In many ways, the response to the COVID-19 pandemic was phenomenal: the near-immediate release of the genetic data, followed by scientists banding together to find vaccines with unprecedented speed, and then a huge public health campaign to administer the jabs. And all the while, frontline healthcare workers fought with astonishing bravery and diligence to help a terrified public. 

However, it came at a cost, in several ways. A new World Health Organization (WHO) report on healthcare waste warns that tens of thousands of tonnes of extra medical equipment, produced in vital response to the pandemic, are putting a huge strain on healthcare waste management systems – and that failure to deal with it threatens human health all over again, as well as potential environmental catastrophe.

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The report is based on the 1.5 billion units – approximately 87,000 tonnes – of personal protective equipment (PPE) procured between March 2020 and November 2021, and shipped worldwide via a joint UN emergency initiative. The majority of this equipment is expected to have ended up as waste.

This is, the report acknowledges, only part of the problem. While the UN distribution figures are accountable, the nature of unsatisfactory waste disposal protocols suggests that we may never know how much of this has been unsafely handled. Furthermore, the report notes that it does not take into account any COVID-19 commodities distributed outside the UN initiative, nor public-generated waste like disposable medical masks.

The report says that more than 140 million test kits have been shipped, which could generate 2,600 tonnes of non-infectious, mainly plastic, waste and 731,000 litres of chemical waste – equivalent to a third of an Olympic-size swimming pool. 

Meanwhile, more than eight billion doses of vaccine have been administered worldwide, which itself has produced 144,000 tonnes of additional waste in the form of needles, syringes, glass vials and safety boxes.

"It is absolutely vital to provide health workers with the right PPE," said Michael Ryan, executive director of the WHO's health emergencies program, "but it is also vital to ensure that it can be used safely without impacting on the surrounding environment."

The problem is that many of the world's healthcare systems were already struggling with waste protocols even before COVID-19. The report says that 30 percent of healthcare facilities aren't equipped to handle pre-pandemic wasteloads – and that proportion rises to 60 percent in the least developed countries. 

Unsafe disposal methods can expose health workers to needle injuries, burns and pathogenic microorganisms, while also affecting communities living near poorly managed disposal sites via contaminated air from burning waste, poor water quality or pest-borne diseases.

Systemic change

The report's authors called for several changes, from manufacture through procurement to disposal. 

"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 Maria Neira, the WHO’s director of environment, climate change and health, calling for "significant change at all levels, from the global to the hospital floor."

Recommendations include using eco-friendly packaging and shipping, safe and reusable PPE, and recyclable or biodegradable materials. At the other end of the chain, the WHO calls for investment in non-burn waste treatment technologies, and in the recycling sector to ensure as second life for materials like plastics.

One area for examination is needless PPE. For instance, the WHO does not recommend using gloves for vaccine injections, but the report said it appeared to be common practice. 

"We find that people are wearing excessive PPE," said Margaret Montgomery, technical officer of WHO's water, sanitation, hygiene and health unit. "In terms of the volume, it's enormous. Part of the message for the public is to become more of a conscious consumer."

"A systemic change in how healthcare manages its waste would include greater and systematic scrutiny and better procurement practices," said Anne Woolridge, chair of the healthcare waste working group at the International Solid Waste Association.

"There is growing appreciation that health investments must consider environmental and climate implications. 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 behaviors."

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