The ban on reusable syringes is a step in the right direction, but a crackdown on quacks and fake doctors is equally important
Pakistan switched to single-use auto-destruct syringes on November 30. The switch is not new in theory but is one of its kind in practice.
The first switch took place in 1955 from the use of glass syringes to plastic syringes. Glass syringes were sterilized in hot boiling water repeatedly, and some would break in the process. They were also expensive. The introduction of plastic syringes solved the problem.
One would think that the problem was resolved, so why are we having this discussion again? In the 1980s, a spike in the spread of blood borne diseases like the AIDS, Hepatitis C and B was seen across the country. Upon investigations, it was found that a major cause of this epidemic was the reuse of contaminated syringes and needles. If reused, a syringe used to inject a patient with a transmissible blood borne disease posed a serious threat of transferring the disease to an otherwise healthy person.
Unfortunately, the issue persisted through decades and was not addressed adequately. The latest mass disaster was the Larkana outbreak of AIDS in 2019. HIV spread among hundreds of very young children of Larkana in a short period of time. Upon investigation, it was found that almost all the children had received injections at a local clinic. It was evident that the injections were administered using contaminated syringes.
In the wake of this public health outbreak, the National Health Services set up a national task force on injection safety in 2019. A comprehensive National Action Plan for Injection Safety was developed. The taskforce recommended an important regulatory intervention to ban the import, manufacture, sale, and use of conventional disposable plastic syringes, causing the spread of hepatitis C and HIV/AIDS. Although the reuse of contaminated syringes is not the only factor responsible for the transmission of blood borne diseases, it is a major culprit.
What is the alternative, one may ask. Auto-destruct (AD) or self-destruct syringes is the answer. The AD syringe cannot be reused after single-use because its plunger gets locked once the medicine is pushed into the body of the patient. Once locked, any attempt to get the plunger out destroys the syringe. This intervention is aimed at ending the possibility of the spread of blood borne diseases through the reuse of contaminated syringes.
The action plan
In an email response Sardar Bahram Rafique, Project Coordinator and Stakeholder Manager at the Strategic Communication Cell at the Ministry of National Health Services, Regulations and Coordination informed TNS, “A National Action Plan was launched in December 2019 and disseminated to all provinces. Some of the key objectives of this plan include: reduction in injection overuse, curtailing reuse of injection instruments, instituting proper disposal and promotion of oral medication. Consequently, a ban was placed on the manufacture and import of conventional disposable syringes. The importers and local manufacturers were given timelines to phase out this switch. The local manufacturers were given exemptions on custom duties and sales tax as an incentive to switch to auto-disable syringes. An extension was made in the deadline when some manufacturers requested more time for getting the required instruments for the production of auto-disable syringes. Conventional syringes will not be manufactured or sold in the market after November 30, 2021.
“The Drug Regulatory Authority of Pakistan (DRAP) is already aware of a potential shortage that may be created once the ban is in effect, but it is working diligently to predict any supply and demand issues and will closely monitor any price hikes. If any issues occur, they will phase out quickly to the ample time given for the switch. The Federal Expansion Programme for Immunisation has already completely switched to using auto-disabled syringes.
“The Federal Expansion Programme on Immunisation launched a media campaign on injection safety in 2020. It was done through TV, radio, print and digital media. A second phase of the awareness campaign is already planned and will be launched soon”.
There is little information available about the big syringe switch. Unless people are aware of this development, the execution will not produce the desired outcome.
The plan looks solid. But the execution is the real question. Dr Anjum Habib Vohra, a senior neurosurgeon in Lahore in a conversation with TNS, expressed scepticism on the efficient execution of the ban. “Public hospitals and reputable private health care centres are already practising ethically. We do not reuse contaminated syringes; whether or not conventional. The issue is with quacks and ill-trained medical health care practitioners. The practice of the reuse of disposable syringes was and is very common with them,” he said.
He added, “in order to save the cost of the syringe, quacks continue to use the same syringe on gullible patients. The government has played its part by intervening and taking the right measures. Now the responsibility lies with the community. We as individuals should play our part in curbing ill medical practices. The onus for building an aware community is on the media. They must create awareness,” said Dr Vohra.
There is little information available about the big syringe switch. Unless people are fully aware of this development, the execution will not produce the desired outcome.
Dr Danish Awan, the Young Doctors Association president, feels that the intervention is a move in the right direction. “It is a great initiative that has potential to reduce the occurrence of blood borne diseases. According to my information, all public hospitals and medical healthcare centres have switched to auto-destruct syringes. However, the implementation and penetration within the private sector is yet to be seen.”
Zubair Anwar, DMS Drugs Sir Ganga Ram Hospital, informed TNS, “We have completely switched to AD syringes as per government’s order for almost two months now. The new tender for the contract is as per updated regulation. We exhausted all the stock of conventional plastic syringes by the end of August 2021.”
A pharmacist at a government hospital confirmed, “we have switched to AD syringes as per the new regulation. The government has cancelled the registration of 19 manufacturing firms, and no stock of 2ml, 2.5ml, 3ml/cc and 5ml/cc of these firms manufactured/imported after July 31, 2021, be available in the marke” She further added, “in case a person is found involved in selling/stocking of the said conventional syringes manufactured after July 31, 2021, their stocks would be seized, and the matter would proceed in accordance with the law after intimation to the office of chief drugs controller. If we do not comply timely, our registration would be cancelled.”
Through consultative, collective and collaborative national effort, Pakistan is set to eliminate a major cause of blood borne diseases spread. We are also setting an example for other countries. The banning of conventional plastic syringes is well received because it makes sense and is the right thing to do. However, where it is welcomed, its efficacy and efficient execution are a concern for all the stakeholders. There is an urgent need for running sustained and robust awareness, educational and training campaigns on the use of AD syringes, the rational use of injections and the proper disposal of medical waste. The objective is clear, but it is yet to be seen if we are able to achieve it.
The writer is a freelance journalist. She can be reached at