MICHEL MARTIN, HOST:

Last month, President Biden and the rest of the G-7 leaders announced a pledge to donate 1 billion doses of the COVID-19 vaccine in an attempt to help end the pandemic. Amidst this global vaccination push, some health experts are warning of a new risk - syringe shortages. We wanted to hear about the dangers posed by this potential shortage and what can be done about it, so we've called Dr. Edward Kelley. He is the former director of integrated health services at the WHO and the current chief global health officer at ApiJect Research Foundation.

Dr. Kelley, thank you so much for joining us.

EDWARD KELLEY: Thank you, Michel, for having me.

MARTIN: As I mentioned, global vaccination efforts are well underway. I'm sure that's a welcome development. But is there any evidence that syringe shortages are becoming an issue?

KELLEY: Yeah, it's a great moment to pause and consider what we're not doing fully in this vaccination campaign. Even though right now, colleagues that I have worked with at different global organizations are saying we're just able to get syringes in place in time, this coming fall, when the U.S. and the other G-7 countries have promised to roll out many, many more doses - almost a billion - it's clear that we're going to have a big shortage on syringes in developing countries.

MARTIN: And what is the problem? Is it that - because, quite frankly, this just seems to be something that's foreseeable. I mean, it seems very clear that if you're going to ramp up a worldwide vaccination program, you're going to need syringes. And so the question is, are the materials not available? Is it a supply chain problem? Is there some sort of disconnect somewhere? What's the problem? What's the source of this looming shortage?

KELLEY: Yeah, well, like many things with - that COVID has shown the light on, it's a peacetime problem, a sort of, you know, outside of the pandemic problem that really has only become tremendously acute during the pressures that COVID has put on. Around the world, there's probably 40 to 50 billion syringes produced annually, but 95% of that is for curative care, for taking care of diseases, diabetic use, other things in hospitals. And only about 5% is for vaccinations. And all of those are mostly committed for childhood vaccinations. So this means you have to borrow from Peter to pay Paul in some cases. And there's been a big question as to how countries will manage regular vaccine programs in the midst of trying to roll out the biggest vaccination program the world has ever known in a very short period of time.

MARTIN: This may be obvious for people in the medical field, but for those of us who are not, like, what's the - what is the worst-case scenario around the syringe shortage? Is it that the vaccination programs will just shut down full stop? Is it that people will start reusing them even if they know that they shouldn't? What is your chief concern?

KELLEY: Well, I guess my main message would be that it's a big problem - injection safety, that is. As someone who directed injection safety for over a decade for WHO and lead patient safety efforts for the U.S. government and for WHO, it's probably the biggest unnoticed problem we have in health care delivery, the reuse of syringes and people getting infected at the point of a dirty syringe. It's a problem in peacetime in low- and middle-income countries. It's not a big problem in the U.S. and Europe and others because we have the resources to make sure that everyone gets their own syringe when they get a vaccination.

But in many countries around the world, you have the reuse of syringes. And 1.3 million people die every year from unsafe injections. So the big issue is that we're now - we have that problem that exists, but we're rolling out the biggest vaccination campaign the world has ever known, basically doubling or tripling or quadrupling the number of injections we're going to be giving around the world without being able to really ramp up and make sure we've got syringes in the right place. So our estimate was that people - we would see about 2 to 3 million deaths unless something radical is done between now and when we see vaccines hitting developing countries later this year.

MARTIN: Just for clarity, I just want to be sure that people understand that the availability of syringes, the safety of syringes in the United States is not in question.

KELLEY: No, certainly not, Michel. This is an issue for the countries around the world who are low- and middle-income countries who are benefiting from doses of vaccines donated by the U.S. government or from COVAX. You - it's not that America is immune from ever having had injection safety incidents in its past, but this is really not about making people afraid of vaccines and getting vaccinated.

MARTIN: Going forward, what are the steps that you think we should all be thinking about? Because I think all of the analysts have made it clear that this isn't the last time we're going to have a global health crisis, that this isn't the last pandemic we're going to face. So what are your thoughts about the steps that we should be taking now to be better positioned in the future?

KELLEY: Yeah, well, it's a great question. I think we would say, look; it's - we need to go back to basics. You need to have the right syringes, which are single-use safety syringes. There are very clear guidance on how those could be used. Ideally, it would be great if they were prefilled. You would also need to have the right people, and the staff need to be trained and understand how to give an injection safely and to not reuse syringes. So those are the two basic elements. But in the medium term and in preparing for the next pandemic, it's quite clear that having syringes and the ability of countries to manufacture and, what you would term in the business, fill and finish vaccines in safe, single-use syringes around the world will be the key to avoiding the type of disaster that we may see this time around.

MARTIN: That was Dr. Edward Kelley, former director of integrated health services at the WHO and the chief global health officer at ApiJect Research Foundation. Dr Kelley, thank you so much for talking with us. It's a sobering message, but thanks for the information.

KELLEY: Thank you, Michel, for having me and for looking at this important issue.

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