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Hidden in Plain Sight
Why Unsafe Injections Remain a Global Challenge
Say the words “unsafe injections” to many medical or public health officials, and they’re likely to respond, “Oh, yes, I am very aware of the possibility of needlestick injuries.”
Tell someone you’re concerned about “syringe reuse,” and quite a few public officials, or even medical experts around the world, might say: “Yes, the pattern of drug addicts sharing needles is why we need safe, clean injection sites.”
But the most insidious — and arguably, the most dangerous — kind of unsafe injection is not about needlesticks or addiction behaviors. The greatest threat comes from deliberate, habitual reuse of syringes by doctors, nurses and health aides in clinical settings.
It is a problem that WHO has said kills 1.3 million people a year. Typically, this issue occurs mostly in Low- and Middle-Income Countries, but now and then it happens in wealthy nations like the U.S. as well.
How is this possible? Very simple: a healthcare provider gives “Patient A” an injection. When the needle is withdrawn, it sucks in microscopic amounts of the patient’s blood into the syringe barrel. If the patient has a blood-borne disease, the tiny droplets of blood in the syringe now carry that disease.
Next, “Patient B” enters the clinic and gets an injection using the same needle. Perhaps the health worker has attempted to disinfect the syringe by putting it in boiling water or giving it an alcohol bath. A generation or two ago, that was an acceptable procedure. Now we know it can transmit disease…especially if inserting the contaminated syringe’s needle into a multi-dose glass vial results in spreading the disease-carrying blood to the entire contents of the vial…which happens far too often.
In addition to the 1.3 million annual fatalities from this issue, WHO estimated (years before COVID-19) that some 20 million patients a year contract lifelong, devastating illnesses this way, including HIV and hepatitis.
Experts within and outside WHO have been writing, speaking, and publishing data on the problem of injection safety for years. WHO published its figures in 2014, but they and other partners have been working on the issue of injection safety since the mid-2000s during the last truly global pandemic, HIV.
After a decade of alarms from WHO, why do so many otherwise informed people remain unaware of this issue? The answer is that these deaths are spread out among tens of millions of communities. The effects also don’t show up for years. A victim of an unsafe injection may only learn months or years later that they have HIV or hepatitis and may have no idea about the source of infection.
On rare occasions, a massive outbreak is traced to a single doctor. This occurred in Rotadero, Pakistan, in 2019. Some 900 people1 in the city — mostly small children — contracted HIV from unsafe injections in one of the largest outbreaks in recent memory. But a concentrated outbreak is the exception, not the rule.
The global COVID-19 vaccination campaign — the largest in world history — could potentially make the unsafe injection fatality rate far worse.
The speed and scale of this global vaccination campaign is unlike any in history. The world needs billions of vaccine syringes specifically for COVID-19. Already, in November 2021, WHO and UNICEF said that we would likely be 2 billion to 5 billion syringes short. This does not even include the syringes needed to catch up with over 25 million children who missed vaccinations during 2020-21.
On May 12, the U.S. government, together with the governments of Belize, Germany, Indonesia, and Senegal, will host the second Global COVID Summit. The summit’s purpose is to “redouble our collective efforts to end the acute phase of the COVID-19 pandemic,” as well as discuss how to prepare for future pandemics.
Yet as of today, only 16% of people in low-income countries have received even 1 dose of vaccines and no real funding has been put behind “vaccination readiness,” meaning syringes and health workers for vaccination campaigns.
In normal times, unsafe injections are a pernicious problem that is hard to identify, investigate, and remedy. COVID-19 has made the problem immeasurably worse. It is understandable that governments and health leaders in wealthy nations are proud of their commitments to provide vaccine doses for the rest of the world.
But if the commitments of this 2nd Global Summit are to have any real impact, we must focus on the literal sharp end of the pandemic first — keeping immunizations safe in all health care systems.
GLOBE is an outlet that allows colleagues and friends of the ApiJect Global Initiative to share their thoughts on matters related to global health and their ongoing work. Send questions or responses to firstname.lastname@example.org.