Injection safety support

Use of AD syringes higher in GAVI INS supported countries
Source: JSI Research & Training Institute, January 2009

To date, 71 GAVI-eligible countries have received GAVI’s injection safety support (INS). By the end of 2009, 66 countries reported that they were supporting injection safety practices either through donor support or their own health ministry budgets.

As early as 2008, GAVI's 2009 evaluation report on injection safety support had reported that 56 of the 58 countries to receive the three-year time-limited support were able to replace and sustain the use of auto-disposable syringes (AD) and safety boxes after GAVI support ended (see diagram). According to the report:

• 30 were fully funding their own injection safety programme;
• 11 were relying on a mix of their own funding and donor support;
• 15 were continuing to rely on donor funding

Spreading to other medical services

Over 90 percent of the countries consulted for the study stated that GAVI’s INS was instrumental in their decision to widen injection safety practices to the broader health sector.

According to the report, developing countries’ growing emphasis on injection safety is spreading beyond basic immunisation to other medical services and programmes, such as curative care, HIV/AIDS programmes and family planning.

More on this topic

From the GAVI site

GAVI catalyses new injection safety standards

 

From other sites

• WHO | Injection Safety

• UNICEF | Vaccine Safety

Graph on decrease in price of AD syringes procured by UNICEF, 1997-2007
Source: UNICEF supply division, 2008

Even after the advent of auto-disable (AD) syringes in 1992, many immunisation programme managers were not aware of the negative consequences of the reuse of single use injection equipment. Sadly, the case of a nurse in India, who allegedly administered 150-200 injections in four hours with only 10 syringes and 25 needles, was not infrequent in the nineties.¹

Prior to the AD, injection technology had offered few practical alternatives to the standard single use syringes. They included:

• Reusable glass syringes that required autoclaving;

• BCG syringes that required the needle to be passed through a flame;

• Portable pressure cookers, developed by WHO and UNICEF in the early eighties, which sterilised plastic syringes and needles with pressurised steam;

WHO specifications

Then, in 1986, WHO developed specifications for a disposable vaccination syringe that could be used for only one injection. This led to the AD, a mechanism that automatically disables the plunger after the initial activation.

By the mid-nineties, UNICEF was supplying 25 million subsidised AD syringes every year to national immunisation programmes throughout the developing world. However, universal acceptance remained elusive because of the expensive price of the device.

There was also widespread fear that most developing countries lacked safe disposal practices and widespread AD use would result in infectious waste. This changed in 1999, with four significant developments:

1. WHO, UNICEF and UNFPA recommend that all countries use only AD syringes for immunisation by 2004 and safe disposal boxes be bundled with syringes;
2. Safe Injection Global Network (SIGN) established to support adoption of AD syringe technology;
3. WHO Department of Immunizations, Vaccines and Biologicals forms Immunisation Safety Priority Project (ISPP);
4. Foundation of GAVI.

More on this topic

From the GAVI site

GAVI catalyses new injection safety standards

 

Injection safety support

 

From other sites

• WHO | Injection Safety

• UNICEF | Vaccine safety

Use of AD syringes higher in GAVI INS supported countries
Source: JSI Research & Training Institute, January 2009

GAVI began offering injection safety support (INS) in mid-2001 to countries that wanted to introduce or increase the use of auto-disable (AD) syringes and safety boxes into their national immunisation programmes for vaccines not supported by GAVI.

In addition, all GAVI supported vaccines are delivered with AD and safety boxes.

Sustainable

To encourage countries to find their own sustainable funding sources for injection safety, GAVI provided approved countries with sufficient AD syringes and safety boxes to immunise children and women for a period of three years only.

Initially, INS support was offered only to countries receiving immunisation services support (ISS), but eligibility was soon broadened to include all GAVI-eligible countries.

Map of countries approved for GAVI's injection safety support

Cash support

In addition to INS in the form of commodities, GAVI offered cash as an alternative form of support to countries where AD syringes and safety boxes were already being ordered.

Instead of actual AD syringes and safety boxes, national immunisation programmes in these countries received funding equivalent to the cost (at prices obtained by UNICEF) of purchasing the materials for three years. This helped countries reinforce their training and monitoring and evaluation activity related to injection safety.

More on this topic

From the GAVI site

GAVI catalyses new injection safety standards

 

From other sites

• WHO | Injection Safety

• UNICEF | Vaccine safety