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WHO report: pandemic exposes lack of sustainable medical waste management practices

A pile of used and discarded PPE equipment
The WHO Global analysis of health care waste in the context of COVID-19 – status, impacts, and recommendations – bases its estimates on the approximately 87,000 tonnes of personal protective equipment (PPE).

Tens of thousands of tonnes of extra medical waste from the response to the COVID-19 pandemic have strained health care waste management systems around the world and exposed a need to improve waste management practices, according to a report from WHO.

The WHO Global analysis of health care waste in the context of COVID-19 – status, impacts, and recommendations – bases its estimates on the approximately 87,000 tonnes of personal protective equipment (PPE) that was procured between March 2020 and November 2021 and shipped to support countries' COVID-19 response needs through a joint UN emergency initiative. Most of this equipment is expected to have ended up as waste.

The report notes that this just provides an initial indication of the scale of the COVID-19 waste problem. It does not take into account any of the COVID-19 commodities procured outside of the initiative, nor waste generated by the public like disposable medical masks.

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 144,000 tonnes of additional waste in the form of syringes, needles, and safety boxes.

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 of the 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 using effective management systems, including guidance for health workers on what to do with PPE and health commodities after they have been used.

Health care workers are potentially being exposed to needle stick injuries, burns, and pathogenic microorganisms because 30 percent of healthcare facilities are not equipped to handle existing waste loads, let alone the additional COVID-19 load. This lack of healthcare infrastructure also impacts 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 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.

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, safely and sustainably reducing and managing health care waste. This can be through strong national policies and regulations, regular monitoring and reporting, increased accountability, behaviour change support, 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).

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