Brazzaville – Masks. Gloves. Personal protective equipment. Vaccines. These items have become ubiquitous during the COVID-19 pandemic: as protection against the virus itself, but also as medical waste, burdening Africa’s already clogged landfills.

Before the onset of the pandemic, Africa produced an estimated 282 000 tonnes of medical waste each year, according to a 2021 report on waste management published by Sage, a journal. Now, many countries are reporting increases in medical waste as high as fivefold.

To address the surge, World Health Organization (WHO) is supporting African countries to develop targeted and tailored waste management protocols that complement existing measures. These include promoting safer methods of waste disposal that are feasible, economical and sustainable.

“WHO is engaging in multi-sectoral efforts to effect changes in waste management systems in Africa,” says Claude Mangobo, Technical Officer for Vaccine Logistics and Supply Chain in the Vaccines Pillar of the WHO Regional Office for Africa. “It is a critical process that we are committed to for the health of the continent and its people.”

With over 435 million COVID-19 vaccines administered in the rollout in Africa thus far – the biggest rollout of any vaccine in the history of the continent – the need for effective disposal of medical waste has become more urgent.

In the African region, the masks, gloves and protective equipment have become a daily uniform, particularly among health workers. They are among the 75% of COVID-19 related medical waste that are non-hazardous when handled properly.

However, the remaining 25% of material is hazardous COVID-19 vaccines waste. It includes discarded COVID-19 vaccine vials and safety boxes containing syringes and other sharp waste.

Properly designed incinerators and engineered sanitary landfills are recommended. However, in many countries there are significant gaps in the use of waste management guidelines. In their absence, measures such as burning waste in an isolated pit or safe burial on hospital premises are preferrable to dumping indiscriminately – or worse, burning waste in a drum or in the open, causing toxic emissions.

In accordance with the 1989 Basel and 2001 Stockholm Conventions governing medical waste management, WHO advocates the use of technologies that do not form and release chemicals or hazardous emissions, such as high-temperature incineration, using a high-pressure steam (autoclaving), or microwaving.

However, a recent WHO assessment of 10 African countries revealed that only four countries scored over 80% in their management of COVID-19 waste, which includes the handling of used syringes, storing and removing safety boxes, recording needle stick injuries, storing and removing used vaccine packaging, managing the waste storage area, and disposing of immunization waste on site.

A WHO report in February found that 60% of health care facilities in the least developed countries are not equipped to handle existing waste, let alone the additional COVID-19 load. This potentially exposes health workers to needle stick injuries, burns and pathogens. It also has a negative impact on communities living near poorly managed landfills and waste disposal sites through contaminated air from burning waste, poor water quality or disease carrying pests.

In response, WHO, along with the United Nations Development Programme, the Global Environment Facility, a conservation group, and Health Care Without Harm—an organization working for environmentally responsible health care—has developed a ‘decision tree’ to assist health workers in making informed decisions about COVID-19 vaccine waste management.

"In the face of COVID-19, sustainable health care waste management is more important than ever to protect communities, health workers, and the planet and prevent pollution," says Ruth Stringer, Science and Policy Coordinator for Health Care Without Harm.

WHO is also managing the effective tracking of expired COVID-19 vaccines in the African region through weekly stock status reports that have to date been pivotal in monitoring the operationalization of the waste management protocols in place to guide destruction and disposal of unusable vaccines. A WHO-designed online waste management questionnaire will be administered each quarter of the year to continuously monitor waste management activities.