By Mary Hearty

Tens of thousands of tonnes of extra medical waste from the COVID-19 response has put tremendous strain on health care waste management systems around the world, threatening human and environmental health and exposing a dire need to improve waste management practices, a new World Health Organization (WHO) report reveals.

The  WHO Global analysis of health care waste in the context of COVID-19: status, impacts and recommendations report bases its estimates on the 1.5 billion units of personal protective equipment (PPE), weighing approximately 87,000 tonnes alone that was 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.

These vaccination activities are expected to generate over 144,000 tonnes of additional waste, comprising 88,000 tonnes of glass vials, 48,000 tonnes of syringes plus needles and 8,000 tonnes of safety boxes, the report says.

At the moment, the authors 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 143 tonnes of additional waste in the form of syringes, needles, and safety boxes.

Furthermore, public use of PPE globally, especially masks, has increased significantly since the start of the COVID-19 pandemic. One estimate suggests that, based on country mask mandates and public mask use, in 2020, up to 3.4 billion single use masks were discarded each day, resulting in a sizable, additional volume of plastic waste.

Most of the mask waste for disposal is plastic, and a sizeable proportion of this waste, especially in low- and middle-income countries with limited waste management systems, ends up polluting terrestrial and marine ecosystems.

“In 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,” Ruth Stringer, Science and Policy Coordinator at Health Care Without Harm says.

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 absolutely vital to provide health workers with the right PPE, “said Dr Michael Ryan, Executive Director, WHO Health Emergencies Programme. “But it is also vital to ensure that it can be used safely without impacting on the surrounding environment. 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.”

According to the WHO analysis, today, three out of 10 healthcare facilities globally lack systems to segregate waste, let alone the additional COVID-19 load. Whereas in the least developed countries, less than 1 in 3 healthcare facilities have a basic healthcare waste management service.

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 of our health care resources, from cradle to grave,” said Dr Maria Neira, Director of Environment, Climate Change and Health at WHO.

“Significant change at all levels, from the global to the hospital floor, in how we manage the health care 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 also 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 organizations that have put into practice in the spirit of “building back better”.

These 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 centralized 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 Dr Anne Woolridge, Chair of the Health Care Waste Working Group, International Solid Waste Association (ISWA).

“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 behaviours.”

Dr Mandeep Dhaliwal, Director HIV Health and Development, UNDP stated: “Waste management is an integral part of the supply chain, as a result 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.”

This analysis comes at a time when the health sector is under increasing pressure to reduce its carbon footprint and minimize the amount of waste being sent to landfill — in part because of the great concern about the proliferation of plastic waste and its impacts on water, food systems and human and ecosystem health.