A Q&A On Why Auto-Disable Syringes Matter in the Developing World

Syringes designed with automatic disabling (AD) prevent the reusing of syringes. Nevertheless, some AD syringe design(s) have been deemed unsafe because of issues related to the activation point of the syringe. It has been extensively investigated whether AD syringe designs are associated with syringe reuse, adverse reactions following vaccines, or transmission of bloodborne viruses. The AD syringe design was not associated with unsafe injection practices, including syringe reuse, AEFIs, or BBVs. It was speculated in three records that AD syringes could be reused if the disabling mechanism were deliberately defeated. One referred to the possibility of using larger than required syringes, but no instance of reuse was reported. Global health communities should promote the use of AD syringe products as an essential strategy to curb BBV transmission instead of standard disposable syringes, which continue to be reused.

Syringe Reuse

The reuse of syringes and other unsafe injection practices (s) contributes significantly to bloodborne diseases' global burden. It is estimated that 1.67 million cases of hepatitis B virus (HBV), 315,120 cases of hepatitis C virus (HCV), and 33,877 cases of the human immunodeficiency virus (HIV) were attributed to unsafe injection practices in 2010. WHO, UNICEF, UNFPA, and the International Federation of Red Cross and Red Crescent Societies (IFRC) jointly recommended on behalf of the global health community in 1999 the use of auto-disable (AD) syringes for immunization reduce the spread of bloodborne diseases. In 2019, they updated their recommendation. AD syringes include a safety feature designed to ensure that a syringe cannot be reused after a single dose, eliminating the risk of reuse. Therefore, AD syringes pose an important threat to the spread of bloodborne diseases. Even though AD syringes have been widely used for the past two decades, there is limited research examining how well they have performed in preventing the reuse of syringes. 

Developments by WHO

It is estimated that 200 million sterile hypodermic syringe products are used annually worldwide. In the late 1990s, WHO developed specifications for AD syringes, which led to developing an ISO standard in 2005, i.e., sterile hypodermic syringe products for single use. In May 2020, an updated version of the ISO will be released. Nevertheless, ISO explicitly left the design of the syringe's disabling mechanism up to manufacturers last year. Even though all AD syringes are designed with a disabling mechanism, the design of the syringes made by different manufacturers varies. For example, some AD syringes are disabled by breaking the plunger off, while a metal clip disables others. According to the WHO specification and subsequent ISO standard, AD syringes are used worldwide largely due to the disabling feature's activation point at various points of administration of injections.10 As of August 2020, 46 AD syringes are prequalified by WHO. Through the Gavi-supported Measles Initiative, AD syringes were used to vaccinate 900 million people across 60 countries from 2001 to 2010. UNICEF provides AD syringes to 89 countries, either by donation or by purchasing them. In 2017, UNICEF supplied >600 million 0.5 ml AD syringes13. Through Gavi-supported programs alone, 65 million children were vaccinated in 2017.

The syringes used for injections in India are they safe?

Syringe reuse is very common in India, especially in smaller towns and villages. Some hospitals fail to properly dispose of used syringes and violate biomedical waste disposal regulations. These syringes are recycled and subsequently sold on the black market in some cases. In several cases, used and repacked syringes have been the source of bloodborne infections. Through the enhanced Biomedical Waste Disposal Act, medical consumables can be disposed of in a legally compliant manner. Many institutions are now following these guidelines.

How could used syringes transmit infections?



Injection site abscesses, HIV, Hepatitis B, and C. Many bloodborne infections are caused by unsafe injection techniques.

What is the answer?

 We should urge all state governments to adopt auto-disable syringes as soon as possible. There are roughly 16 billion injections performed each year globally. The majority take place in India. About 15% of these injections are given to children for immunization. WHO protocols require the use of auto-disable (AD) syringes. In the other cases, 10 percent of the syringes are used for single-use, and 85 percent are repackaged and marketed fraudulently. State governments are currently attempting to persuade them to require the use of auto-disable syringes. 

For COVID vaccination campaigns, is this why AD syringes are recommended?



Absolutely! Several syringes are required for this program due to its scope. Individuals with ill intentions can take advantage of this opportunity to resell used syringes. An important vaccination program like this does not require single-use disposable syringes. COVID vaccination can pose a health risk if single-use disposable syringes are used.

How safe are AD syringes?

There is a reason to have auto-disable syringes so that healthcare workers can avoid needle-stick injuries. A safety feature of SoloShot prevents non-sterile syringes from being reused. Large groups of people can be immunized with a syringe that is longer. A fixed-needle design reduces the number of wasted vaccines or medicines in the syringe.