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Strategies to Promote Mercury Free Health Care

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. Who Is Health Care Without Harm?.

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Strategies to Promote Mercury Free Health Care

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  1. 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

  2. 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

  3. 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 inter-governmental efforts to eliminate environmental contamination from mercury.

  4. 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. Mercury in Health Care As Messenger

  5. The HCWH Mercury Experience in the US • Convinced all the top pharmacy chains in the nation to stop selling mercury thermometers. • 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.

  6. 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.

  7. 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.

  8. 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.

  9. three “A’s” and the Big “D” We must replace mercury with devices that are: Accurate Affordable Available The fourth challenge: DISPOSAL Four Challenges for Mercury Substitution in Health Care

  10. HCWH Mercury Campaign in Asia, Africa and Latin America • Education • Demonstration on the ground • Policy Development and Implementation • Moving Markets– fostering supply and demand.

  11. 1. Education:HCWH/UNEP Partnershipwww.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 • Southern Africa – Durban, November 14-16, 2007 • Country workshops in Brazil, Mexico, Malaysia, Vietnam Phase 3– Contemplated for 2008 • South Asia, India – 2008 • More country workshops and policy initiatives.

  12. 2. Demonstration:Toward Mercury Free Health CareChange on the Ground Asia • More than 30 hospitals already moving toward mercury-free 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. • 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.

  13. 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…..

  14. 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

  15. 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 • 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

  16. 4. Moving Markets:Toward Mercury Free Health CareFostering 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.

  17. 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.

  18. Philippines Moving Forward 2. Shifting Policy– Administrative Order Mercury Waste Management 3. Moving Markets– Identifying suppliers, increasing demand. 4. Working Regionally in SE Asia.

  19. 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.

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