For Online E-newspaper
The East African : Mar 1st 2015
34 The EastAfrican OUTLOOK FEBRUARY 28 - MARCH 6, 2015 D E VE LO PME N T Why it took long to adopt non-≥eusables By TODD C. FRANKEL The Washington Post LEO Pharma’s pharmaceutical manufacturing plant in Vernouillet, France where it makes injectable products. Pic: File WHO pushes for use of ‘smart’ syringes to reduce infections The devices have featu≥es that p≥event ≥euse, and thei≥ launch is pa≥t of a longte≥m st≥ategy to imp≥ove injection safety By CHRISTABEL LIGAMI Special Correspondent T he World Health Organisation has unveiled a new policy and global campaign on the safety of injections, with the aim of cutting infections from diseases such as HIV and hepatitis. Under the new policy, WHO is urging countries to adopt safety-engineered syringes or “smart” syringes that have features that prevent reuse. “The new policy and global campaign represent a decisive step in a long-term strategy to improve injection safety by working with countries worldwide. We have already seen considerable progress,” said Edward Kelley, director of WHO’s and safety department. Countries are expected to transition to the exclusive use of the new “smart” syringes by 2020. at However, the syringes cost least twice the price of those without safety features. The latter go for between $0.03 and $0.04 when procured by a UN agency for a developing country. In that regard, WHO is calling on donors to support the transition to the “smart” devices, and is expecting that prices will drop over time as demand rises. The organisation is also calling for policies and standards for the procurement and safe use and disposal of syringes that have the potential for re-use in situations where they remain necessary, such as in programmes for people who inject drugs. Continued training health workers of in injection supported for decades — is another key recommendation. WHO is calling on manufacturers to begin or expand, as soon as possible, the production of “smart” syringes that meet the organisation’s standards quality and safety. service delivery needle and potentially posed to an infection. Other models include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back, while in others the needle Needle reuse The use of the same syringe or needle to give injections to safety — which the WHO more than one person is drivhas for performance, ing the spread of a number of infectious diseases worldwide. Millions of people could be protected from infections acquired through unsafe injections if all health-care programmes switched to syringes that cannot be used more than once. The syringes are being en- WHO, which focused on the gineered with safety features most including devices that protect health workers against accidental needle injury, also called “needle stick” injuries, and consequent exposure to infection. A sheath or hood slides over the needle after the injection is completed to protect the user from being injured accidentally by the A 2014 study sponsored by recent available data, estimated that in 2010, up to 1.7 million people were infected with the hepatitis B virus, up to 315,000 with the hepatitis C virus and as many as 33,800 with HIV through unsafe injections. There are 16 billion injections administered every year. Around five per cent of these “Countries are expected to transition to the exclusive use of the new ‘smart’ syringes by 2020.” retracts into the syringe barrel at the end of the injection. ex- CAMPAIGNS Between 2000 and 2010, as injection safety campaigns picked up, reuse of injection devices in developing countries decreased by a factor of 7. Over the same period, unnecessary injections also fell: The average number of injections per person in developing countries fell from 3.4 to 2.9. In addition, since 1999, when WHO and its partner organisations urged developing countries to vaccinate children only using syringes that are automatically disabled after a single use, the vast majority have switched to this method. THE WORLD Health Organisation called this week for the worldwide use of needle syringes that selfdestruct after a single injection. These “smart” syringes are a response to a problem that medical authorities have recognised for decades — the frequent reuse of disposable shots, which pose a health risk. But changing the practice — especially in poor countries — has proven difficult. In some places, syringes are scarce. Or the dangers are not fully appreciated, despite education campaigns. And sometimes healthcare providers can just get lazy. So how do you stop people from reusing syringes? The WHO has been hunting for solutions for nearly 25 years. Only recently has the technology become feasible — cheap, easy to use, hard to break. “It’s not simple,” WHO spokeswoman Judith Mandelbaum-Schmid said. “There had to be quite a lot of engineering.” The WHO’s quest began in 1987 — just as the spread of HIV was beginning to cause alarm. The agency put out a call for syringe designs that automatically and irrevocably stopped working after a single filling and injection. The syringes essentially needed to break after one use. The WHO wanted to use these shots to deliver vaccines. One body that took up the challenge was Path, a small international health technology nonprofit in Seattle. Path came up with a plastic syringe with a metal clip inside it that locked into place after the plunger was depressed. A syringe manufacturer licensed the product. skin (subcutaneous or intradermal route). In many cases these injections are unnecessary or could be replaced by oral medication. “We know the reasons why this is happening,” said Dr Kelley. people expect “One reason is that in many injections are for immunising most children and adults, and five per cent are for other procedures like blood transfusions and injectable contraceptives. Another that believing they represent the effective is to receive injections, treatment. health workers in developing countries, giving families.” The remaining 90 per cent of ments salaries that may be injections are given into muscles (intramuscular route) or in private practice inadequate to support suppletheir for many injections “Smart” syringes are a response to the frequent re-use of disposable shots (as above), which pose a health risk. Pic: File countries In 1990, the Soloshot hit the market. Since then, it has been used to deliver more than six billion vaccine shots. But the Soloshot was limited to the vaccination market, which accounts for only five to 10 per cent of all injections worldwide. The product didn’t work in syringes with varying dosages, where the plunger is pulled back to different levels. “People started to realise, what about the other 90 per cent?” said Lisa Hedman, the WHO’s technical officer for essential medicines and health products. Solving that problem would take several more years. Boost from US The effort received an unexpected boost in 2000 when the US Congress passed the Needlestick Safety and Prevention Act, which required steps to reduce the risk of healthcare workers accidentally stabbing themselves with needles. “That led to inventions such as the spring-loaded needle, which retracts after use like a ballpoint pen,” Hedman said. And there are syringes with plastic covers that can be slipped over a needle and locked into place. Although these devices were designed to protect nurses and doctors, they also rendered the syringes inoperative after a single use. Other designs came on the market. A man named Marc Koska developed the K-1 syringe, with a plunger that breaks off if you try to reload it. Today, there are more than 70 suppliers of non-reusable syringes. “But it took a long time for the industry to respond,” Hedman said. The WHO’s call to use self-destructing syringes is seen as a step to pushing for the widespread adoption of the devices. The need is greatest in the developing world.
Feb 23rd 2015
Mar 9th 2015