HIV Outbreak in Pakistan: A Call for Safer Medical Care

Approximately 37.9 million people suffered from Human Immunodeficiency Viruses (HIV) across the globe in 2018. Roughly one million people have been infected every year since 2010. HIV is transmitted through bodily fluids, such as blood, breast milk, and semen, and therefore can commonly be contracted through sexual intercourse.

Yet dirty, reused syringes were the culprits of a recent HIV outbreak in Ratodero, Pakistan. At least 1,200 people, more than 900 of whom are children younger than 12, have been infected in the devastating outbreak, which was first identified in May. Many of these infected children, whose immune systems were not as developed as those of adults, died. Muzaffar Ghanghro, a pediatrician in Ratodero, was arrested soon after the outbreak was detected. He was accused of reusing syringes because he could not afford to buy new ones. In doing so, he doubled the number of children infected with HIV in Pakistan in a matter of months.

Though his clinic was shut down after his arrest, Ghanghro’s clinic was one of the least expensive clinics in Ratodero. He charged 20 cents a visit, thus attracting an immense number of patients. One father, Imtiaz Jalbani, has four children—all whom were infected by Ghanghro’s dirty needles. Jalbani told The New York Times that, according to the doctor himself, Ghanghro and his wife starved themselves in order to afford syringes for his patients.

Yet Ghanghro is not the only medical official in an impoverished country to have misused medical equipment because of a shortage of supplies. According to the World Health Organization (WHO), one-third of new Hepatitis B infections, 40 percent of new Hepatitis C infections, and nine percent of new HIV infections were caused by syringe reuse, totaling to more than 24 million new infections in 2000. In less-developed countries, 70 percent of all injections are applied using reused equipment, and 40 percent of injections around the world are given using reused equipment. The HIV outbreak in Ratodero isn’t just an unfortunate occurrence and the result of a doctor’s misguided mistake; it is a wake-up call to the rest of the world.

Solving the problem of syringe reuse isn’t as simple as providing clinics with more syringes. Syringe reuse has been a common practice for years and was even encouraged in the 20th century. Until 2000, the WHO itself claimed that a syringe could be reused up to 200 times if disinfected properly. Furthermore, the syringe market is a relatively small one. Since it is dominated by 30 manufacturers, introducing safer, single-use syringes requires a massive shift in financial outlook and spending in the private sector. Corporate manufacturers see no reason to introduce new and expensive syringes into the market when “reusable” syringes already generate millions of dollars of revenue. Marc Koska, a British scientist who has been promoting safer syringe use for more than 30 years, said that he had created a syringe that falls apart after a single use and costs five cents apiece—the same price as today’s widely-used syringes. Yet Koska’s potentially revolutionary invention was rejected out of hand by the medical technology industry because it could threaten the success of other syringes already established on the market.

Nevertheless, the drive for creating better and safer “single-use” syringes still continues. The WHO has created a “smart syringe” whose plunger locks after one use, rendering it ineffective for multiple applications, and the organization hopes to distribute it in great numbers around the world by 2020. This smart syringe costs three to four cents more than traditional syringes, but it will reap great economic benefits for many developing nations across the globe. According to Koska, every dollar spent on the syringes will produce a $14.57 margin in other economic benefits. Meanwhile, using such syringes would save a substantial amount of money because the number of infected patients needing injections and treatments would plunge.

The outbreak in Ratodero is just one harmful effect out of many caused by the unsafe reuse of syringes. Infection rates cannot be brought down if medical practitioners do not receive the supplies necessary to treat their population. The reuse of medical equipment is an issue that will continue to grow if it is not properly addressed. It is up to syringe marketers and activists to properly educate populations and enforce better methods of providing injections.