In a report released Monday by the World Health Organization (WHO), researchers estimated that the response to the Covid-19 pandemic resulted in tens of thousands of tons of excess medical waste, straining health care waste management systems worldwide, threatening both human and environmental health, and exposing a critical need to improve waste management practices across the health care industry.
The Hippocratic Oath stops at climate change—let's change that.
According to the report, led by WHO's Water, Sanitation, Hygiene and Health Unit in collaboration with several other WHO teams and partners, roughly 87,000 tons of personal protective equipment (PPE) were distributed through a joint United Nations (UN) emergency initiative between March 2020 and November 2021—most of which was estimated to have ended up as waste.
The report said more than 140 million test kits have been distributed so far, which could create 2,600 metric tons of non-infectious waste and 731,000 liters of chemical waste—the equivalent of one-third of an Olympic-size swimming pool.
In addition, over 8 billion doses of the Covid-19 vaccine have been administered globally, resulting in 144,000 tons of excess waste in the form of syringes, needles, and safety boxes.
So far, WHO reported that only five million biohazard bags—with the capacity to dispose of approximately 61,000 metric tons of waste—have been requested, which means 26,000 metric tons of waste potentially cannot be stored safely.
Moreover, WHO said the Covid-19 pandemic likely resulted in much more pollution than the report estimates since the researchers did not account for products that were procured and distributed outside the emergency initiative, or any disposable masks that were improperly disposed of by the public.
Noting that the health care waste alone has further strained "under-resourced health care facilities and exacerbate[ed] environment impacts from solid waste," WHO added that "since the start of the Covid-19 pandemic, plastic production has more than doubled, raising concerns about both the short-term impacts on fresh water, oceans and air quality (from burning), and the longer-term impacts of persistent nano-plastic particles."
Although countries prioritized locating and distributing high-quality PPE for health care workers, the report states that many nations did not devote adequate time and attention to ensuring the safe and sustainable management of health care waste associated with the Covid-19 pandemic.
According to WHO, 30% of health care facilities around the world were not capable of handling existing waste loads prior to the pandemic—let alone the additional waste that has overwhelmed systems during the pandemic. As a result, some health care workers and communities with poorly managed waste disposal facilities have been left vulnerable to needle-stick injuries, burns, pathogenic microorganisms, contaminated air from burning waste, poor water quality, and disease-carrying pests.
"It is absolutely vital to provide health workers with the right PPE," said Michael Ryan, executive director of WHO's Health Emergencies Programme. "But it is also vital to ensure that it can be used safely without impacting on the surrounding environment."
To accomplish this, WHO said effective waste management systems must be implemented, with guidelines that outline how health care workers should dispose of PPE and other health commodities after they finish using them. The WHO report provides several recommendations for implementing environmentally sustainable waste practices, including the industry:
Overall, "[a] systemic change in how health care manages its waste would include greater and systematic scrutiny and better procurement practices," said Anne Woolridge, chair of International Solid Waste Association
"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 behaviors," she added.
Separately, Ruth Stringer, science and policy coordinator for Health Care Without Harm, said, "[i]n the face of Covid-19, sustainable health care waste management is more important than ever to protect communities, health workers, and the planet and prevent pollution." (World Health Organization news release, 2/1; Knutson, Axios, 2/1; Gretler, Bloomberg, 2/1)
The WHO report is bleak, but not overly surprising, especially considering health care is one of the worst offending industries when it comes to waste. But think about what this means for the sector beyond causing harm to the planet. The waste produced throughout the pandemic came at significant fiscal and logistical cost to the health care organizations that perpetrated it. The more waste health care organizations produce, the more it affects their bottom line.
In fact, the 'everyone for themselves' panicked stockpiling of perishable medical supplies in 2020 led to a sixfold increase in hospital medical waste and the inequitable distribution of supplies around the world. It gets worse. Millions of unused vaccines have been thrown away amounting to hundreds of millions of dollars lost, not to mention wasted time spent on procurement, valuable storage space squandered, and extensive logistical pathways rendered obsolete. And There have been stories of PPE—once the proverbial pot of gold at the start of the pandemic—being stored in damaging conditions, costing health systems tens of millions of dollars and preventing life-saving equipment from reaching those at the frontlines.
Of course, at the start of the pandemic, there was a level of necessity as health systems had to rapidly procure and deploy whatever resources they could spare to the frontlines. And with single-use items being the universal standard for sterile clinical equipment, one could argue that we really didn't have any other choice. But it's the decisions we have made over the last two years that are going to drastically affect and disrupt the environment in which we operate in the long-term.
And this leads me to another, longer-term problem—health care's failure to effectively control and manage waste means it is barreling towards a scary level of unsustainability. Not just at an environmental level, but also in the way health systems operate and pay for goods. The population is growing, ageing, and there is an ever-increasing abundance of co-morbidities, naturally ramping up the pressure on health systems. But as health systems treat more people, the amount of waste from single-use resources skyrockets. And that's just not feasible in the long term.
Take another world-changing event as an example: WWII. After the end of the war, militaries the world over dumped their unused, stockpiled ammunition into the ocean. We are only now beginning to see the downstream effects of this with long term damage of underwater ecosystems and the scrapping of engineering projects deemed unsafe because of explosives on the ocean floor. The decisions we made nearly 80 years ago are now costing us ecologically, logistically, and financially. Waste from the Covid-19 pandemic is essentially the 21st century version of that.
There is reason to be hopeful. With Covid-19 gradually transitioning into an endemic disease, there will be space for us to re-think the materials and resources we procure for health care. There is a perceived cost benefit to using single-use plastics (hence health care's overdependence on them), but there's another, more powerful angle to consider: a culture change.
Clinicians often don't know how much their supplies and equipment cost, meaning they use whatever they think they need, or whatever they are accustomed to. But some hospitals are now sticking the price to every piece of equipment or calling out those who are racking up high equipment costs. The result is that clinicians are more frugal, costing the system less, and reducing the long-term damage to the environment.
And, in terms of procurement, innovative start-ups and sustainability departments in incumbent producers have ramped up the creation and supply of biodegradable alternatives such as gowns, gloves, sharps, and gauzes, while some organizations are revisiting the old method of sterilization and re-use.
These are long-term solutions that will be around long after Covid-19 ceases to be a pandemic and will help health care respond sustainably when the next big challenge arrives.
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