Tens of thousands of tonnes of extra medical waste from the response to the COVID-19 pandemic has put tremendous strain on healthcare 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 World Health Organisation (WHO) report.
The WHO’s global analysis of healthcare waste in the context of COVID-19: status, impacts and recommendations based its estimates on the approximately 87,000 tonnes of personal protective equipment (PPE) procured between March 2020 and 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 noted 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 pointed 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 vital to provide health workers with the right PPE. But it is also vital to ensure that it can be used safely without impacting on the surrounding environment,” said the executive director, WHO Health Emergencies Programme, Dr. Michael Ryan.
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 per cent of healthcare facilities (60 per cent 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 our wastes from healthcare, from cradle to grave,” said the director, environment, climate change and health at WHO, Dr. Maria Neira.
“Significant change at all levels, from the global to the hospital floor, in how we manage the healthcare 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 organiszations 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 centralised treatment and investments in the recycling sector to ensure materials, like plastics, can have a second life.
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 the chair of the Health Care Waste Working Group, International Solid Waste Association (ISWA), Dr. Anne Woolridge.