Dan Jacobs, Waste and Resource Management Technical Director at Mott MacDonald, considers the global impact of Covid-19 on healthcare waste and how organisations must work together to address it.
The Covid-19 pandemic generated a huge global surge in healthcare waste, comprising vast amounts of disposable masks, testing kits, vaccination needles and personal protective equipment (PPE).
The impact of that extra waste emphasised the immediate need for a more robust and modernised waste infrastructure network. Many countries are still struggling with a legacy of backlog waste or expired and unusable health products.
The need for global action
Worldwide, the importance of safe, sustainable and compliant healthcare waste management often falls under the radar.
Understandably, the attention of the public, media and industry is often drawn to the more visually impactful issues, like the need to eliminate single-use plastics, tackle marine litter and eradicate uncontrolled dumpsites.
Yet, as reported by Healthcare Without Harm, it’s estimated that if the global health sector were a country, it would be the fifth largest emitter of greenhouse gas emissions, with a climate footprint equivalent to 4.4% of global net emissions.
Based on the UNICEF and World Health Organisation (WHO) Joint Monitoring Report for 2021, as many as one in every three healthcare facilities lacked even the most basic waste management systems, such as three bin segregation and some form of safe disposal.
The WHO estimates that 15% of healthcare waste is infectious, toxic or radioactive, so it’s critical that more is done to tackle the problem.
In many low- and middle-income countries, the only available way to dispose of healthcare waste is to openly burn it or dump it in enclosed pits.
The treatment of healthcare waste in outdated and non-compliant incinerators is also commonplace, meaning that the most harmful dioxins, furans and pathogens are not destroyed.
A lack of local guidelines, effective segregation and training often leads to undertreatment of certain waste types and inadequate disposal practices.
The environmental and climate related consequences of this improper management, and particularly the impact on society and local communities, is inevitably severe.
According to the United Nations Environment Programme (UNEP), “improper treatment and disposal of healthcare waste poses serious hazards of secondary disease transmission due to exposures to infectious agents among waste pickers, waste workers, health workers, patients, and the community”.
Hope
However, there is hope. International donor organisations and development banks are joining forces to stimulate investment and provide momentum.
Organisations like UNICEF, the Global Vaccine Alliance (GAVI), the United Nations Development Programme (UNDP), and WHO are coordinating efforts at a global, regional and national level to improve waste management systems.
The World Bank and other global and regional financing institutions now readily include healthcare waste in their investment portfolios.
The key to success is making sure this is implemented sustainably, founded on an established enabling environment and long-term benefit.
Case study: The Global Fund to Fight AIDS, Tuberculosis and Malaria
The Global Fund has been working to strengthen the approach to waste management. With portfolios in over 140 countries, mainly in regions like sub-Saharan Africa, Latin America, Asia and Eastern Europe, the Fund invests up to $5 billion each year to fight diseases and strengthen systems for health.
Mott MacDonald has been working with the Fund since 2019 to help improve the way waste is managed in its investments.
Through the development of industry-leading technical guidelines, decision-making tool kits and the delivery of training, the countries that the Global Fund supports are better armed to mitigate waste impacts.
We are now helping to ensure that these waste investments are robustly implemented, so there is a legacy of sustainable systematic change long after any funding ceases.
In 2024/25, the Global Fund is expected to invest over $72 million in healthcare waste management.
In 2024/25, the Global Fund is expected to invest over $72 million in healthcare waste management. Much of this is focused on transitioning away from unsafe disposal by introducing technically and environmentally compliant waste treatment, such as modern high temperature incineration and sterilisation technologies.
Importantly, though, it is also providing funding to establish long-term management plans, supervision, guidelines, training and engagement campaigns.
Using interventions like these to create a lasting enabling environment is critical if infrastructure investments are to succeed in the long-term.
With increased multi-agency cooperation and coordination there is optimism that international resources can be targeted in a more impactful and sustainable way.
Through working with organisations like the Global Fund, who prioritise country ownership and national strategies, we can help countries at an early stage in this journey start to catch up.
The UK picture
Even in the UK, it has taken many years to establish priorities. Increased healthcare waste combined with an ageing and sparsely distributed waste treatment network have placed extreme stress on local waste management arrangements for many NHS Trusts.
The long-awaited release of NHS England’s Clinical Waste Strategy in 2023 was certainly timely. Its six strategic priorities placed infrastructure resilience, effective segregation and carbon reduction at the heart of national ambition.
It is supported by the launch of revamped national technical guidance, a dedicated workforce training programme (with the help of the Chartered Institution of Wastes Management (CIWM)), increased supply chain engagement and its inaugural awards for the sector later this year to will highlight best practice and innovation.
With a new focus on circularity, green procurement and better engagement with the supply chain, there is now a more solid foundation for addressing future challenges.
