New Delhi: Pakistan has a new public health deadline. It will not utilise reusable syringes after 30 November, which is one of the major causes of blood-borne diseases. This is a significant breakthrough in a sector affected by the unhygienic use of syringes, and quacks. Pakistan will now fully switch to auto-destruct syringes.
In an opinion article for Dawn, former Special Assistant to the Prime Minister on Health Zafar Mirza said that Pakistan has been beset with blood-borne infections like HIV-AIDS and Hepatitis B and C since the 1980s, causing the reuse of syringes to be viewed with greater scrutiny.
“The syringe used in an injection administered to a patient of a blood-borne disease if not sterilised properly and used again on another patient can introduce the virus of the previous patient in the new one. It has been found again and again in various settings, especially in low and middle-income countries, that the reuse of contaminated syringes triggers outbreaks of blood-borne diseases,” Mirza added.
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A public health problem for decades
Reusing syringes has been a hygiene and public health problem on a global level for decades, dating as far back as 1986, when the World Health Organisation put in a request for the development of auto-destruct, or auto-disable syringes. While a WHO panel considered 35 responses to that request a year later, only four auto-destruct syringe models were being manufactured by the turn of the century.
More than 20 years later, however, supply chain bottlenecks during global Covid-19 vaccine rollouts have resulted in a renewed focus on auto-destruct syringes, with UNICEF in February this year emphasising the importance of it and proper health and safety protocols as part of its target to purchase 1 billion syringes by the end of the year.
Much like Pakistan, India has faced issues of its own with mass syringe reuse. In recent years, the country set targets to switch from reusable to auto-destruct syringes by 2020.
Pakistan’s Mirza also further explains that it is not possible to reuse an auto-destruct syringe as its plunger locks following the administering of the medicine into the patient’s body via injection, to the extent that attempting to remove the plunger would destroy the syringe.
The news reported in Zafar Mirza’s opinion article would represent a major breakthrough in Pakistani healthcare — a sector that was affected by quack doctors exacerbating the unhygienic reuse of syringes as recently as 2019, when Larkana District in Sindh experienced an HIV outbreak with nearly 900 people, most of them children, testing positive. This number had increased to 1,500 by June this year.
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The quacks in Pakistan
“According to the Pakistan Medical Association (PMA), there are more than 600,000 quacks currently practising in the country with more than 80,000 based in Punjab province alone…The clinics that are actually operated by qualified doctors are in putrid conditions and end up causing more damage than good. However, people tend to go to these because the doctors there charge less both for their services and the syringes,” journalist Shahab Omer wrote for Pakistan Today earlier this year.
Omer provides some greater context on the business behind the widespread reusing of syringes in Pakistan, a country that has imported 450 million syringes annually while producing nearly 800 million.
According to Mirza, this high number of syringes can be put down to a lack of regulation and the irrational belief perpetuated by some Pakistani medical practitioners that “injections are needed for any minor ailment.”
While imports and manufacturing on old technology syringes were to be banned from 1 April onwards, the entry of the auto-destruct syringes would represent a potential loss in revenue for the wholesalers of the cheaper old technology syringes, Omer had reported.
However, Mirza writes that the Imran Khan government has played its role in facilitating the switchover “by waiving custom duties and sales tax on AD syringes” for manufacturers and importers.
“The good news is that out of the currently 16 manufacturers of syringes in Pakistan, nine have converted to AD syringes or have obtained the mould for it. The rest are in the process,” Mirza added.
Also Read: Pakistan HIV outbreak caused by infected needles, contaminated blood transfusions: Study
Responses to AD syringes
Mirza’s article was met with a muted but positive response as members of Dawn‘s English-speaking readership in Pakistan expressed their relief and delight with the news.
“An extremely important initiative to curb the transmission of blood-borne infections. We must remember a policy is only as good as its implementation, including efforts to raise awareness and monitor,” health researcher Shifa Habib said.
An extremely important initiative to curb the transmission of blood borne infections. We must remember a policy is only as good as it’s implementation, including efforts to raise awareness and monitor. https://t.co/VxrShAr9S4
— Shifa Habib (@shifa_habib) November 5, 2021
“Dr. Zafar Mirza was firm on the decision to implement AD syringes as the misuse of syringes had increased the prevalence of Hepatitis and HIV and we could no longer have another HIV outbreak like Larkana in 2019,” user Omer Ahmed wrote.
Being in the import business of syringes for 27 years I would like to share my experience regarding the switch over to AD syringes initiated by Dr. Zafar Mirza when he was the SAPM on Health. I admit I was apprehensive at first, not on the decision to move towards AD Syringes, https://t.co/QvXNL5XCuE
— Omer Ahmed (@syedomerahmed) November 5, 2021
Not everyone might be convinced though, as several people on social media also viewed the news with considerable scepticism.
Facebook user Zahid Malik commented on the article, saying the problem was misdirected. “Has anybody looked into the matter that syringes do not contain bacteria or viruses it is the needeles. The needeles are made of stainless steel and can be chemically or thermally sterlised so the doctors/quacks who do not have/use adequate sterlising equipment should be stopped to practice,” he said.
“Although the deadline is 30 November but on the ground it seems that it will take a long time to meet the target,” said another user.
Sikandar Khan, who hails from Peshwar, commented on the article on Facebook, saying, “The AD syringes produced here are not according to international standards and I think one can reuse them.”
(Edited by Srinjoy Dey)