Medical waste or healthcare waste can be interpreted as waste generated by healthcare facilities like hospitals, blood banks, clinics, research facilities, laboratories, etc. Medical waste has always been an issue under the larger umbrella of waste management, but the ongoing COVID-19 pandemic has placed a substantial strain on how developing countries are responding to increasing threats of human and environmental health.
Although the classification of healthcare waste varies widely, according to the World Health Organization (WHO), there are eight broad categories:
Infectious (waste contaminated with blood and other bodily fluids, or waste from infectious patients)
Pathological (tissues, organs, or fluids), Sharps (syringes, needles, scalpels, blades)
Chemical (solvents, reagents, disinfectants, or sterilants)
Pharmaceutical (expired, used, or contaminated drugs)
Cytotoxic (waste with genotoxic properties)
Radioactive (waste contaminated by radionuclides)
Non-hazardous or General waste (waste that does not have a particular biological, radioactive, chemical, physical hazard)
As of February 2022, there have been 10.7B COVID-19 doses administered worldwide, producing over 192,000 tonnes of waste in the form of syringes, needles, and safety boxes according to the WHO. Additionally, over 140 million rapid testing kits have been shipped worldwide, generating over 2600 tonnes of non-infectious waste and 731,000 liters of chemical waste. Other major contributors to medical waste include personal protective equipment (PPE) in the form of disposable masks, gloves, and gowns. Furthermore, more than 87,000 tonnes of PPE were shipped to countries who need support in responding to the pandemic. Last, in developing countries in particular, millions of unused vaccines are being destroyed and thrown away, which further contributes to the medical waste issue.
These numbers are of enormous concern because they not only reveal how our increasing wastefulness threatens both human and environmental health, but also emphasize the urgency of improving our current waste management systems before it gets too late. For example, the WHO has stated that health workers should be fitted with the correct PPE, but it is essential for individuals to pay more attention to how they can use PPE in a safe and environmentally sustainable manner. Although it is not recommended to wear gloves for COVID-19 vaccine administration, data reveals that each healthcare employee discards an average estimate of 50 pairs of disposable gloves per week. The WHO has reported that 30% of healthcare facilities, and up to 60% of developing countries, are not properly equipped to handle our current waste loads, thus posing a health hazard.
So how can healthcare professionals ethically follow their obligations to avoid causing harm to patients while also following the ethics of public health and management to thwart medical waste production? What makes up healthcare ethics, and what explains the issues that developing nations are facing in terms of waste management systems?
In developing nations in Africa and Asia, research has estimated that Asia will generate the highest quantity of discarded facemasks per capita per day (1.8B) followed by Europe (445M) and Africa (411M). Because of existing COVID-19 policies and pandemic protocols, PPE waste (medical waste) is potentially boosted by single-use masks, gloves, and face-shields. Two main problems with this is that 1) discarded PPE may form a bulk of mismanaged waste which would end up as litter in terrestrial environments or coastal shorelines, and 2) developing countries may find it more difficult to handle excess waste given that have already been an ongoing issue of waste mismanagement.
What is contributing to waste mismanagement in developing countries? African countries such as Ethiopia, Botswana, Ghana, and South Africa have not separated the way they manage medical waste compared to regular waste, which is problematic because contamination of regular waste could create unexpected secondary chemical reactions that may result in unprecedented reactions when chemicals are oxidized and react with other substances. Similarly, many healthcare facilities and pharmacies are unaware of where their medical waste is disposed of because of limited funding, thus hindering many developing countries from hiring private contractors services to dispose of and transport medical waste. Unlike other continents and countries around the world that implement a wide variety of practices for disposing and classifying waste according to their country/state legislation, developing countries in Africa and Asia are having difficulties doing the same, as they are stricken by severe poverty, limited resources, and natural disasters.
Studies and publications on sustainable waste management of medical waste in developing countries in particular have suggested that a substantial waste management model should be implemented for countries to take more control over their waste. For example, instead of open-dumping or incineration, solid waste can be disposed of at a management facility or at an available DUMP (Disposal of Unused Medicines) programme for pharmaceutical waste. For countries and healthcare professionals to ethically follow their obligations to not cause harm while also aligning themselves with the ethics of public health and management, pushing towards socio-economic change and finding approaches to overcoming challenges within existing government guidelines and policies for proper waste handling should be addressed first. After establishing proper waste handling policies and guidelines, a call for reform and additional public support towards a reduction of medical waste among the common and professional world will successfully prevent tonnes of medical waste from being generated.
References:
Aljazeera. “Huge volumes of COVID medical waste posing health hazard: WHO.” Al Jazeera, 1 February 2022, https://www.aljazeera.com/news/2022/2/1/huge-volumes-of-covid-medical-waste-posing-health-hazard-who. Accessed 19 March 2022.
Benson, Nsikak U., et al. “COVID pollution: impact of COVID-19 pandemic on global plastic waste footprint.” Heliyon, vol. 7, no. 2, 2021, p. 9. ScienceDirect, https://www.sciencedirect.com/science/article/pii/S2405844021004485.
Chisholm, Jade Megan et al. “Sustainable waste management of medical waste in African developing countries: A narrative review.” Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA vol. 39,9 (2021): 1149-1163. doi:10.1177/0734242X211029175
Hassan, Adeel. “A Deluge of Medical Waste Is Swamping the Globe, a UN Report Says.” The New York Times, 3 February 2022, https://www.nytimes.com/2022/02/03/world/medical-waste-environment-covid.html. Accessed 19 March 2022.
Khan, Bilal Ahmed et al. “Healthcare waste management in Asian developing countries: A mini review.” Waste management & research : the journal of the International Solid Wastes and Public Cleansing Association, ISWA vol. 37,9 (2019): 863-875. doi:10.1177/0734242X19857470
Washington State Department of Health. Glove and Other PPE Guidance for COVID-19 Vaccine Administration. 2021. Department of Health, https://doh.wa.gov/sites/default/files/legacy/Documents/1600/coronavirus//COVID-19VaccineGloveGuidance.pdf.
World Health Organization. Tonnes of COVID-19 health care waste expose urgent need to improve waste management systems. 2022. World Health Organization, https://www.who.int/news/item/01-02-2022-tonnes-of-covid-19-health-care-waste-expose-urgent-need-to-improve-waste-management-systems.