Transcript HCWH Global Mercury Goals

Strategies to Promote
Mercury Free Health Care
Joshua Karliner, International Team Coordinator, Health
Care Without Harm
www.noharm.org
www.mercuryfreehealthcare.org
UNEP Mercury Products Workshop
Bangkok, May 18, 2007
What is HCWH?
HCWH’s work sits at the intersection
of two core principles—
the right to health care and
the right to a healthy environment
We take the Hippocratic Oath: “First Do
No Harm,” as our point of departure.
We address the paradox inherent in health
care systems that pollute and therefore
undermine human health.
We transcend that paradox by advocating
for a healthier, more ecologically
sustainable health care sector and positive
alternatives to polluting technologies,
products and practices.
Who Is Health Care Without Harm?
“the Campaign for Environmentally Responsible Health Care”
Health Care Without Harm is an international coalition of 443 organizations in
52 countries working to transform the health care sector so it is no longer a
source of harm to people and the environment.
Issues: Alternatives to medical waste incineration, mercury, PVC in the health
care sector. Green buildings. And more.
Offices in: USA, Prague, Buenos Aires, and Manila. Partners in South Africa
and India.
www.noharm.org
HCWH Global Mercury Goals
1. Phase mercury out of the health care industry, globally.
2. Replace mercury in health care with viable, cost-effective
alternatives and safely dispose of mercury as it is
phased out of the health care system.
3. Contribute to broader coalition, governmental and intergovernmental efforts to eliminate environmental
contamination from mercury.
Mercury in Health Care As
Messenger

Addressing mercury in
health care raises the
public and policy makers’
awareness of the issue.

Eliminating mercury in
health care can be a key
part of a national,
regional and global
strategy.
The HCWH Mercury Experience in
the US

Convinced all the top pharmacy chains in the
nation to stop selling mercury thermometers.
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11 of the top 15 national retailers
20,429 of 31,844 retail stores or 64% no longer sell
mercury thermometers
With allies, passed mercury thermometer bans
in 11 states.

Worked through H2E to convince more than 5,000
hospitals, to sign a pledge to eliminate the use of
mercury by 2005

Convinced the largest Group Purchasing Organizations
(GPOs) to take mercury "off contract," including
Consorta (buys for 480 hosptials), and Premier and
Novation (3,100 hospitals).

Currently working to convince hospitals to only donate
mercury-based medical devices based on prior-informed
consent and donor responsibility, or to curtail the
practice.
Mercury Free Medicine in the
European Union

Many countries phasing out
mercury.

EU about to ban mercury
thermometers; considering
sphygmomanometers.

Sweden has eliminated mercury
from health care almost entirely.

European Commission has
approved a mercury export ban.
Products may be next.

HCWH working in coalition on
these issues.
New WHO Policy on Mercury in
Health Care
Short Term: Develop and implement plans to
reduce the use of mercury equipment and
replace with mercury-free alternatives. Address
clean-up, storage, disposal.
Medium Term: Increase efforts to reduce use of
unnecessary mercury equipment
Long Term: Support a ban of mercury containing
devices and promote alternatives.
Four Challenges for Mercury
Substitution in Health Care
three “A’s” and the Big “D”
We must replace mercury with
devices that are:


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Accurate
Affordable
Available
The fourth challenge:
 DISPOSAL
HCWH Mercury Campaign in Asia,
Africa and Latin America
1.
2.
3.
4.
Education
Demonstration on the ground
Policy Development and Implementation
Moving Markets– fostering supply and
demand.
1. Education:
HCWH/UNEP Partnership
www.mercuryfreehealthcare.org
Phase 1: 2006

SE Asia– Manila—January 25-26, 2006.
200 Health care leaders from 7 countries in
the region

Latin America–Buenos Aires August 3-4.
150 Health care leaders from 11 countries in
the region.
Phase 2: 2007
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Southern Africa – Durban, November 14-16,
2007
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Country workshops in Brazil, Mexico,
Malaysia, Vietnam
Phase 3– Contemplated for 2008

South Asia, India – 2008

More country workshops and policy initiatives.
2. Demonstration:
Toward Mercury Free Health Care
Change on the Ground
Asia

More than 30 hospitals already moving toward mercuryfree health care in Philippines.

India– 5 hospitals have piloted mercury free health care.
Toxics Link expanding this work.

China– SEPA, US EPA and HCWH piloting mercury free
health care in Beijing.

HCWH workshops in 2007 in Malaysia, and possibly
Vietnam.
Latin America

More than 40 hospitals moving toward mercury-free
health care in Argentina.
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42 hospitals in Sao Paulo Brazil have switched to
mercury free health care. More than 50 more are
committed to doing so. HCWH supporting these efforts.

Mexico, HCWH is working with Mexican government and
CEC to pilot mercury free health care in two hospitals in
2007.
3. Policy Initiatives
National Policy Model

Philippine Ministry of Health developing national policy in
the form of Administrative Order to phase out mercury
from health care across the country.

Philippine Department of Environment and Natural
Resources has required regional offices to set up storage
facilities for mercury containing devices and supplies.
Municipal Policy Model

City of Buenos Aires, Argentina has issued policy to
phase out mercury from 33 public hospitals and 38 health
care centers– largest public health system in Argentina.
HCWH/US EPA/UNEP engaged in a partnership to
support this effort in 12 hospitals). This could be a
model for large cities in developing countries.
Policy Development: HCWH/UNDP/WHO

Global Environment Facility project to pilot mercury free
health care in 7 countries: Senegal, Lebanon, Latvia,
India, Vietnam, Philippines, Argentina. Policy
component.
Global Policy…..
Health Care Leaders Call for a
Binding Treaty
“We will advocate through our health care
institutions, national governments and
professional associations for national
legislation and a binding international
instrument to substantially reduce global
supply and demand of mercury.”
-Manila Declaration on Mercury Free Health
Care, January 26, 2006
“We…agree to…advocate for a legally binding
international instrument, or the inclusion of
organic mercury in the Stockholm
Convention, so as to substantially reduce
the global mercury supply and demand.”
--Buenos Aires Declaration, August 4, 2006
4. Moving Markets: Mercury-based
Medical Device Industry
Total Global Medical Device Industry Market more
than $100 billion.
Production is growing in Asia. China and India are
key producers.
Mercury Thermometers
China: Annual Production (2003): 120 million (40 million for domestic
consumption, and 80 million for export.
India: Exports 570,000
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Mercury Sphymomanometers
China: Annual Production: More than 1 million
India: Exports 60.000.
(Sources: Global Village of Beijing; Toxics Link)

Alternative Devices: HCWH is investigating
Anecdotal evidence shows that India and China are increasing
production and export of mercury-free devices.

ASIA HAS THE POTENTIAL TO PRODUCE THE ALTERNATIVES
AND SELL THEM GLOBALLY
4. Moving Markets:
Toward Mercury Free Health Care
Fostering Alternative Industry

Must change both demand and supply at the same time.

Identify existing suppliers of alternatives. HCWH South East Asia
has produced a guidebook

Support the development of affordable, accurate non-mercury
thermometer industry in India, China and elsewhere.
Philippines Moving Forward
Demonstrating Change
•
South Cotabato Hospital (150 beds) procuring
alternative thermometers and blood pressure
devices
•
National Children’s Hospital (250 beds) and
Philippine Heart Center (300 beds) training
doctors, nurses, staff, waste handlers.
•
Manila Adventist Medical Center, 150 beds, has
switched to alternative thermometers and blood
pressure devices.
•
Central Luzon Doctor’s hospital 200 beds,
conducting comprehensive mercury audit.
•
Davao is conducting region-wide inventory.
Philippines Moving Forward
2. Shifting Policy–
Administrative Order
Mercury Waste Management
3. Moving Markets– Identifying suppliers,
increasing demand.
4. Working Regionally in SE Asia.
Mercury in Vaccines a Precautionary Approach

Despite the lack of conclusive scientific evidence of harm from thimerosal, enough plausible
concern has been raised to justify reformulating vaccine preparations so that they do not
require thimerosal.

This conclusion is justified because organic mercury is a neurodevelopmental toxicant and
there are viable alternatives to vaccine formulation without sacrificing safety or efficacy.

Regulators, public health officials and pharmaceutical companies have recognized this and
moved to phase-out thimerosal use in the US and in several European countries.

Such phase-outs, by switching to single-dose vaccines that do not require thimerosal as a
preservative, are positive steps, but do not address the broader problem of multi-dose vaccine
preparations in developing countries, where thimerosal use continues.

In this regard, viable options for the delivery of multi-dose vaccines in developing countries
should be developed as a matter of priority. This effort should be led by the World Health
Organization, with participation from other intergovernmental agencies, national governments,
pharmaceutical companies, international NGOs and foundations.