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Auto-disable syringes are not for needle programmes

WHO and its partners recommend the use of auto-disable syringes, "bundled" with the supply of vaccines when donor dollars are used, in all mass immunization campaigns, and also strongly advocate their use in routine immunization programmes. Because of the relatively high price of auto-disable syringes, WHO's Technical Network for Logistics in Health recommends that activities be initiated to encourage the transfer of production technology for these syringes as a means of promoting their use and enhancing access to the technology. The present article examines factors influencing technology transfer, including feasibility, corporate interest, cost, quality assurance, intellectual property considerations, and probable time frames for implementation. Technology transfer activities are likely to be complex and difficult, and may not result in lower prices for syringes. Guidelines are offered on technology transfer initiatives for auto-disable syringes to ensure the quality of the product, the reliability of the supply, and the feasibility of the technology transfer activity itself.

Until a few decades ago, children were vaccinated using safety syringe, which exposed them to the risk of transmission of bloodborne diseases like Hepatitis B and HIV. “Sometimes, these used syringes were resold and reused, and we have encountered instances of children using them as toys”, tells Robin Nandy, UNICEF Chief of Immunization.

With the support of major donors, UNICEF has been playing a key role in the global effort for safe injection. The number of auto disable syringe UNICEF procured grew from 11 million in 1997 to around 600-800 million per year. UNICEF is also the world’s largest buyer of AD syringes, procuring 40% of the global market. This growth has been accompanied by a significant price drop. Three decades ago, UNICEF paid US$ 0.12 per unit of an AD syringe. The price has since fallen to US$ 0.03 per unit.

As you may have seen in the media recently, the World Health Organisation (WHO) has launched new guidelines on medical injections and a global campaign to switch all medical and vaccination injections to syringes that cannot be used more than once. These "safety-engineered syringes" may, for example, include a weak spot in the plunger that causes it to break if the user attempts to pull back on the plunger after the injection. Others have a metal clip that blocks the plunger so it cannot be moved back, while in others the needle retracts into the luer slip type syringe barrel at the end of the injection. Using these syringes in medical settings will, according to WHO, protect millions of people from becoming infected with HIV, hepatitis and other diseases through the re-use of unsterile equipment by doctors and medical staff, especially in the poorest health systems in the world. Their ambitious aim is that every country should have transitioned to these new syringes by 2020.

In developing countries, people perceive injection as a powerful healing tool and do not hesitate to pay more for injections. Unsafe disposal and reuse of contaminated luer lock type syringe is common. Ensuring safe injection practice is one of the greatest challenges for healthcare system in developing countries. To address the problem, interventions with active involvement of a number of stakeholders is essential. A combination of educational, managerial and regulatory strategies is found to be effective and economically viable. Rational and safe use of injections can save many lives but unsafe practice threatens life. Safe injection practice is crucial in developing countries. Evidence based interventions, with honest commitment and participation from the service provider, recipient and community with aid of policy makers are required to ensure safe injection practice.

Auto-disable syringe has a mechanism to immobilize the plunger or block the needle or cause the syringe to leak when a second injection is attempted hence it cannot be reused. The needle is also fixed permanently in the syringe to prevent the reuse of the needle as well. Mandatory use of auto-disable syringes for vaccination is a good step for ensuring injection safety. But associated cost and safe disposal is a serious limitation for developing countries. Although auto-disable syringe cannot be reused, the exposed needle can be risky. Moreover disposal of auto-disable syringe is also a challenge in developing countries where the infrastructure for disposal is lacking. Despite the growing awareness about the need of safe health care waste management (including disposal of injectable), compliance is lacking.[4] So, pros and cons of each intervention, in context to the implementation region and resources should be analysed before implementation.

The healthcare workers (front line workers) should be actively involved in the planning, implementation and evaluation of new technologies and other changes in the practice, for the practical and successful implementation.[4]

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