Auto-disable Syringes in the Developing World: A Technical Solution Addressing a Behavioral Problem

Edward Hoekstra, UNICEF

Friday, May 13, 2011

Spanos Auditorium

This seminar is part of the Jones Seminars on Science, Technology, and Society series

Immunization is the most cost-effective intervention to prevent disease and death in children. Seven of the eight EPI vaccines are administered through injection. All vaccines and injection equipment provided by UNICEF have been pre-qualified by the World Health Organization (WHO) for performance, quality and safety, and when used correctly, have been shown to be safe and effective. However, poor practices, particularly the reuse of syringes, have been reported worldwide, causing some injections to be unsafe by promoting the spread of blood borne diseases. In 2003, Hutin et al estimated that each year, 6.7 billion injections (39%) are given with equipment that has previously been used. Reuse of injection syringes has been shown to be a major route of transmission for both hepatitis B and C viruses, HIV, malaria, and viral hemorrhagic fevers as well as causing abscesses and septicaemia. In 1999, WHO and UNICEF began to address the spread of blood borne diseases through reuse of needles and syringes by recommending that autodisable (AD) syringes be used for all immunizations. Since their introduction in the mid-1990s, AD syringes have been widely accepted and are now used to administer immunizations globally. I will describe how the UN agencies addressed this problem, how industry solved a behavioral problem among health workers by coming up with a technical solution. By 2004 all countries in Sub-Saharan Africa had already replaced their disposable and sterilizable syringes with auto-disable syringes to improve injection safety.

About the Speaker

Dr. Edward Hoekstra is the Senior Health Advisor in the Global Measles Mortality Reduction Programme at UNICEF headquarters, responsible for the $100M program. In the past six years the world has seen a 78% reduction in deaths due to measles — the single most successful public health initiative in recent memory. As one of UNICEF's experts in immunization he set up a massive immunization campaign reaching over 80 percent of the 1.5 million children in the affected areas. During the Pakistan earthquake in November 2005, delivery of the many vaccines included use of mule trains, military helicopters and coordinating over 1,000 health workers trekking throughout the mountains. Dr. Hoekstra has trained in Occupational Medicine, Public Health and epidemiology both in the Netherlands and the United States. He has worked as chief occupational physician for multinational corporations such as Mercedes-Benz and Avery in the Netherlands. In 1990 he set up the Occupational Health Centre Aruba for the Ministry of Health in Aruba. Dr. Hoekstra worked for the World Health Organization and the Centers for Disease Control and Prevention. In that position he worked for President Bill Clinton's Initiative to increase vaccine coverage among 2 year olds in the United States. He specifically focused on serving the underserved inner-city children.