When the Victorian Government today announced its support for local manufacture of rapid antigen tests (RATs), this was described as important for ensuring supply and creating jobs.
But it may also be a win for the environment – local supply chains are recommended in a new World Health Organization report urging countries to tackle the surge in healthcare waste caused by the pandemic.
The report, ‘Global analysis of healthcare waste in the context of COVID-19: status, impacts and recommendations’, calls for actions – global, national and local – to reduce waste in the COVID context and at a time of accelerating environmental and climate crises.
“Any investment in COVID-19 PPE, testing or vaccination must be accompanied by investments in reducing and managing the waste from products used,” says the report.
Addressing waste and climate change is no longer a “preferred” strategy, but an essential component of health systems planning, it says. “An important policy measure at the national level is to develop environmentally sustainable health infrastructure standards.”
Regular national monitoring and reporting on healthcare waste practices and systems is important for accountability, for targeting resources, and for greater impact of COVID-19 supplies and health commodities more generally.
The report says that more than 60 percent of global PPE production is in China and the United States – with the exception of gloves, which are mostly made in Malaysia and Thailand (about 85 percent).
Procurers are advised to consider offering regional manufacturers preferential access to tenders, with procurement requirements and indicators to consider innovative products that are environmentally friendly.
“There is growing appreciation that healthcare investments must consider environmental and climate implications, including implications for how PPE is procured, used, managed and treated,” says the report. 
Safety concerns
Globally, safe waste management services for healthcare waste are lacking, especially in least developed countries, with the latest data showing that in 2019, one in three healthcare facilities around the world do not safely manage healthcare waste.
The report cites one estimate that in 2020, up to 3.4 billion single use masks were discarded each day, and says that plastic production has more than doubled since the pandemic began.
“The COVID-19 pandemic led to a double burden of an increase in waste plus a reduced capacity of healthcare workers to manage waste because of increased patient loads, COVID-19 work and societal constraints. As a result, safe management of healthcare waste suffered,” says the report.
“Poor waste management has the potential to affect healthcare workers through needlestick injuries, burns and exposure to pathogenic micro-organisms. It may also affect communities living in proximity to poorly managed landfills and waste disposal sites, through contaminated air, poor water quality or disease-carrying pests.
The report repeatedly mentions the importance of reducing unnecessary use of plastic gloves, noting that their overuse was a longstanding problem even before COVID-19.
It presents case studies of effective waste management; in England, for example, one study found that 75 percent of COVID-19 waste could be avoided through rational use, local manufacturing and safe reuse.
It also cites evidence that local manufacturing of PPE in the UK had a significant impact on the carbon footprint of PPE items. The UK Government has a PPE strategy to build a UK manufacturing base so that there is a resilient domestic supply – with a target of 70 percent of PPE (excluding gloves) to be manufactured locally.
Germany also features as case study; its response to PPE shortages was to tender for domestic manufacture of masks and to guarantee prices for all PPE produced until the end of 2021.
Around 50 German companies, including technology firms, raw materials suppliers, manufacturers and distributors, have been included in the government scheme to produce 10 million respirator masks and a further 40 million surgical masks. Companies temporarily producing masks were also eligible for the government’s subsidy program if they commit to purchasing 70 percent of raw materials within the European Union.
The report says many facilities and countries mistakenly classify 100 percent of COVID-19 healthcare waste as hazardous, rather than the 10 to 15 percent level typically generated from routine health service provision. In New Delhi, for example, classifying all COVID-19 waste as infectious nearly quadrupled waste volumes during the peak of the outbreak in May 2021.
Since the pandemic began, WHO has stated that extra or special procedures beyond normal classification into infectious and non-infectious are not needed for waste from COVID-19 patients. As an enveloped virus, SARS-CoV-2 is inactivated relatively quickly by environmental factors such as sunlight or heat.
Calls to action
The report’s recommendations include:
• reduce the amount of unnecessary PPE through safe and rational use
• use smaller quantities of, and more sustainable, packaging
• develop and use safely reusable and easily disinfected PPE (gloves, aprons and masks)
• use PPE made with a greater proportion of renewable, biobased or recyclable materials
• invest in recycling systems for general healthcare waste
• implement reverse logistics and centralised treatment of waste using non-burn technologies
• invest in local and regional PPE production, and just-in-time shipments.
A healthy recovery
The report also recommends strengthening healthcare waste systems, through improved and more sustainable standards and regulation, regular monitoring and reporting, and increased investments in safe waste management.
It cites efforts in France to develop compostable face masks made with locally produced hemp fibres, while Spain has produced masks made from natural raw materials that can be biodegraded within 22 days by industrial composting. Australia gets one mention in the report, for research investigating the recycling of used medical masks for repurposing as road construction materials.
The report says that although the health sector’s contribution to COVID waste is relatively small compared the increased volumes generated by the public, “it does present an opportunity to direct COVID-19 resources and innovation to sustainably strengthen healthcare waste management, while also putting in place environmentally sustainable policies and practices”.
“Indeed, waste minimisation, green procurement, safe reuse, recycling and recovering, and safe healthcare waste management are all key prescriptions in the WHO manifesto for a healthy recovery from COVID-19.”
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