A consequence of the Sars-CoV-2 pandemic is the huge amount of extra medical waste it has generated as health systems the world over continue to respond to the impacts of the coronavirus.
The pandemic exposed yet another metric of unpreparedness of health systems and the dire need to improve health-care waste management and disposal systems and practices around the world.
The World Health Organization (WHO) in a new report, Analysis of Healthcare Waste in the Context of Covid-19, last week warned of a “mountain of extra medical waste” comprising largely masks, gloves and gowns (all infectious), rapid antigen tests, PCR cartridges, vaccine vials and needles, and plastic packaging and containers.
Dr Mandeep Dhaliwal, director: HIV Health and Development at UNDP, a WHO partner, said: “Waste management is an integral part of the supply chain, because of the use and expiry of health products. Inadequate and inappropriate handling of health-care waste can have serious public health and environmental consequences and can significantly impact on the health of people and planet.”
The data is dire, based on estimates of a joint UN emergency Covid-19 response initiative. A UNDP study of five Asian cities covering March 2020 to January 2022 showed that Covid-19 increased the amount of hazardous health-care waste tenfold compared with the average pre-pandemic volume.
Globally, three out of 10 health-care facilities lack systems to segregate waste. Today, 30% of health-care facilities (60% in least developed countries) are not equipped to handle existing waste loads, let alone the additional Covid-19 load. Nearly one third of personal protective equipment (PPE) totalling 87 000 tons shipped under the initiative cannot be safely bagged or stored because of too few biohazard bags.
The problem is exacerbated by the misclassification of hazardous waste by many facilities and countries. Sars-CoV-2, reminds WHO, is an enveloped virus, which means that it is inactivated relatively quickly by environmental factors such as sunlight or heat. The evidence indicates that the main virus route of transmission is directly from person to person through exhaled respiratory particles.
The depressing news is that the report “just provides an initial indication of the scale of the medical 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”. It also does not include the waste related to dear departed loved ones due to the virus including clothing, undertaking materials as per Covid protocols for funerals, personal masks, etc.
The authors stress that more than 140 million test kits, with a potential to generate 2 600 ton of non-infectious waste (mainly plastic) and 731 000 litres of chemical waste have been shipped, while more than eight billion doses of vaccine have been administered globally, producing 144 000 tons of additional waste in the form of syringes, needles and safety boxes.
The key recommendations include using eco-friendly packaging and shipping; safe and reusable PPE; recyclable or biodegradable materials; investment in non-burn waste treatment technologies, such as autoclaves; reverse logistics to support centralised treatment and investments in the recycling sector to ensure materials such as plastics can have a second life.
Sars-CoV-2 being a highly infectious pathogen, it threw up several issues on the fragility and vulnerability of national health systems. Wealth, class, power and advanced medical facilities, equipment and research, as the latest WHO pandemic dashboard distribution and death figures show, are no insurance against the pathogen. By February 8, some 400 million people across the globe had contracted the virus at some stage since its onset in March 2020, of which 5.75 million people died. In a twisted way, Covid-19 was a great equaliser in this respect.
Where the gross inequalities between the rich and poor nations become stark is in the response to the pandemic – the race to develop vaccines which led to vaccine nationalism and unequal access to and hoarding of vaccines, resulting in vaccine inequality and poverty.
Even here, taxpayers in first-mover countries such as Israel and the UK, it has since emerged, paid a heavy price for this “advantage” through agreeing to highly inflated prices and potentially corrupt practices in PPE procurement and other clinical safety products through favoured “VIP lists” of firms effectively involved in alleged pandemic profiteering. South Africa in this respect is no exception.
Overall, the global response to the pandemic had been left woefully wanting if we also consider the knock-on effects on health, lives and livelihoods through diversion of previously allocated scarce resources to fighting other pandemics, such as malaria, TB and HIV/Aids, and lockdowns.
It is not all gloom and doom, though. The COP26 conference in Glasgow last November elicited a commitment to develop “climate-smart health care”. Covid-19 showed that the world was unprepared to cope with a surge in medical waste. But there are those who maintain that adversity also presents an opportunity to fix a waste management problem that has huge implications for mitigating climate change, fighting pollution and creating resilient health systems.
The increased number and severity of extreme weather events disrupts health services and essential fundamentals for providing these services, including water, sanitation, waste management, transport and logistics. Alas, the health-care sector is a substantial contributor to greenhouse gas emissions, accounting for approximately 4 to 5% of total emissions globally, according to WHO.
The COP26 climate-smart health-care aspiration requires a more holistic approach. “Addressing environmental concerns does not necessitate compromising on safety. A win-win is possible by strengthening basic infection prevention and control practices, improving safe and sustainable waste management, and protecting human and environmental health,” says WHO.
Covid-19 and the environment are not a zero-sum game. Action now will help ensure that responses to future climate and health emergencies will promote and protect human and environmental health – leading to safer and more resilient communities.