A guest blog from Advanced Earth Fellow Marie-Louise Wöhrle, organiser of the ‘The Plastic Pandemic: Rethinking Medical Device, Innovation, Use and Disposal for a Circular Economy’ event with Dr Alice Street.

“There is no carbon-neutral Scotland without a carbon-neutral NHS”, Wendy Rayner (Head of NHS Circular Economy Programme) emphasised at the end of an afternoon of vibrant interdisciplinary discussions about medical device waste and sustainability. Hosted by the Edinburgh Earth Initiative and co-organised by the DiaDev project at the University of Edinburgh and the MKK Laboratory Group at Heriot-Watt University, ‘The Plastic Pandemic: Rethinking Medical Device, Innovation, Use and Disposal for a Circular Economy’ brought together social scientists, historians, engineers, activists and policymakers to tackle the growing global challenge of healthcare waste.

The Plastic Pandemic organisers photographed at the event

Speakers explored the historical evolution and future possibilities for engineering of medical devices including surgical masks, syringes, and diagnostics. A final panel examined the systems that underpin the transition of NHS Scotland to a net-zero circular economy, including the challenges of restructuring supply chains, infrastructure and logistics.

The workshop was interdisciplinary in format: partnering  social scientists or historians with engineers or policymakers in each session allowed attendees to visit medical devices from multiple perspectives. Presentations emphasised the pervasiveness of disposable plastics, but also highlighted the opportunities of collaborative research in bringing about carbon-neutral, sustainable health care. Presentations included:

The history and recycling of disposable surgical masks

Professor Bruno Strasser (University of Geneva) and Professor David Bucknall (Heriot Watt University)

As inevitable as disposable mixed-material masks may appear to us today, our acceptance of them resulted from the emergence of “throwaway living” as a lifestyle trend and market opportunity in the 1960s. Bruno Strasser took the workshop on a journey from the now-forgotten knowledge of reusable mask maintenance in early 20th century hospitals, through the marketing tactics of medical manufacturers, to the hospital administrators who saw in disposable masks a convenient freedom from maintenance and related labour costs. Moving away from the freedoms associated with disposability to focus on the constraints of recycling and medical waste streams, David Bucknall dissected the complex combination of woven and non-woven textile components of the facemask, highlighting the need for design and material choices that facilitate rather than hinder recycling and reuse. Reducing the number of different materials in any device was highlighted as key to recyclability, alongside the need to invest in recycling infrastructures that can preserve the key properties of materials without making the cost of recycling prohibitive.

The public imaginaries and recycling of hypodermic syringes

Professor Jeremy Greene (Johns Hopkins University) and Ruth Stringer (Health Care Without Harm)

Syringes fill a more hazardous space in the public health imaginary, as carefully illustrated by Jeremy Greene’s presentation on the “syringe tides”  covering beaches in New Jersey in 1987. Newspaper headlines illustrate the widespread fear and moral panic arising from hypodermic syringes that were seen not just as trash but as a potential AIDS risk. While syringes in New Jersey disappeared with the turn of the tide, needle safety remains a problem for healthcare and waste management worldwide today. The WHO and UNICEF provide specialised sharps containers with shipments of vaccines, encouraging medics to bin the entire empty syringe for incineration. Yet the point of the sharps cointainer is precisely that, for safety reasons, it cannot be opened up again, making dismantling and recycling impossible. Ruth Stringer detailed Health Care Without Harm’s efforts to reduce syringe waste through the provision of manually operated, portable, needle cutters and syringe containers designed to fit into autoclaves. Through trials in Nepal, they have shown that recycling syringe plastics is possible. But this simple intervention is made more difficult through legislative barriers and worries around syringe recycling inherited from events coverage such as the syringe tides.

The governance of disposable diagnostics and sustainability in diagnostic R&D

Dr Alice Street (University of Edinburgh) and Professor Maïwenn Kersaudy-Kerhoas (Heriot Watt University)

Picking up on the theme of regulation, Alice Street and Marie-Louise Wöhrle explored how disposability is built into global health values and norms. The ASSURED criteria for point of care tests emphasise access and deliverability to an extent that constructs disposability as the obvious solution. Environmental concerns remain in the margins of policies and largely excluded even from aspirational documents like Target Product Profiles. Responsibility for waste management is placed primarily with national governments, without much infrastructural support. Maïwenn Kersaudy-Kerhoas, by contrast, showed us what it might mean to try to build values of sustainability into diagnostic design from the outset. Making use of recycled and recyclable materials, bioplastics, reduced designs, and innovatively reusing or ‘upcycling’ otherwise discarded parts all offer routes into designing more sustainable diagnostics.

Supply chain considerations and developing a circular economy in NHS Scotland

Associate Professor Claire Lindsay (Heriot Watt University) and Wendy Rayner (Head of NHS Circular Economy Programme)

From individual objects to a stream of medical devices, Claire Lindsay discussed supply chain sustainability. The efficiency agenda placed on healthcare forces cost-driven just-in-time procurement rather than extending opportunities for resilient and sustainable supply chains. Redesigning the supply chain means expanding definitions of stakeholders – including thinking about how manufacturing and supply systems contribute to local livelihoods-, taking on development costs, and shifting mindsets. What this looks like for NHS Scotland was the topic of the talk by Wendy Rayner. She used the metaphor of an urban mine to describe the discards of the hospital, but also noted that “if I’m recycling, I failed”. Changing the NHS into a circular economy is a paradigm shift requiring a multitude of changes, from making the physical space for reuse to working with manufacturers on materials. The panel ended with a call to action from both panellists – system change needs everyone to take responsibility for building pressure from the bottom up; to  become an  ‘imperfect environmentalist’ and to ask uncomfortable questions about waste and sustainability.

The Exhibition: Diagnostic Discard: The Making of a Plastic Pandemic

(Dr Alice Street (University of Edinburgh) and Professor Maiwenn Kersaudy-Kerhoas (Heriot Watt University)

A pop-up exhibition followed the workshop, taking attendees on a more detailed tour of diagnostic discard. Old test cassettes, interrupted on their way to becoming waste, provided the centrepiece of the exhibition. The differences in material use/composition between different cassettes highlight that there is room for many manufacturers to reduce the material imprint of their tests within the possibilities offered by current technology and manufacturing, and some examples of sustainable tests (including a flushable LIA pregnancy test) show that single-use plastic is far from the only diagnostic solution.

The plastic pandemic workshop and exhibition showed that medical waste is not only a problem for public health emergencies, but is an endemic aspect of our innovation and healthcare systems. Tackling the challenge of throwaway culture in healthcare will require that very different communities of critical social scientists, engineers and policy-makers work together to identify and find solutions to the causes of healthcare waste. By bringing together these diverse communities to exchange ideas and explore the opportunities for developing more sustainable medical devices, this event set in process the important work of imagining alternative healthcare systems for the future.

Author biographies

Marie-Louise Wöhrle is a PhD candidate at the School of Social and Political Sciences, University of Edinburgh, and Advanced Earth Fellow at the EEI with the DiaDev project. Marie-Louise’s research interests include infectious disease, health systems, OneHealth, and conservation/sustainability.

Alice Street is a Senior Lecturer in Social Anthropology at the University of Edinburgh and Principal Investigator for ‘Investigating the Design and Use of Diagnostic Devices in Global Health’ (DiaDev), funded by the European Research Council. Her research includes studies of health systems, global health interventions and medical innovation.

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