The world is celebrating great medical triumphs: the successful development of multiple highly effective coronavirus vaccines as well as an unprecedented global effort to enable countries to vaccinate their populations.
But producing the 15 billion to 19 billion doses needed will be an empty victory if it triggers avoidable deaths from unsafe injection practices.
We strongly believe that these vaccines are safe and can save lives from the spread of covid-19. But if nations reuse disposable syringes in this effort, such a vaccination campaign could result in as many as 2 million to 3 million lives lost, and 40 million more injured from blood-borne disease.
Many low- and middle-income countries too often witness such tragedies, as syringes and the multi-dose vials they contaminate invisibly transmit diseases such as HIV/AIDS and hepatitis. In some countries, studies have shown that many doctors reuse syringes on two or three patients each.
Experts within and outside the World Health Organization have been writing, speaking and publishing data on this problem for years. Before the pandemic, the WHO estimated that 20 million people are infected every year with devastating lifelong disease from unsafe injections, resulting in more than 1 million deaths each year.
After a decade of alarms from the 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 Ratodero, Pakistan, in 2019. Some 900 people 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 coronavirus vaccination campaign — the largest in world history — could potentially make the unsafe injection fatality rate far worse for a number of reasons.
First, the speed and scale of this upcoming global vaccination campaign will be unlike any in history. The world needs billions of vaccine syringes specifically for the coronavirus. These syringes are specialized and are usually fully committed to global childhood vaccination programs well in advance. Syringe shortages for coronavirus vaccinations are likely to be commonplace, if not severe.
Second, governments will face enormous pressure to administer vaccines they have received as donations. They will insist on using all donated vaccines before they expire, even if there aren’t enough syringes. And while well-off nations have already planned to donate almost 1 billion vaccine doses, there are negligible plans to provide the syringes that go along with them, let alone the support needed for personnel training and other necessary support equipment and resources. Fewer resources encourage people — especially undertrained workers — to make do with what they’ve got.
Finally, in many countries, patients will wait in long lines and demand a vaccination, even if the clinic runs out of new syringes. Incredibly, in some countries, we are already seeing patients being told by health leaders to bring their own syringes to the clinic. It’s difficult to blame people for wanting to get an injection they think will save their lives even when a new syringe is not available.
The necessary steps to avoid catastrophe are clear: The world must immediately ramp up emergency production of vaccine syringes and fund this as aggressively as vaccines. Health authorities must elevate this issue to maximum priority so that patients, vaccine administrators and health ministries all understand the risks of unsafe injections.
In addition to the massive health threat, global confidence in vaccines across the entire world is at risk. During an age in which social media is used to amplify the sharing of information, it’s inevitable that some individuals who wish to sew discord will exploit this to claim not that contaminated syringes are causing outbreaks of HIV/AIDS and hepatitis, but that the vaccines themselves are inherently fatal and intentionally so. The world cannot afford this medical domino effect.
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. At the same time, it will be unforgivable if, in the rush to airlift doses in mass quantities around the world, we ignore the need for appropriate tools, resources and staff to inject them without causing unnecessary harm.
We are raising these issues as a group of public health professionals who have supported global efforts to improve patient safety over the past decade. That’s how we know our collective historic responsibility in this multidimensional crisis is, first, to see the whole picture, and second, to ensure that countries worldwide can safely deliver those billions of doses into the arms of real human beings — now, and for generations to come.