New Delhi: First there were the PPE kits, with masks, gowns, face shields, gloves, etc, being used by healthcare and frontline workers, and diagnostic equipment for conducting Covid-19 tests. Now, there are syringes — lakhs and lakhs of them — for India’s Covid vaccination drive, which is the world’s largest.
Since it took hold last year, the Covid pandemic has resulted in the generation of tonnes of biomedical waste.
Last month, the government estimated India’s daily biomedical waste output at 146 tonnes. This means that every day India is producing roughly the equivalent of a blue whale — the largest animal in the world — in biomedical waste.
The contribution of syringes alone is ballooning. According to one estimate offered by Onsite Waste Technologies, an American company that specialises in medical waste disposal, the needles from the number of vaccine doses needed to inoculate the entire US population — about 66 crore — would be enough to wrap around the Earth 1.8 times.
To put it into context, India’s population (including minors, who are currently not eligible for vaccination) exceeds the US’ by approximately 100 crore. As of Friday, India had administered 9,43,34,262 doses.
Another estimate, this one by industry body Association of Indian Medical Device Industry (AIMED), said the world needs 800 crore-1,000 crore syringes to vaccinate 60 per cent of the population — the approximate threshold for herd immunity. India alone would require at least 150 crore syringes to inoculate 60 per cent of its approximately 135 crore people, they calculated.
It may sound like a lot, but experts say the disposal of used syringes — which weigh no more than a one-rupee coin — isn’t something to fret about. According to them, no biomedical waste is of any concern if disposed of appropriately.
India has a dedicated legal framework to oversee its disposal, which lays down an elaborate procedure — comprising colour-coding, sterilisation, incineration, recycling and burial — to strip the waste of any risk.
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‘Nothing worrisome’
Amesh Adalja, a senior scholar at the US-based Johns Hopkins Center for Health Security, whose work focuses on pandemic preparedness, said “there is nothing worrisome” about the biomedical waste being generated as a result of Covid.
“The disposal of syringes generated due to the Covid-19 vaccination is the same as for any other syringes,” he added. “Even the disposal of masks, PPE kits, and gloves remains the same as any other medical waste.”
Vikas Ghallot, director, Biotic Waste Solutions, one of the waste management agencies working for Delhi, said “as the weight of an empty syringe is only around 4.25 g, the volume generated through the Covid vaccination drive is very low and it is easily manageable”.
In February, for instance, 4.37 lakh kg or 437 tonnes was the total waste processed by Biotic Waste Solutions, out of which 94,565 kg was related to Covid.
Vinod Kachhadia, president of the industry body Common Biomedical Waste Treatment and Disposal Facility Association, said each trash bag picked up from different centres does not weigh more than 2-3 kg and is easily manageable.
“In fact, the volume of waste was coming down with the falling number of cases. The trash, overall, has remained more or less the same. When the Covid waste had gone up, waste due to non-Covid procedures and elective surgeries had fallen (due to paranoia among people to visit hospitals).”
However, H.S. Ratti, an epidemiologist and project adviser at Safe Point, an NGO (funded by India’s largest syringe-maker Hindustan Syringes & Medical Devices) that is working towards safe injection practices, said the biomedical waste generated on account of syringes has “at least doubled against a non-Covid year”.
“The biomedical waste has easily ‘more than doubled’ including PPE kits, gloves, and masks. However, the guidelines to handle the waste are strong enough, if practised well,” he added.
Separation of waste
According to the Union government’s Biomedical Waste Management (BWM) Rules, 2016, syringes and needles are thrown into red and white coloured bags, respectively, at healthcare centres.
The red-coloured non-chlorinated plastic bag is for contaminated but recyclable waste such as intravenous tubes, catheters, bottles, urine bags, syringes (without needles), and gloves.
The white one is a tamper-proof container for “sharps”, or sharp metal medical equipment such as the needle of a syringe.
For the purposes of waste management, every state has been divided into four zones. Each zone is further divided into districts where waste management agencies are tasked with collecting biomedical waste from hospitals and clinics in a specific area.
The waste collected from districts is then taken to their plants for treatment and disposal.
“Waste disposal plants are state-specific and cannot cross the boundary or collect the waste from other states,” said Ghallot.
The Ministry of Environment informed Parliament in March that the state pollution control boards and pollution control committees have authorised 202 waste treatment and disposal facilities to participate in this exercise.
How waste is disposed
Ghallot said the waste collected is autoclaved before being shredded “to ensure that it loses its shape and size”.
Autoclaving is a method for disinfecting and sterilising waste at high temperatures and pressures. It aims to kill microorganisms and spores.
“The process of autoclaving is important as needles can be infected with blood,” said Kachhadia who is also the director of Distromed Bio Clean, an agency that works in Gujarat. “It generally requires a temperature of 120 degrees Celsius for 30 minutes.”
After autoclaving, the waste that can be recycled is sent to authorised recyclers.
Waste that can’t be recycled is sent for incineration. These plants reduce volume (up to 90 per cent) and weight (up to 75 per cent), and break down hazardous substances such as pathogens and toxic chemicals.
The remaining waste is buried into a ‘sharp pit’ — a pit or a facility for sharp encapsulation.
Under BWM 2016 rules, a sharp pit can be circular or rectangular, and should be lined with cement-plastered brick masonry or concrete rings. Once the pit is full, it can be sealed completely.
“The pits can be made only in areas approved by the government and all vendors have been given a list of certain areas,” Kachhadia said.
While the standards are in place, experts said the challenge is to check whether they are being followed in smaller healthcare facilities.
“The Indian government has defined standards and protocols and guidelines for different categories of biomedical waste but these guidelines may not be easy to follow in primary healthcare centres and small clinics,” said AIMED forum coordinator Rajiv Nath.
“Dangerous disposal of sharps in open dustbins is not uncommon and, hence, the government needs to keep a strict vigil on the disposal.”
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