Can money buy immunity?
Travel can lead us anywhere. Trips can be planned years in advance or right at the last minute; the destination can be just a few miles away or on the other side of the world. Holidays can also range from once-in-a-lifetime opportunities to youngsters ‘slumming it’ on gap years or wealthy business executives enjoying the creature comforts of the latest luxury five-star resort. The one thing holidays do have in common? The risk of tropical diseases and the need for travel vaccinations.
The risk of disease and illness varies along with destinations and different areas of the country that you are visiting. Polio, typhoid, yellow fever; none of these sound very inviting and they are only three examples of what travellers are at risk from when they go abroad.
Malaria is one tropical disease that has received a fair amount of media attention in recent times. News stories have covered scientists edging closer to a cure, famous celebrities who have fallen suspect to the illness and a startling rise in the number of diagnosed cases among travellers.
Commonly spread by mosquitoes that are already infected with the malaria parasite, it can be a fatal disease. Just one bite is enough to contract malaria if the parasite is injected into the bloodstream; the most serious is the falciparum parasite. Malaria is present in many areas of the world and particularly prevalent in Africa, South-East Asia and South America.
The most common precaution that travellers take when visiting malaria hotspots is to take anti-malarial tablets before, during and after their trip. The type of anti-malaria medication you need will be dependent on the area of the world that you are visiting. The key to malaria prevention is preparation. Most courses of anti-malarials need to be taken six to eight weeks before travel and in some cases they need to be taken during and after the trip.
This can be a particular hindrance to the rather glamorous image of wealthy travellers jetting off in a private plane to a luxurious island whenever they wish; although possible sometimes it is just not practical as the health risks of a destination need to be considered.
Complacency is also a contributing factor to the contraction of malaria, as some people think they become ‘immune’ to the risk. This is particularly true of business travellers who often have to go abroad at late notice: “Frequent business travellers are particularly at risk as the familiarity of travel often means that they take the threat of malaria less seriously,” says the websitemalariahotspots.co.uk. “It doesn't just affect people travelling ‘rough’ or for extended periods of time. It can affect anyone, even if they are on a short business trip and staying in five star accommodation.”
The quality of the resort or accommodation can lead to another common misconception about malaria; that the disease cannot infiltrate luxurious areas. Studies have proven some holidaymakers think they are less at risk of catching malaria if they are staying in a five star hotel and as a result some people do not take anti-malaria medication. It has also been discovered that many business travellers are unaware they should seek medical advice after their trip, resulting in them being a high-risk group for contracting malaria.
However, there are some areas and travel destinations that market themselves as being exclusively ‘malaria-free’. African safaris and game reserves dominate the malaria-free travel market offering the ultimate luxury in safari adventure and ecotourism. The Shamwari Game Reserve is just one of many malaria-free exclusive destinations. It showcases ‘Africa’s Big 5’ animals (lions, elephants, leopards, rhinos and buffalo) and provides guests with deluxe lodges and facilities to compliment the tranquil settings. The Shamwari confidently states on its website its malaria-free status and claims there is no need to take preventative malaria medication, although for peace of mind there is no harm in asking a healthcare professional about the precautions required for any malaria-free destination.
However, the key thing to remember is that malaria does not pick and choose its victims based on the standard of hotel or resort and no one is immune to the disease.
Driving sustainability in medical device production
Environmental protection and stewardship are rapidly rising to the top of the corporate agenda and medical device businesses are no exception. The healthcare sectors of the United States, Australia, Canada, and England combined emit an estimated 748 million metric tons of greenhouse gases each year, an output greater than the carbon emissions of all but six nations worldwide. In order to curb this situation various European standards have been introduced.
The Waste Electrical and Electronic Equipment (WEEE); Restriction on Hazardous Substances (RoHS); Registration, Evaluation, and Authorisation of Chemicals (REACH) and the Energy Using Products (EuP) regulations have all significantly altered manufacturing processes, specific labelling, compliance with disposal restrictions, and creation of instructions for end-of-life management and recycling.
At the moment many medical devices are currently exempt from these regulations but several directives, including RoHS and WEEE, are in the process of being reviewed and could be applicable in future. This is especially relevant for devices that are ‘connected’ and have a digital monitoring component which then brings them under the regulatory purview of authorities that govern devices with electronic components.
Safety, Usability and Sustainability
While medical device manufacturers have been working to respond to increasing demand for environmental sustainability from the market, they also have to contend with a key element of their mission: to ensure safety and usability to healthcare workers and patients. Parenteral and other invasive devices are strictly regulated to help reduce the risk of Healthcare Acquired Infection which typically runs as high as 5% and 8% in most developed countries, according to the European Centre for Disease Prevention and Control. As a result, they typically contain disposable single-use plastic elements.
At the same time, many hospitals and purchasing organisations have started to recognise that sustainable purchasing practices play a pivotal role in reducing costs over time. Many GPOs have appointed and empowered Senior Directors of Environmentally Preferred Sourcing who are successfully implementing the sustainable purchasing business case. In addition global pharmaceutical companies are increasingly creating senior positions with sustainability objectives as key to the role.
Medical device disposal is a particularly burning issue; generally carried out through incineration in the EU, it typically releases nitrous oxide, as well as known carcinogens including polychlorinated biphenyls, furans and dioxins. Some of the strategies trialled by manufacturers to reduce waste matter destined to incineration include sterilisation and reprocessing.
Sterilisation, however, falls short on the environmental front, and may consume more energy and produce more emissions than incineration itself. In the United States for example, 50% of all sterile medical devices are sterilised with ethylene oxide but since this method releases harmful emissions, the US Food and Drug Administration is now encouraging the development of new methods or technologies. Many other established sterilisation methods use glutaraldehyde that is not only harmful to the environment but also tends to be regulated by strict usage and disposal rules such as COSSH guidelines.
Focus on Recycling
The outlook on recycling is changing significantly thanks to new research and technologies enabling, for example, monomer extraction. Recycled polymers can be broken down to their constituent monomers promoting an almost limitless recyclability of some polymers. In addition to this, Polyvinyl chloride (PVC), renewable polyethylene and polyethylene terephthalate (PET) can be recycled several times without losing critical properties.
Reducing the impact of packaging can also significantly reduce the materials that need to be dealt with through either waste or recycling. Packaging manufacturers are decreasing packaging volume by favouring sealed trays instead of pouches, laser-etching instructions directly on to the tray where regulation permits it, or reducing the number of components required overall. In addition to this, for recycling plans to be successful it important to have a full understanding of the practices surrounding device use and to establish, where possible, closed loop recycling systems that recover the waste materials from hospitals or patients and bring them back into the recycling process.
Sustainable Manufacturing: Technology and Research
Greater employment of fast degrading plastics or material from other sources is a key strategy to reduce harmful pollutants both at production and disposal stage. Bio-based materials can in fact offset the carbon emitted during processing as the monomer source grows, and a growing range of sources for bio based monomers -such as wood pulp or sugar cane- is available. However, when assessing the most suitable material for a part, the entire lifecycle of the product needs to be considered. For example: bio-degradable polymers can contaminate a recycling stream and emit methane when incinerated.
The use of environmentally friendly materials should also be supported by an increase in clean renewable energy sources. Lower energy consumption means fewer carbon emissions but also financial savings, making this an appealing measure for manufacturers. New technologies are proving a major gamechanger on this front, helping manufacturers marry their environmental stewardship with cost savings and efficiency. 3D printing, for example, can help develop optimum product moulds more quickly, refining production parameters to minimise raw materials volumes and maximising output productivity.
Similarly, ‘digital twin’ production software uses inline sensors to create a virtual, real-time mirror of the production environment to enable inline refinements. The objective is to achieve “zero defect”, waste-free manufacturing. In addition to this, LEAN manufacturing methodologies are already helping to optimise inventory management and reduce overproduction.
Sustainability by Design
It is increasingly clear that effective environmental sustainability in the medical device sector cannot exist without a full view of the product life cycle from concept development, material selection, design and engineering to manufacturing, packaging, transportation, sales, use, and end-of-life disposal. These evaluations are typically made for factors such as manufacturing efficiency, time to market, or safety and regulatory compliance, packaging and transportation costs, but should be extended to energy efficiency and environmental impact by means such as life cycle analysis.
In addition to this, with devices rapidly becoming more digitally connected, developers need to be aware that the costs of disposable electronics would simply not be viable, or indeed acceptable in the light of electronics disposal regulations. Design therefore should focus on creating a simple, repeatable interface between the two component sections so as not to impair the functionality or efficacy. As reducing waste and harmful emissions continues to exert businesses and governments globally, the medical devices industry cannot stand by. The environmental but also commercial implications of inaction are too serious and the array of solutions now available is exciting and diverse.