Medical Device Production and Climate Change
Contributor: Alice Feng
Medical devices have been deemed essential to health care systems in the prevention, diagnosis, and treatment of illness and disease for all populations. The advances and innovation of medical devices over time have improved accuracy, efficiency, and efficacy within health care systems, allowing people to live longer, healthier lives. During the COVID-19 Crisis, devices like ventilators play an even more crucial role in determining the outcome of the patient. Yet, the lifecycle of such devices could have a huge environmental impact.
Ventilators and COVID-19
Simply put, ventilators are machines that help patients breathe when they can’t on their own. Air is delivered through a tube in the patient’s windpipe into the lungs, mimicking the way we breathe naturally. Covid-19 targets the lungs and severe cases will require a ventilator to be able to deliver enough oxygen from the lungs to the rest of the body. Without one, the patient could die.
In normal circumstances, 170,000 ventilators are more than enough for all healthcare facilities in the U.S. In fact, many facilities have some of the ventilators in storage, indicating that there wasn’t a pressing need for them, However, the American Hospital Association estimates 960,000 people will need them in response to COVID-19 — which is why public health experts continue to recommend that people do whatever they can to slow the spread of the virus so that not all patients need ventilators at the same time. But when we take a step back, there is one question worth answering: What will happen to these ventilators once the outbreak is over?
Medical Device Donations to LICs
It’s safe to assume that after the outbreak the majority of these devices will lie idle. But after that, companies will produce better models and the obsolete models will be removed from the hospitals. And most of the time, they will end up as donations to developing countries.
Many hospitals in developed countries, including the U.S., have partnerships to donate their medical devices to hospitals in low resource settings. Health systems in low-income countries (LICs) often have limited access to even seemingly commonplace medical devices. As a result, these countries rely heavily on donations. The World Health Organization (WHO) estimates that 80 percent of the medical equipment in developing countries is donated. These devices make a huge impact right?
Yes, but not always a good one. The WHO also found that only 10 to 30 percent of these donations are ever put into operation. The vast majority of health technology is designed for—and sold to—developed countries and thus requires "high spending on health, a reliable energy supply and large numbers of trained health care professionals". Many donated devices, such as incubators and ventilators, could never work in the hospitals in LICs, because they were delivered broken or required a different electrical voltage than is standard in the U.S. There are also usually few supply chains to get replacement parts, and local technical expertise is sparse. Hence, while most donations are given with the intent to strengthen health systems and improve the well-being of the populations being served, up to 70 percent of these equipment lies idle, and eventually are thrown away and treated as waste.
eWaste and Climate Change
Waste from end-of-life electrical and electronic equipment, known as e-waste, is a rapidly growing global problem. Depending on the age and type of the discarded item, the chemical composition of E-waste may vary. But overall, most E-waste is composed of a mixture of metals like Cu, Al, and Fe. Unfortunately, the majority of e-waste is discarded in the unregulated informal sector, especially in LICs. This can result in significant adverse human health effects and environmental pollution.
Increased regulation of electronic wastes and concern over the environmental harm in nature economies creates an economic disincentive to remove residues prior to export. Critics of trade in used electronics maintain that it is still too easy for brokers calling themselves recyclers to export unscreened electronic waste to developing countries, such as China, India and parts of Africa. The developing countries have become toxic dump yards of e-waste. Developing countries receiving foreign e-waste often go further to repair and recycle forsaken equipment. Yet still, 90% of e-waste ended up in landfills in developing countries. Proponents of international trade point to the success of fair trade programs in other industries, where cooperation has led to the creation of sustainable jobs and can bring affordable technology in countries where repair and reuse rates are higher.
The amount of e-waste being generated is increasing rapidly and is compounded by both illegal exportation and inappropriate donation of electronic equipment from developed to developing countries. As little as 25% of e-waste is recycled in formal recycling centers with adequate worker protection. When the e-waste is used as landfills, many toxins are administered to the soil and potable water. This may result in the toxins to leech into the soil and take a toll on nearby residents. This contamination of soil will also result in loss of vegetation and affecting the ecosystem. Many developed countries have put a limit to these landfills according to the amount of toxins in it, most LICs lack in regulations.
The damage caused by incineration is another one of the biggest environmental impacts from E-waste. It releases toxic chemicals into the air and damages the atmosphere. Incineration is also a massive environmental injustice. The people who are subjected to the pollution from these incinerators often are the ones who are least responsible for the waste in the first place and have to bear the brunt of the impacts. Toxic materials like lead, zinc, nickel, flame retardants, barium and chromium, found in most electronics, if released into the environment when burned, can cause damage to human blood, kidneys as well as the central and peripheral nervous system. The chemicals would then accumulate in the air and eventually enter into the food chain. Additionally, most electronic products also contain plastic and PVC components, which are petroleum-based material. When burned, they cause harmful dioxides to enter the atmosphere and ultimately help accelerate climate change.
However, the health consequences of both direct exposures during recycling and indirect exposures through environmental contamination are potentially severe but poorly studied. Policy frameworks aimed at protecting vulnerable populations exist but are not effectively applied.
Conclusion
As we can see, many medical devices are essential to our response to the COVID-19 crisis. Yet, stakeholders and donors also have to be mindful of how we will handle the surplus of medical devices after the crisis. Direct donation to LICs has often failed to help due to technical incompatibility. The health and environmental impact of such donations are irreversible. Hence, finding a balance between helping those in need and protecting the environment is something to think about for the days to come.