Before Covid-19, healthcare waste was an important, but niche service, rarely discussed outside Ministries of Health and local municipal authorities. But when the coronavirus pandemic hit, the safe collection, transportation and eventual disposal of increasing quantities of potentially infected waste quickly became a serious and pressing issue for the authorities across the world.
The response to the pandemic in the Middle East and Africa has shown what can be achieved with a committed response from both the private and government sectors working in different forms of partnerships. It has also thrown light on what needs to change, both with this pandemic and any future ones.
Pre-Covid, medical waste was only generated by medical institutions such as hospitals, clinics and dental surgeries. However, with the emergence of Covid-19, a much wider number of non-medical sites began to generate waste, including used tissues, gloves and masks, that were potentially infectious and needed to be collected and disposed of accordingly. These included hotels being used to quarantine people and a number of businesses providing essential services, that had to stay open.
Averda is the leading end-to-end waste management and recycling provider across the Middle East and Africa. With years of expertise in handling medical waste across emerging markets, it was able to bring its experience and capacity to bear to assist governments to respond. However, to do so required agility, professionalism and a creative approach.
Staying operational and supporting clients
At the outset, a committee of experienced directors was formed within Averda, led by the CEO Malek Sukkar. This Crisis Committee was tasked to take any and all necessary measures to provide a safe service, including coordinating and cooperating with public and private clients to suggest solutions to address the emerging pandemic.
This committee assured day-today business continuity, ensured infection control protocols across the workforce and fostered innovations to support Averda clients through sharing knowledge, expertise and lessons learned from all countries where the company operates. The safety and well-being of the thousands of frontline workers was, and remains, Averda’s top priority.
Personal Protective Equipment (PPE) rules for collection crews were quickly upgraded to include Hazmat suits and two overlaying gloves, with rapid training and a zero-tolerance approach to failure. Each service delivery team was split into three, each having different accommodation, to limit any potential spread of the virus between teams. Total disinfection of common equipment and trucks took place between shifts provided additional protection.
Making the impossible possible
The collection of medical waste is only part of the solution, the other important question is what to do with it? Thermal treatments, including incineration, are considered the gold-standard methods of disposing of hazardous medical waste, but most countries did not have sufficient facilities or capacity for the quantities the pandemic was generating.
In the UAE, Averda worked with the authorities responsible for waste management, in both Abu Dhabi and Dubai, to solve this dilemma. The company scoured the global market for the best mobile incineration treatment units available, and with the support of aviation partners and some determined creative logisticians, four high-capacity stateof- the-art incineration units were built and delivered within days of the order being placed. Together, these units brought the capacity to destroy up to 900 kilos of waste per hour, twenty hours a day.
Working around the clock, Averda’s teams were able to install the units in just a few days, ensuring that all Covid-related waste can be safely treated in relevant locations across UAE. Youssef Barake, General Manager for Averda in UAE, commented: “Averda showed immense strength and resoluteness mobilising these projects; many aspects of this solution were performed for the first time. It was simply impractical to fit four incinerators, each 12 metres long weighing 30 tonnes into an aircraft, and therefore the incinerators had to be re-designed and split into smaller pieces in order to be lifted and air-shipped to the UAE.
“For the manufacturer and the airlines, accommodating such solutions was another first and will be added to the UAE’s outstanding track record for making the impossible possible. With travel restrictions in place, Averda delivery team had to install and commission these solutions whilst being guided by the UK team via video conference.”
Across the world, similar challenges but adapted responses
Across all the territories where Averda works, the company sought to adapt its response to meet the priorities and requirements of its clients – both public/municipal and private. This required close collaboration and a ‘can do’ approach, with some authorities engaging in public disinfection at massive scale. Fortunately, an open dialogue between public and private institutions has significantly contributed to shaping the Covid-19 response. Further commitment and investment in such proactive communication and discussion can only be beneficial in shaping a faster response and a safer, hygienic and sustainable future in this world where we are all interconnected.
In the UAE, Averda assisted both public and private clients in disinfection efforts, and provided a compulsory deep cleaning for all items, whether at its depots and or placed at customers’ sites. In Oman, the company has helped its partners to disinfect streets, local markets and governmental institutes. In addition, Averda collected Covid-19 waste from quarantine facilities and research areas, such as hospitals, hotels, and labs. Along with the facilities, the containers and vehicles that collect the Covid-19 waste were continuously disinfected.
In Morocco, Averda conducted daily cleaning of public markets, roads, and surfaces. In South Africa, where the company caters for a wide range of clientele, it expanded its medical waste collection services to include the collection, treatment and disposal of Covid-19 waste. Averda also played a vital role in advising the authorities to ensure alignment and cooperation between different public bodies such as the Ministry of Health, which is overseeing the logistics, and the Environmental Agency, whose remit includes treatment sites.
A dissection of three market models in UAE, Oman and South Africa is needed to understand how Averda adapted its response: To start with, in the UAE, Dubai allowed private and public collection teams to work side by side, while the municipality teams operated and oversaw the treatment and disposal of the Covid waste. This meant that the medical waste collection activity was partially managed by municipal vehicles and some other parts were managed by the private contractors, and the waste was eventually treated at Jebel Ali Hazardous Waste Treatment Facility (a Dubai Municipality facility).
Alternatively, in Oman, a government company fully controls both the collection and treatment of medical waste through appointed contractors. State-controlled schemes demonstrated an advantage of quickly mobilising giant forces in times of pandemics beyond rigid regulation, but it does not come cheap when compared to South Africa where it is totally privatised. There, collection and treatment are privately operated and so commercially very competitive.
Averda witnessed that in the early days of the pandemic, the private sector reacted slowly and with prudence due to limited bandwidth forced by the current regulations; once these regulations are thoroughly reviewed and with the full agreement of relevant governmental bodies, mobilisation catches up, and at relatively modest cost when compared to a full state controlled operation. While different operating models conclude different responses, the company is able to produce the right response under any of the economic models adopted. The authorities in UAE, for example, had to mobilise more trucks to accommodate the increasing amount of Covid-19 medical waste being generated and ramp up its treatment capacity and, in both activities, Averda proved to be essential.
In South Africa, the government relied on the private sector to treat Covid-19 waste and so, to keep up with the rising treatment demand, Averda proactively freed up incineration capacity by diverting non-Covid medical waste to alternative treatments. There were some differences in the agility that the company could deploy to address the issue of medical waste; the speed of responsiveness was, in most cases, dictated by current regulations governing the industry.
Solving the crisis longer-term
The Covid pandemic has forced the waste management industry to reimagine the medical waste systems and infrastructures. For a start, the quantities have mushroomed; the healthcare sector is no longer the only generator of healthcare waste. This has led to a discrepancy in the quantities of waste, and disrupted the segregation mechanics, eventually leading to the waste being solely treated through incineration. Averda proposes five recommendations to help the industry in emerging markets reshape itself:
1. Regulatory bodies engaging with waste management contractors on best practice and implementing new regulations;
2. Updating and enforcing regulations to allow higher competitiveness among contractors;
3. Updating guidelines and enforcing segregation at source to benefit from different specification and allow different treatment methods to be able to lower the costs associated.
4. Single-use plastics have re-emerged as part of the response to avoid cross contamination - reversing that trend requires massive awareness and commitment from all stakeholders.
5. Redesigning PPEs, masks and gloves so that they can be recycled, as their current disposal method is unsustainable. This represents a serious development opportunity as well that might be an enabler for the whole industry. Massive amounts of PPE have already been found polluting the natural environment on both sea and land, endangering our fragile ecosystems.
This pandemic marks a transformational milestone in the medical waste business, the treatment value chain has changed; it has received massive increase in quantities; it became more costly as it has adopted more sophisticated protection protocols; it has room for innovation as it has to navigate outside the costly incineration process which will allow more room for innovation and development.
Whatever innovations come next, Averda’s expertise and healthcare waste services will continue to support healthcare providers, public authorities and other concerned businesses that are generating potentially infected or medical waste. And, with no end to the pandemic in sight, this business line will only be more prominent in the future.