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.

The Covid-19 pandemic led to 'large increases' in health care waste

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."

Environmentally sustainable waste disposal practices are 'more important than ever'

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:

• Implement eco-friendly packaging and shipping methods
• Purchase safe and reusable PPE
• Use recyclable or biodegradable materials
• Invest in non-burn waste treatment technologies, like autoclaves
• Reverse logistics so they support centralized treatment and investments in the recycling sector to give materials, such as plastics, a second life

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)