% for least developed settings. The pressure of medical waste was observed to be more in least developing countries, especially due to lack of safe and proper waste management services in those countries. The COVID-19 pandemic has led to huge spikes in medical waste, straining under-resourced healthcare facilities, and exacerbating negative environmental impacts from solid medical waste on public health. According to the report, the COVID-19 pandemic waste from healthcare facilities includes 144,000 tons of syringes, needles, and safety boxes from 8 billion doses of vaccine; 2,600 tons of mostly plastic waste and 731,000 liters of chemical waste from at least 140 million test kits. This also includes 87,000 tons of PPE shipped via a United Nations emergency initiative alone.
However, the report captures only medical waste volumes generated from PPE, COVID-19 testing, and vaccinations from March 2020 to November 2021. The data is sourced from the United Nations COVID-19 Supply Portal, which represents only a small fraction of global procurement. The global analyses encapsulates neither the substantial amounts of pandemic commodities that have been procured outside the United Nations system, nor COVID-19-related waste generated by the general public, including surgical masks. Thus, the actual medical waste would surmount to a much larger size and impact.
So, how did the medical waste problem start?; what are the consequences?; India’s case; future solutions for low- and middle-income countries (LMICs), and recommendations targeted at global, national, and facility (local) level. Let’s discuss!
The COVID-19 pandemic struck in December 2019/January 2020, and accelerated globally through March 2020. Sudden chaos resulted in severe and mounting disruptions to the global supply of PPE. Initially, due to rising aggregate demand for PPE (including hoarding), there was a global shortage of PPE. This also resulted in rising deaths of healthcare workers (including needle-stick injuries, burns, and exposure to pathogenic microorganisms). Thus, the immediate focus of global efforts was to increase availability of PPE. Since, the United Nations and its Member States grappled with the urgent task of securing supplies and assuring their quality, less attention and resources were devoted to the pandemic-related safe medical waste management. resulting in poor solid waste management services, especially in LMICs.
Globally, countries lacked the capacity to manage existing medical waste loads, let alone increases in waste volumes during pandemic. Further, this has weakened our fight against climate crisis and accelerated environmental degradation. The pandemic tested the resilience of health systems globally, with dire consequences for least developed settings with poor waste management, lack of proper water and sanitation, and poor quality of healthcare.
So, where does India stand?
In India, recycling of plastics from medical waste reduces healthcare waste volumes that need to be treated. That said, India generated approximately 100 tonnes of daily COVID-19-related medical waste during the first wave of the pandemic. This is in addition to the 609 tonnes of waste generated daily from routine health services. This makes it a total of at least 700 tonnes of waste generated per day. Albeit the total available capacity for incineration of pandemic waste in the country is 840 tonnes, the capital city of New Delhi accounts for about 10% of India’s daily COVID-19 waste generation but has only two incinerators. During the first wave, 70% of this capacity was being used, and measures were needed to ensure that capacity was not exceeded by sending waste to industrial incinerators and centralized waste treatment centers. Thus, in order to address the pressing issue of increased pandemic medical waste, the Central Pollution Control Board, under the Ministry of Environment, produced a set of waste guidelines in 2020. The guidelines emphasized the importance of waste segregation. The ministry regularly amended the guidelines in an effort to further reduce the amount of waste incineration and placed a greater focus on non-burn and environmentally sustainable technologies and practices, such as autoclaving, microwaving and recycling by state-approved facilities. Training in local languages on COVID-19-appropriate waste disposal and hygiene practices was conducted, and mass media communication was used to educate the general public on management of COVID-19 waste generated at home. Simultaneously, the ministry launched a COVID-19 medical waste mobile application to track generated waste amounts, as well as transport and reception at the treatment centers. This includes tracking of waste vehicles to prevent theft of waste and unauthorized recycling of waste.
Whilst conducting a case study on India, the report noted a number of indigenous solutions that were trialed during the pandemic. These included conversion of COVID-19 waste into clean energy (hydrogen fuel) using sunlight, and conversion of PPE waste into eco-friendly construction materials, including construction bricks, bituminous road surfaces and partial replacement of cement in concrete. However, evaluation of their impact was out of scope. The report further noted that waste management proved to be very challenging in rural areas where there are limited waste treatment and disposal facilities.
Furthermore, there is an urgent need to increase the number of authorized, trained waste recyclers to respond to the increase in waste generated. Overall, the emphasis on waste segregation by the Central Pollution Control Board resulted in less waste being incinerated, reducing the environmental impact.
Lastly, the report suggested the need for implementing a waste management system that allows waste generators and authorities to identify the current waste streams and determine how much waste is generated, and what waste can be recycled or reused to reduce the climate footprint. This information will help with planning adequate infrastructure such as storage, and required waste treatment capacities. Moreover, it can support healthcare facilities to monitor adequate segregation and evaluate performance of the waste tracking system.
Drawn from various global health system experiences, some of the innovative and scalable solutions for improving environmental sustainability of safe medical waste management that were noted by the World Health Organization are: a) reducing the amount of unnecessary PPE through safe and rational use; b) using sustainable packaging; c) development of reusable masks and gloves; d) use of recyclable PPE; e) implementation of reverse logistics and centralized treatment of waste using non-burn technologies; and f) investment in local and regional production of medical equipment.
At a global level, following recommendations were suggested in the report:
a) Strengthening coordination among global health donors, logistics, infection and control, medical waste, and environmental actors;
b) Promoting and investing in more sustainable PPE and solid waste management systems; and
c) Supporting behavior change away from single use and overuse of PPE.
At the national level, following recommendations were suggested in the report:
a) Updating, implementing, and regulating medical waste standards and practices;
b) Investing in safe medical waste management services and infection prevention and control; and
c) Monitoring and reporting medical waste practices.
At the facility level, following recommendations were suggested in the report:
a) Improving training, mentoring, and investments for safe and sustainable waste management services;
b) Supporting hand hygiene and good water and sanitation practices; and
c) Improving environmental sustainability of waste treatment technologies.
In closing, a more holistic approach is required to address the global issue of increasing medical waste. The solutions and recommendations enlisted above do not compromise on safety issues, suggesting that a win-win outcome can be achieved. As the pandemic response transitions into the next phase of endemicity, there is both a need and opportunity to invest in resilient health systems. This includes investing in underlying systems supporting a strong health workforce and waste management system. Implementing the WHO solutions and recommendations will help ensure proactive global responses to effectively counter climate crisis and future public health emergencies. This in turn will lead to promotion of health of individuals, communities, and populations, and ensuring resilient environmental health systems are in place to tackle future waste management shocks.
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Ankur Chhabra 