A global climate crisis is underway. Climate scientists the world over have formed a consensus that human driven climate change is happening. It is a threat to our health, habitats, and biodiversity. Single-use plastic has become the public face of wasteful and environmentally damaging behaviour. Plastic litters our waterways, with experts indicating that there will be more plastic than fish in the world’s oceans by 2050.
Governments are looking at ways to curb single-use plastic waste. In October, Scotland announced a ban on plastic cotton buds. In 2016, France outlawed all plastic cutlery, cups, and plates. Certain items, such as plastic straws, have become synonymous with the issue of plastic waste and are held up by environmentalists as being non-essential and, as such, very wasteful. Fast food chains McDonalds and KFC, among others, have switched to paper based straws as a result of the controversy surrounding the plastic ones.
There are industries that have thus far escaped scrutiny when it comes to single-use plastic waste. According to National Geographic, in the USA a quarter of healthcare waste is single-use plastics. Considering the number of medical procedures completed daily, that makes healthcare a major contributor to the single-use plastic issue. Syringes, surgical gowns, IV bags, and many other items, are all immediately disposed of after use in hospitals and clinics.
Why has the medical field become so reliant on disposable equipment? In reaction to the spread of blood borne diseases such as HIV and hepatitis, and antibiotic resistant bacteria like MRSA, the medical field must be more stringent about hygiene and safety. While reusable materials that can be sterilised might seem appealing, for certain products such as syringes the risk to patients is simply too high. The idea of going back to the days of shared syringes or catheter tubes causes many medics to balk. One infection caused by incorrectly sterilised equipment is one too many. After all, a key element of the modern Hippocratic Oath is that prevention is preferable to cure. Single-use plastics have helped to achieve that.
In the case of medicines, both prescription and over-the-counter drugs are often packaged in disposable plastic blister packs. These packages serve a multitude of essential functions. The chemicals that make up medicines have many varied properties. Drug products could become unstable or lose their effectiveness if not protected adequately. Absorbing water or being in direct sunlight could break important chemical bonds and make the drugs ineffective or unsafe for patients. The plastic packaging protects medicines from the environment around them and eliminates these risks. No alternative to plastic packing has been developed yet for the pharmaceutical industry. A durable and sustainable alternative may be possible to design, but it will take significant investment from not only pharmaceutical companies, but from materials companies as well. Furthermore, if alternative packaging will compromise integrity of the drug in anyway or will reduce the shelf life of the drug, it is unlikely to be acceptable to the industry or to those in the medical field.
What options are available to the healthcare industry? How can it become more sustainable while also protecting patient safety?
There is no question that there is waste in the healthcare industry. Metal surgical implements can be sterilised and reused but they’re wrapped in single-use sterilised wrapping. This is cheap and readily available. Sterilisable and reusable containers have a high up front cost and are expensive to replace if broken or damaged. In over-stretched public healthcare systems like the NHS it is appealing to use the cheaper option in order to make limited financial resources go the distance. In commercial healthcare systems like in the USA, profit is prioritised and cheaper materials are favoured.
Change is possible, but as with all environmental protections it comes at a cost. In the case of plastics in healthcare, that cost is not only financial. The lives of the vulnerable and disabled could be seriously compromised by cutting out plastic completely. Ill and elderly patients who are at a higher risk of infection due to their vulnerable immune systems could suffer if hospital equipment is poorly or incorrectly sterilised. Disabled individuals who often rely on items like straws could incur much higher living costs or a decrease in their quality of life if they lose access to these products.
Across all industries there is environmental waste. There needs to be an engaging discussion between industry bodies and environmental groups to establish which plastic products are essential. Those products could be protected with other non-essential single-use plastics then being banned. Importantly, alongside any ban that is introduced there must also be research funding set aside to find better and more sustainable alternatives. Blanket bans on products, though well-intentioned, ignore many of the nuances of modern life. Limiting the use of single-use plastic to essential cases and providing adequate recycling facilities for those plastics makes for a much more effective environmental strategy. Those companies and governments that are changing their approach are making positive strides. Could the healthcare industry follow suit? Consider how the first death due to poorly sterilised hospital equipment or damaged drug products could set the environmental movement back years.
So perhaps the question we should be asking is not “could medicine be plastic free?” but “should medicine be plastic free?”.
Plastic in the ocean: https://www.earthday.org/2018/04/05/fact-sheet-plastics-in-the-ocean/
Scotland ban cotton buds: https://www.bbc.co.uk/news/uk-scotland-50016878
National Geographic article on plastic in healthcare: https://www.nationalgeographic.com/science/2019/10/can-medical-care-exist-without-plastic/
Classical and modern Hippocratic Oath: https://www.pbs.org/wgbh/nova/article/hippocratic-oath-today/
Can Pharmacies ever be plastic free: https://www.pharmaceutical-journal.com/opinion/blogs/will-pharmacies-ever-go-zero-waste/20204990.blog?firstPass=false