tag:theconversation.com,2011:/us/topics/medical-waste-83433/articlesMedical waste – The Conversation2022-09-05T13:09:47Ztag:theconversation.com,2011:article/1894362022-09-05T13:09:47Z2022-09-05T13:09:47ZThe PPE used throughout the COVID-19 pandemic is getting tangled up in wildlife<figure><img src="https://images.theconversation.com/files/481952/original/file-20220831-14-b7noe0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6000%2C3997&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Used masks threaten urban wildlife.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>Throughout the COVID-19 pandemic, masking has been one of the key public health measures put in place to combat the disease. Since March 2020, billions of disposable surgical masks have been used around the world, raising the question: What happens to all those used masks?</p>
<p>As researchers in single use plastic and microplastic pollution, the onset of a global wave of plastic debris pollution became evident to us in the early days of the pandemic — we could see the evidence even during lockdowns when exercise was limited to short daily walks in the neighbourhood. Masks and gloves were on the ground, fluttering in the wind and hanging on fencing. </p>
<p>As ecologists, we were also aware of where the debris would end up — in nests, for example, or wrapped around the legs or in the stomachs of wildlife.</p>
<p>In Canada, a team of researchers led by conservation biologist Jennifer Provencher <a href="https://doi.org/10.1139/er-2018-0079">studied how plastic debris impacts wildlife</a>. In a study conducted during a canal cleanup in The Netherlands, biologists at the Naturalis Biodiversity Center documented <a href="https://doi.org/10.1163/15707563-bja10052">that Personal Protective Equipment (PPE) debris would interact with wildlife in the same way as other plastics</a>. </p>
<h2>Effects on wildlife</h2>
<p>There’s <a href="https://www.reddit.com/r/RATS/comments/i4nv66/face_masks_for_the_win/">a cartoon circulating on the internet</a> that goes like this: a rat comes home carrying bags of groceries to see two rats laying in bunk beds made from medical grade masks. The rat in the bottom bunk exclaims, “Free hammocks, all over town. It’s like a miracle!”</p>
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<p>We shared this cartoon with our colleagues at the beginning of the pandemic, while we were conducting surveys of PPE litter around Toronto streets and parking lots. </p>
<p>We found that within the area that we were surveying — which covered an area of Toronto equivalent to about 45 football fields — over 14,000 disposable masks, gloves or hand wipes accumulated by the end of the year. That’s a lot of rat hammocks.</p>
<p>We set out to understand the breadth of the harm that PPE is doing to wildlife. What we learned is just how many other people were equally concerned. </p>
<h2>Jarring images</h2>
<p>We conducted a global survey using social media accounts of wildlife interactions with PPE debris. The images are jarring: A hedgehog wrapped in a face mask, the earloops tangled in its quills. A tiny bat, with the earloops of two masks wrapped around its wing. A nest, full of ivory white eggs, insulated with downy feathers and a cloth mask. </p>
<p>Many of these animals are dead, but most were alive at the time of observation. Some were released from their plastic entanglement by the people who captured the photo.</p>
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<p>In total, we found 114 cases of wildlife interactions with PPE debris as documented on social media by concerned people around the world. Most of the wildlife were birds (83 per cent), although mammals (11 per cent), fish (two per cent), invertebrates such as an octopus (four per cent) and sea turtles (one per cent) were also observed. </p>
<p>The majority of observations originated in the United States (29), England (16), Canada (13) and Australia (11), likely representing both the increase in access to mobile devices and our English-language search terms. Observations also came from 22 other countries, with representation from all continents except Antarctica. </p>
<h2>Weighing costs and benefits</h2>
<p>With an <a href="https://doi.org/10.1021/acs.est.0c02178">estimated 129 billion face masks</a> <a href="https://doi.org/10.1016/j.jece.2021.105222">used monthly around the world</a>, how do we, as ecologists and environmental researchers, tell a global population experiencing a global pandemic to use fewer masks? We don’t. </p>
<p>N95 masks have been essential in reducing the transmission of COVID-19 and, although they are more environmentally harmful than cloth masks, <a href="https://doi.org/10.1021/acs.chas.1c00016">the benefit to health is demonstrably superior</a>.</p>
<p>So, what could we have done better? One thing we noted during our PPE litter surveys is the abundance of discarded masks and gloves in close proximity to public garbage bins. </p>
<p>We hypothesize that a lack of clear messaging from municipalities and provinces about safe ways to dispose of PPE, along with our reluctance to gather near sources of discarded PPE, may have contributed to this global pollution event.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="a public rubbish bin filled with PPE and surgical masks to the point of overflow" src="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/481955/original/file-20220831-12-g98rae.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Developing better ways for people to get rid of their PPE waste may help prevent used surgical masks from ending up in the environment.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
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</figure>
<p>These are lessons that can still be implemented as we continue to cycle through waves of this pandemic; the use of masks is not yet behind us. Our surveys continue as we track an accumulation of PPE debris that will likely find its way into more nests and tangled around the bodies of more animals.</p>
<p>The rise of single use plastic use due to COVID-19 may not have been avoidable. But the rise in plastic pollution could have been mitigated with some investment in public outreach and modifications to waste management infrastructure to allow for masks and other PPE to be disposed of and processed correctly with minimal leakage to the environment.</p><img src="https://counter.theconversation.com/content/189436/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Billions of face masks and other personal protective equipment have been used throughout the pandemic. Containing plastic, these items are damaging wildlife and their environments.Shoshanah Jacobs, Associate Professor, Integrative Biology, University of GuelphJackie Saturno, Research Associate, Dalhousie UniversityJustine Ammendolia, PhD Student, Resource and Environmental Studies, Dalhousie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1543282021-03-02T13:22:25Z2021-03-02T13:22:25ZCOVID-19 costs could push hospitals to rethink billions of dollars in wasted supplies<figure><img src="https://images.theconversation.com/files/385934/original/file-20210223-16-14962ps.jpg?ixlib=rb-1.1.0&rect=10%2C10%2C6679%2C4456&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The pandemic's supply crunch led to more reuse and decontamination techniques that can save money and reduce waste.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/nurse-reaches-for-supplies-in-clinic-supply-room-royalty-free-image/1245241080">SDI Productions via Getty Images</a></span></figcaption></figure><p>The United States <a href="https://data.oecd.org/healthres/health-spending.htm">spends more on health care</a> than any other nation. What many people don’t realize is that a large portion of this spending goes to waste.</p>
<p>Every year, an estimated US$760 billion to $935 billion is wasted through overtreatment, poor coordination and other failures, amounting to about <a href="https://www.doi.org/10.1001/jama.2019.13978">a quarter of total U.S. health care spending</a>, research has shown. Medical supplies and equipment are part of that. One study estimated that <a href="http://doi.org/10.3171/2016.2.JNS152442">nearly $1,000 in unused supplies</a> are wasted on average during each neurosurgery procedure.</p>
<p>With hospitals <a href="https://www.aha.org/guidesreports/2020-05-05-hospitals-and-health-systems-face-unprecedented-financial-pressures-due">under financial pressure</a> from COVID-19 and medical waste <a href="https://www.waste360.com/medical-waste/hidden-risks-medical-waste-and-covid-19-pandemic">volumes even higher</a>, the pandemic could finally trigger a much-needed reset in how health care organizations and hospitals think about supply-related waste. That includes how they reuse supplies, how they plan for surgeries and what they look for in prepackaged surgical supplies.</p>
<h2>Decontaminating and reusing supplies safely</h2>
<p>It’s important to recognize that not all single-use equipment and supplies are safer. Cleaning, sterilizing and reusing equipment can be safe and cost less in the long run. For example, the U.S. Food and Drug Administration points out that surgical instruments such as clamps and forceps <a href="https://www.fda.gov/medical-devices/reprocessing-reusable-medical-devices/what-are-reusable-medical-devices">can be reprocessed and reused</a>, but they are often thrown away after a single use.</p>
<p><a href="http://doi.org/10.1001/jamainternmed.2020.4221">New sterilization methods</a> can help. For example, N-95 masks that were sterilized and sanitized with ethylene oxide and vaporized hydrogen peroxide were able to retain their more than 95% filtration efficiency. The approvals hospitals received from the Centers for Disease Control and Prevention to <a href="https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/decontamination-reuse-respirators.html">decontaminate</a> some disposable items could become long-term safe methods to reduce waste.</p>
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<img alt="Supplies on tables in an operating room during surgery" src="https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=374&fit=crop&dpr=1 600w, https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=374&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=374&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=470&fit=crop&dpr=1 754w, https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=470&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/385930/original/file-20210223-18-unrksz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=470&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Operating rooms are a large source of hospital supply waste.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/surgeons-performing-open-heart-surgery-royalty-free-image/467546155?adppopup=true">Thierry Dosogne via Getty Images</a></span>
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<p>Being able to <a href="https://doi.org/10.1016/j.ajic.2020.10.013">reuse personal protective equipment</a> could not only reduce waste in landfills, lower the environmental footprint of supply production and delivery, and save money, but it could also strengthen health care organizations’ ability to be prepared for supply chain breakdowns in future pandemics.</p>
<h2>Ways to cut waste in the operating room</h2>
<p>Operating rooms are a source of large amounts of hospital supply waste. They account for over <a href="http://doi.org/10.1007/s10729-015-9318-2">50% of hospital revenues and 25% of their expenses</a>.</p>
<p>Supplies and materials in operating rooms average nearly <a href="http://doi.org/10.1097/ACO.0b013e32832798ef/">half of operating room spending</a> and account for <a href="http://doi.org/10.1016/j.jhsa.2017.11.007">70% of the 4 billion pounds of health care waste</a> produced in the United States annually. </p>
<p>A big part of that waste happens when there is a mismatch between the supplies requested and those actually needed during surgery. Surgeons submit a physician preference card that lists all the supplies they believe they will need in the operating room. In one study, my colleagues and I found that <a href="https://doi.org/10.1002/joom.1070">more frequent updates</a> to those preference cards before surgery can reduce unplanned costs.</p>
<p>We estimated that the unplanned costs in operating rooms averaged about $1,800 per surgery, adding up to tens of millions of dollars. These costs include both supplies that are opened but go unused and additional supplies brought in during surgery that make it harder to manage supply use efficiently. We found that as the frequency of updating physician preference cards increased, waste and costs initially went up but then came down as surgeons were able to narrow down the supplies actually needed. This learning can translate into an annual cost reduction of millions of dollars. </p>
<p>Just understanding how supplies are being wasted can help. When surgeons in a San Francisco hospital were given information about their supply use and an incentive to reduce it, they <a href="http://doi.org/10.1001/jamasurg.2016.4674">cut their supply waste by 6.5%</a>.</p>
<p>Rethinking packaging, including working with suppliers to reformulate surgical packs, could also reduce waste. Supplies used in the operating room often come in surgical packs, which include items typically needed during a procedure, but not all are used.</p>
<h2>Ramping up recycling</h2>
<p>Hospitals can also increase their recycling. A survey conducted across four Mayo Clinic locations across the United States in 2018 found that single-use plastics made up <a href="https://doi.org/10.1016/j.amjsurg.2018.06.020">at least 20% of medical waste</a> generated in the hospitals. Among the more than 500 hospital staff members surveyed, 57% didn’t know which items used in operating theaters could be recycled; 39% said they either sometimes or never recycled; and 48% said the greatest barrier to recycling was “lack of knowledge.”</p>
<p>In fact, <a href="http://doi.org/10.1016/B978-0-08-102528-4.00008-0">only 15%</a> of health care wastes are hazardous. The remaining 85% include packaging materials that can be recycled and gloves. Gloves worn to inspect a noninfectious patient are not hazardous and can be reused.</p>
<p>The pandemic-triggered awareness of supply waste in health care could provide an impetus for a fresh look at health care supply chain management. The result can benefit patients, hospitals and the environment, as well.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=experts">Expertise in your inbox. Sign up for The Conversation’s newsletter and get expert takes on today’s news, every day.</a></em>]</p><img src="https://counter.theconversation.com/content/154328/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anand Nair does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hospitals have a lot of room to reduce, reuse and recycle supplies – as many were forced to discover during the pandemic.Anand Nair, Eli Broad Endowed Professor, Department of Supply Chain Management, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1426512020-07-16T05:38:18Z2020-07-16T05:38:18ZHealth care has a huge environmental footprint, which then harms health. This is a matter of ethics<figure><img src="https://images.theconversation.com/files/347798/original/file-20200716-29-y6eac7.jpg?ixlib=rb-1.1.0&rect=13%2C13%2C3001%2C1980&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>The health impacts of environmental change are now squarely on the radar. Australia’s recent intense wildfires is <a href="https://theconversation.com/how-does-bushfire-smoke-affect-our-health-6-things-you-need-to-know-130126">one glaring example</a>. Spillover of the virus causing the COVID-19 pandemic from animals to humans <a href="https://theconversation.com/coronavirus-is-a-wake-up-call-our-war-with-the-environment-is-leading-to-pandemics-135023">is another</a>. </p>
<p>But less is known about the reverse: environmental harms from health care. This is what our study, <a href="http://www.thelancet.com/journals/lanplh/article/PIIS2542-5196(20)30121-2/fulltext">the first global assessment</a> of the environmental footprint of health care, aimed to do. </p>
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Read more:
<a href="https://theconversation.com/we-must-rethink-health-care-to-include-social-and-environmental-costs-of-treatment-121649">We must rethink health care to include social and environmental costs of treatment</a>
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<p>We quantified resource consumption and pollution by the health-care sector in 189 countries, from 2000 to 2015. We found health care is harming the environment in ways that, in turn, harm health, thereby counteracting the primary mission of health care. </p>
<p>For example, we found the health-care sector causes a substantial share of the world’s emissions of greenhouse gases and air pollutants: 4.4% of greenhouse gases, 2.8% of harmful particulate matter (air particles), 3.4% of nitrogen oxides and 3.6% of sulphur dioxide. </p>
<h2>A vicious cycle</h2>
<p>As part of broader economic systems, the health-care sector can inadvertently harm health through purchased resources, and the waste and pollution produced. In other words, it can unwittingly harm health in efforts to protect and improve it.</p>
<p>The aim of our study was not to assign blame to health care. Rather, as our dependence on health care increases, we need to support this sector to become more sustainable so we don’t enter a vicious cycle, where more health care means more environmental damage, and vice versa. </p>
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<a href="https://theconversation.com/what-happens-to-waste-ppe-during-the-coronavirus-pandemic-137632">What happens to waste PPE during the coronavirus pandemic?</a>
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<p>Using a <a href="https://worldmrio.com/">global supply-chain database</a>, we measured direct and indirect environmental damage driven by health-care demand. </p>
<p>We focused on environmental stressors the health-care sector contributes to with known adverse feedback cycles for health, such as greenhouse gas emissions, particulate matter (10 micrometers or less in diameter) and scarce water use. </p>
<p>We found health care causes environmental impacts that range between 1% and 5% of total global impacts, depending on the indicator. It contributes to more than 5% for some indicators at the individual country level. </p>
<p>For example, along with its contributions to greenhouse gases and air pollutants, health care uses 1.5% of scarce water in the world. Scarce water is measured as water consumption weighted by a “scarcity index”, which takes into account insufficient access to clean water in different countries.</p>
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<a href="https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Shutterstock" src="https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=347&fit=crop&dpr=1 600w, https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=347&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=347&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=436&fit=crop&dpr=1 754w, https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=436&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/347799/original/file-20200716-15-1xyantl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=436&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">To begin addressing the problem, all health-care professionals should first understand how their work impacts the environment.</span>
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<h2>Polluting economies lead to polluting health care systems</h2>
<p>For all stressors, countries with large populations, economies and health budgets (the US and China, for instance) dominate the results in absolute terms. </p>
<p>The key message is that we need to understand how these stressors are trending over time, and what measures can be taken to improve health and protect the environment at the same time. </p>
<p>For example, in South Korea emissions of greenhouse gases, sulphur dioxide, nitrogen oxides and particulate matter from health care decreased by between 27% and 60% during 2000 and 2015. </p>
<p>Whereas in China, sulphur dioxide, nitrogen oxides and particulate matter from health care increased by between 91% and 173% in the same period. </p>
<p>For some indicators such as greenhouse gas emissions and particulate matter, a majority of impacts are hidden in upstream supply chains. Unravelling supply chain connections will help us understand the hotspots of environmental impacts, such as pharmaceuticals and medical supplies.</p>
<h2>A matter of ethics</h2>
<p>The environmental impact of health care is both a practical and ethical issue for health-care professionals.</p>
<p>In 2015, <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32594-7/fulltext">more than 460,000 premature deaths</a> were related to coal combustion globally. Frankly, why should any hospital purchase coal-fired energy when it produces toxic air pollution that harms health? </p>
<p>Some health professionals may baulk at this additional responsibility because they’re busy providing life-saving treatments and don’t have time to worry about the pollution they cause.</p>
<p>And some might say a global pandemic is not the time to burden health-care professionals with another responsibility. </p>
<p>We argue there’s no better time to raise this issue than when the eyes of the world are on health care. The pandemic has shown us we can achieve change at pace and scale if the evidence is clear and the collective will is shared.</p>
<p>The pandemic has brought attention to <a href="https://theconversation.com/what-happens-to-waste-ppe-during-the-coronavirus-pandemic-137632">waste from single-use personal protective equipment</a>. However, we are yet to develop consistent systems for monitoring these environmental impacts, and to implement effective strategies to reduce these impacts across the world.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/347800/original/file-20200716-31-1svfvhm.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Waste from single-use personal protective equipment has no doubt skyrocketed since the pandemic began.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>The way forward</h2>
<p>Health-care organisations at every level (national, regional, hospital, primary care) should measure and track their environmental footprint over time, as they do for health outcomes and financial costs.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/avoiding-single-use-plastic-was-becoming-normal-until-coronavirus-heres-how-we-can-return-to-good-habits-140555">Avoiding single-use plastic was becoming normal, until coronavirus. Here's how we can return to good habits</a>
</strong>
</em>
</p>
<hr>
<p>All health-care professionals – from doctors and nurses, to managers and members of hospital boards – should understand the environmental footprint of the health care they provide and take steps to reduce it. </p>
<p>The purchasing power of health care should be harnessed to drive sustainability transitions in other sectors. For example, health-care organisations purchase large amounts of food for patients. The managers responsible for this food procurement should ensure the food is healthy, value for money and produced in sustainable ways. </p>
<p>Some health-care organisations <a href="https://theconversation.com/five-ways-hospitals-can-reduce-their-environmental-footprint-90390">are already making progress</a>. Civil society organisations like <a href="https://www.greenhospitals.net/">Global Green and Healthy Hospitals</a> are spreading the word. But there is an urgent need for all health organisations to step up. </p>
<p>As health professionals around the world <a href="https://www.theguardian.com/environment/2020/may/26/world-health-leaders-urge-green-recovery-from-coronavirus-crisis">increasingly call for action on climate change</a>, it’s important to ensure <a href="https://www.mja.com.au/journal/2020/212/8/sustainable-future-health-ensuring-health-professionals-our-own-house-order-and">their own house is in order</a>.</p><img src="https://counter.theconversation.com/content/142651/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Capon receives funding from the National Health and Medical Research Council, the Australian Research Council and the Wellcome Trust. He is a member of the Expert Advisory Committee for the Climate and Health Alliance. </span></em></p><p class="fine-print"><em><span>Arunima Malik receives funding from the Australian Research Council, and from the National eResearch Collaboration Tools and Resources project (NeCTAR) through its Industrial Ecology Virtual Laboratory Infrastructure. </span></em></p><p class="fine-print"><em><span>Manfred Lenzen receives funding from the Australian Research Council, and from the National eResearch Collaboration Tools and Resources project (NeCTAR) through its Industrial Ecology Virtual Laboratory infrastructure. </span></em></p><p class="fine-print"><em><span>David Pencheon and Helga Weisz do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>“Frankly, why should any hospital purchase coal-fired energy when it produces toxic air pollution that harms health?”Tony Capon, Director, Monash Sustainable Development Institute, Monash UniversityArunima Malik, Lecturer in Sustainability, University of SydneyDavid Pencheon, Honorary Professor, Exeter UK / Adjunct Professor, Monash Sustainable Development Institute / Visiting Professor, Surrey UK, University of ExeterHelga Weisz, Professor of Industrial Ecology and Climate Change, Humboldt University of BerlinManfred Lenzen, Professor of Sustainability Research, School of Physics, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1324792020-03-04T19:01:49Z2020-03-04T19:01:49ZVaccines without needles – new shelf-stable film could revolutionize how medicines are distributed worldwide<figure><img src="https://images.theconversation.com/files/318665/original/file-20200304-66112-9v1pww.jpg?ixlib=rb-1.1.0&rect=43%2C43%2C1115%2C817&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Films that dissolve rapidly when placed under the tongue or high in the cheek will make vaccines cheaper and more reliable.</span> <span class="attribution"><span class="source">Stephen C. Schafer</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span></figcaption></figure><p>The race is on to identify an effective vaccine for the COVID-19 virus. Once discovered, the next challenge will be manufacturing and distributing it around the world. </p>
<p>My research group has developed a novel method to stabilize live viruses and other biological medicines <a href="https://doi.org/10.1126/sciadv.aau4819">in a rapidly dissolving film</a> that does not require refrigeration and can be given by mouth.</p>
<p>Since the ingredients to make the film are inexpensive and the process is relatively simple, it could make vaccine campaigns much more affordable. Large quantities could be shipped and distributed easily given its flat, space saving shape.</p>
<p>Globally, vaccination rates have improved over the past decade, but are still too low – 13.5 million children were <a href="https://ourworldindata.org/vaccination">not vaccinated in 2018</a>. This new technology, recently published <a href="https://doi.org/10.1126/sciadv.aau4819">in the journal Science Advances</a>, has the potential to dramatically improve global access to vaccines and other biological medicines.</p>
<h2>Inspired by hard candy</h2>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&rect=0%2C177%2C2297%2C1661&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&rect=0%2C177%2C2297%2C1661&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=655&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=655&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=655&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=823&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=823&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318397/original/file-20200303-66084-1403psg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=823&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Not your grandmother’s vaccine.</span>
<span class="attribution"><span class="source">Maria Croyle</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>My research team began developing this technology in 2007, when the National Institutes of Health asked us to develop a needle-free, shelf-stable delivery method for a vaccine. </p>
<p>The idea of developing a film was inspired by a documentary about how the DNA of insects and other living things can be preserved for millions of years in amber. This got us thinking about hard candy, like my grandmother used to make.</p>
<p>It was a simple idea, yet no one had tried it. So we went to work mixing a variety of formulations containing natural ingredients like sugars and salts and testing them for their ability to form a solid amber-like candy.</p>
<p>Initially, many of the preparations we tested either killed the organism as the film formed or crystallized during storage, shredding the virus or the bacteria we were trying to preserve.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=103&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=103&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=103&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318668/original/file-20200304-66052-112hifn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=129&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Vaccines like those for measles, polio, influenza, hepatitis B and Ebola, as well as many of the therapeutic antibodies used to treat infections and cancer, can be carefully sandwiched between protective layers.</span>
<span class="attribution"><span class="source">Stephen C. Schafer</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>But finally, after about 450 tries over the course of a year, we found a formulation that could suspend viruses and bacteria in a peelable film.</p>
<p>As we gained more experience with the production process, we worked to simplify it so extensive technical training would not be needed to make it. Additionally, we tweaked the ingredients so they would dry faster, enabling one to make a batch of vaccine in the morning and ship it after lunch. </p>
<p>I’m involved with a startup aiming to get this technology to market within the next two years. </p>
<h2>More benefits</h2>
<p>All stored vaccines lose their potency over time. The rate at which they do so mostly depends on the <a href="https://doi.org/10.1586/erv.09.20">temperature at which they are kept</a>. Keeping vaccines continuously refrigerated is <a href="https://doi.org/10.1016/j.vaccine.2007.02.052">difficult and expensive</a> – and in some parts of the world, <a href="https://theconversation.com/cracking-the-cold-chain-challenge-is-key-to-making-vaccines-ubiquitous-99329">nearly impossible</a>. So creating a vaccine that can be stored and transported at room temperature is a huge advantage. </p>
<p>The biggest breakthrough for this project came when we were finishing up our Ebola vaccine project and found films containing virus made three years ago, stored in a sealed container on the lab bench. On a whim, we rehydrated them and tested them to determine if the vaccine was still capable of inducing an immune response. To our surprise, more than 95% of the viruses in the film were still active. To achieve this kind of shelf-life for an unrefrigerated vaccine was astonishing.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=361&fit=crop&dpr=1 600w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=361&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=361&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=454&fit=crop&dpr=1 754w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=454&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/318436/original/file-20200303-66069-18ofksf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=454&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The film can stabilize the vaccine in a space-saving format, making it easier to ship and distribute around the globe.</span>
<span class="attribution"><span class="source">Stephen Schafer and Maria Croyle</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc-sa/4.0/">CC BY-NC-SA</a></span>
</figcaption>
</figure>
<p>The ecological footprint left by global immunization campaigns is not often considered. The 2004 Philippine Measles Elimination Campaign, which immunized 18 million children in one month, generated 19.5 million syringes, or 143 tons of sharps waste and nearly 80 tons <a href="https://noharm-global.org/documents/disposal-mass-immunization-waste-without-incineration">of nonhazardous waste</a> – empty vials, syringe wrappers, caps, cotton swabs and packaging. The implications for a larger campaign are significant.</p>
<p>Our film, by contrast, can be distributed by health workers equipped with only an envelope containing the vaccine. Once taken, it will leave no trace, except for a healthy global population.</p>
<p>[<em>Insight, in your inbox each day.</em> <a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=insight">You can get it with The Conversation’s email newsletter</a>.]</p><img src="https://counter.theconversation.com/content/132479/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The film technology developed in the Croyle Laboratory at the College of Pharmacy, University of Texas at Austin, has been licensed to a new startup company based in Chapel Hill, North Carolina for which Dr. Croyle is a scientific advisor. Dr. Croyle currently receives funding from the National Institutes of Health. </span></em></p>Inspired by amber and hard candy, researchers figured out a new, needle-free, shelf-stable way to preserve vaccines, making them easier to ship and administer around the world.Maria Croyle, Professor of Pharmaceutics, The University of Texas at AustinLicensed as Creative Commons – attribution, no derivatives.