Vendredi 29 Septembre 2017
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This is the fifth and last topic in my six-part Vaccine Supply Chain Futures series focused on the potential to address safety issues related to the management of sharps waste including syringe and needles.

Progress of efforts to achieve safe infectious sharps disposal in many low to middle income countries is impeded by the lack of funding to establish an infrastructure of medical waste handling in the countries. Immunization generates a small fraction of the sharps waste in public health services but the clients for immunization are not ill at the time they make contact with the service. Rejection of the service is provoked by perceived risks to a healthy child from a preventive intervention. As tolerance of the public to perceived risks reduces towards zero, immunization should be a leading champion of safe disposal of injection materials.

Immunization services have introduced safe collection boxes for use syringes and needles. Many countries use on-site incinerators as an alternative to burial to dispose of filled safety boxes. In-spite of some progress in immunization services, disposal facilities remain far below acceptable standards, especially in health centers. Strategic options do exist and are described briefly in the attached paper. They depend on a new or stronger link between the financing and infrastructure of medical supplies together with disposak of infectious sharps. A successful outcome of efforts to establish safe medical waste disposal in a country should include:

  • National policy for system of disposal of infectious sharps, centralized or localized
  • National plan for the introduction of waste management infrastructure country-wide including disposal ‘hubs’ and transport integrated with supply
  • Integration of disposal and supply via regulation of packing volumes and materials, and establishment of annual budget built on the workload/medical supplies anticipated
  • SOPs in health facilities aligned with hospital waste management practices and adjustments made to in-service and basic training of health personnel

Please open attached file for full text.

Please reply to this post with your views.

Thank you!

6 years ago

Thank you John for highlighting another under-developed but very important component of immunization services.

I have an additional question.

  • Where are the patches?  

Nearly 20 years ago I was in a meeting where microneedle patches were demonstrated for delivering vaccines.  These patches were to be developed for vaccines administered singly or in combination with other antigens - DTP and DTP+ for example.  They came with an applicator to press the patch to the child's or adult's arm to give exactly the right pressure, the packed volume for transport was far lower than that of vaccines in vials and, above all they eliminated the need for syringes and needles for the vaccines that are 'microneedle-compatible'.  

It has been clear for some years that patches would be (could be?) a disruptive technology for vials and syringes and the benefits for immunization programmes could be substantial.  There would be fewer needle-sticks for health workers and the rag-pickers who scour the rubbish dumps to recycle used syringes, less plastic waste—and the used patches can simply be burned. Not to mention less stress for the kids who see the nurse coming at them with a nasty looking needle.  

What does it take to make a disruptive change in our world?  Is it leadership from one of the big agencies - WHO, UNICEF, GAVI, the Bill & Melinda Gate Foundation?  Or is there some other way to encourage a vaccine manufacturer research the feasibility of volume manufacturing of microneedle patches for vaccines.  PATH has made a great start by researching microneedle patch delivery for antiretroviral drugs covering issues of acceptability and Identifying product development pathways—including the clinical, regulatory, manufacturing, and scale-up.


Is there anyone out there who would like to consider supporting a parallel study for using microneedle patches for vaccines?

Let's hope so.

6 years ago

TechNet Futures report on Topic 5: Addressing Safety to Maintain Acceptance: please see full results in attached file.

6 years ago

Thank you John Lloyd for sharing this , its really useful for us. As you know, mostly (70%) immunization service in Indonesia through out reach service (Posyandu) , we use safety boxes for waste sharp (syringes) and collect it to Health center after the service over. Almost 80% of Health centers in Java already have MOU with the third party which is collect the safety boxes every month and bring this to one place for destroy all of this follow the environment department regulation.

Thank you so much


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