The world is switching to a new generation of syringes. Russia is next in line
Ivan Petrovsky
From frightful to not intimidating one. A Brief History of the Medical Injection Syringe
If someone thinks that the first smallpox inoculation, made in 1796 by Edward Jenner, was performed with a syringe, then they are deeply mistaken. The English doctor simply rubbed the contents of the pustules of a woman who had contracted cowpox into a scratch on the patient's body.
The palm in the invention of the syringe familiar to us belongs to two doctors: the Scotsman Alexander Wood and the Frenchman Charles-Gabriel Pravaz. They designed the injection devices independently, although they came up with similar designs. This happened in the middle of the 19th century.
Alexander Wood proposed a piston syringe for subcutaneous injections of morphine as an anesthetic.
Since then, injection techniques and equipment have changed only slightly. Until the middle of the 20th century, the technologies for creating syringes were honed, but they still consisted of structures made of glass and metal. They could be boiled or sterilized in other ways and used many times.
The needles for the first piston syringes were gradually improved, but were thicker and dumber than modern ones and became more and more blunt with each new sterilization. The injections made with their help were painful. Reusable glass syringes could "jam". The first piston seals made of leather and asbestos wore out quickly, and this also affected the pain of the injection.
The first disposable glass syringes were mass-produced by Becton, Dickinson and Company in 1954. And in 1956, New Zealand pharmacist Colin Murdoch invented the disposable plastic syringe. The disposable syringe was a real breakthrough - it helped to solve the issue of the risk of infection with blood-borne infections.
Compared to previous injections, modern vaccination is a mosquito bite. In disposable syringes, the needles are thin and hollow, easily entering the skin.
The main danger of the single-use syringes is its multiple use
However, in the case of disposable syringes, a serious problem was revealed - people started to use them more than once and without sterilization. This is done either by hack doctors or drug addicts around the world.
For example, in 2007, in the US state of Nevada, an outbreak of hepatitis C was the result of the practice of a single doctor who injected a painkiller into a patient who had hepatitis C. The doctor then drew other doses of painkiller from the same ampoule into this syringe.
In December 2014, more than 200 children and adults in the city of Battambanga, Cambodia, were infected with HIV due to medical negligence as a result of injections.
“Introducing safe syringes is critical to protecting people around the world from contracting HIV, hepatitis and other diseases. This should become an absolute priority for all countries”, - said Gottfried Hirnshall, Director of the WHO Department of HIV/AIDS.
According to a 2014 study, approximately 1.7 million people were infected with hepatitis C virus and 33,800 people with HIV in 2010 through unsafe injections.
For 12 years, the situation with the misuse of disposable syringes has not changed much. In Russia, for example, in the first half of 2021, 28.9% of new HIV infections were due to injecting drugs or medicines with previously used syringes. And it's not just drug addicts. Thus, the health of tens of thousands of people is at stake.
For reference: In Russia, there are more than a million HIV-infected and more than five million patients with hepatitis B and C, and the disease continues to spread, including through the use of simple disposable syringes.
Syringe with anti-fool system
Is it possible to protect the whole range of injections "from the fool"? It is possible, experts say.
- The technology of self-destructing syringes is known, as well as the methods of their production. - says the head of the department of vaccines, bacteriophages and probiotics of Microgen (managed by Nacimbio of the Rostec State Corporation) Yelena Otrashevskaya.
First, there are safe auto-disable syringes. Sometimes they are called third-generation syringes - after reusable glass and disposable plastic ones. This syringe is not disassembled; immediately after the injection, a mechanism is triggered that draws the needle into the body. Such a syringe cannot be used twice.
Secondly, pre-filled syringes should be used.
The pre-filled syringe, as its name suggests, is already loaded with the correct dose of medicine or vaccine and is sealed in an airtight package. It significantly saves the health worker time: there is no need to assemble a syringe, open a glass ampoule, dilute the drug, and draw it up. In addition, such a drug delivery system provides 100% accuracy, because the necessary dose of the vaccine is in the syringe from the very beginning.
“Whichever primary system is used, today the stress of the situation from the introduction of the vaccine is not comparable to the last century. You can get vaccinated against certain infections, such as the flu, on the go, on your way to work, or while visiting the mall. Today it is a practically painless and absolutely not terrible procedure, which for many is an ordinary routine”, - summarizes Yelena Otrashevskaya.
Nevertheless, it is not necessary to talk about the massive and widespread use of third-generation safe syringes. The reason is simple:
The use of conventional disposable syringes should be legally prohibited
This is what Dmitry Davydov proposes in the project "20 Ideas for the Development of Russia".
The logic for the ban is clear. Third-generation syringes are more expensive than ordinary disposables, and therefore doctors and patients buy what is cheaper on the principle "nothing bad will happen to us". However, life shows that the bad still occurs, and on an alarming scale.
"In the case of syringes, we should all learn from the experience of the automotive industry. Security systems in modern cars (pillows and curtains, a power body frame, ABS, ESP, auto braking, collapsible bumpers and hoods, etc.) double or even triple the cost of a car, but no one says that these systems are redundant and not needed. Moreover, the laws of different countries oblige automakers to install them regardless of the wishes of the buyer", - says technical expert Viktor Levin.
WHO has recommended that all countries switch to new smart syringes by 2020. Their cost in 2015 was twice that of ordinary ones. But the organization has warned that the costs of minimizing the consequences of dangerous injections will skyrocket if protective mechanisms are not put in place. The price is expected to decrease as demand increases. Experts predict the market for “third generation” syringes will skyrocket: from $16.9 billion in 2020 to $27.9 billion in 2025.
At the legislative level, the problem of syringes in the United States was first raised in 2001. Then an act was passed that obliged all medical institutions to regularly introduce safer and more commercially effective injection devices. So the country began the massive use of safe syringes. A similar act was adopted by the European Union in 2010, which obliged all countries by May 11, 2013 to introduce into medical institutions the practice of using devices with built-in mechanisms to protect against injuries with sharp-piercing objects.
There is also an example from developing countries following WHO recommendations. Since January 2022, the government of Pakistan has introduced a complete ban on the sale of conventional syringes in the country as a measure to combat the spread of HIV. To encourage local manufacturers to switch to new generation syringes, the authorities have abolished the sales tax and export duties on this type of product.
The example of Pakistan, which is not a wealthy state, shows that in Russia the ban on disposable syringes of old designs will not be any particular problem.
Dmitry Davydov, in this regard, proposes to establish a transitional period of 2 to 3 years after the issuance of the relevant law. During this time, medical institutions will get used to the use of new devices, and the Russian industry will master their production in the required volumes. By the way, we have the experience of an emergency increase in the production of everything necessary to combat the same coronavirus!
As a result of the implementation of this proposal in Russia:
- Significantly reduce the number of infections transmitted through blood
- The level of vulnerability of medical staff will decrease, which will have a positive impact on the development of medicine in general
- A new import-substituting direction of the medical industry will be developed with the creation of jobs and attraction of capital
But the most important effect is the preservation of the lives and health of thousands of citizens who are at risk due to the use of outdated syringes.
The point is small - to draw the attention of the state to the proposal of Dmitry Davydov on the introduction of new generation syringes.