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Medicine Science

The World Needs Syringes. He Jumped In To Make 5,900 Per Minute. (nytimes.com) 139

Posted by msmash from the moving-forward dept.
In late November, an urgent email popped up in the inbox of Hindustan Syringes & Medical Devices, one of the world's largest syringe makers. It was from UNICEF, the United Nations agency for children, and it was desperately seeking syringes. Not just any would do. These syringes must be smaller than usual. They had to break if used a second time, to prevent spreading disease through accidental recycling. Most important, UNICEF needed them in vast quantities. Now. From a report: "I thought, 'No issues,'" said Rajiv Nath, the company's managing director, who has sunk millions of dollars into preparing his syringe factories for the vaccination onslaught. "We could deliver it possibly faster than anybody else." As countries jostle to secure enough vaccine doses to put an end to the Covid-19 outbreak, a second scramble is unfolding for syringes. Vaccines aren't all that useful if health care professionals lack a way to inject them into people.

Officials in the United States and the European Union have said they don't have enough vaccine syringes. In January, Brazil restricted exports of syringes and needles when its vaccination effort fell short. Further complicating the rush, the syringes have to be the right type. Japan revealed last month that it might have to discard millions of doses of the Pfizer-BioNTech vaccine if it couldn't secure enough special syringes that could draw out a sixth dose from its vials. In January, the Food and Drug Administration advised health care providers in the United States that they could extract more doses from the Pfizer vials after hospitals there discovered that some contained enough for a sixth -- or even a seventh -- person. "A lot of countries were caught flat-footed," said Ingrid Katz, the associate director of the Harvard Global Health Institute. "It seems like a fundamental irony that countries around the world have not been fully prepared to get these types of syringes." The world needs between eight billion and 10 billion syringes for Covid-19 vaccinations alone, experts say. In previous years, only 5 percent to 10 percent of the estimated 16 billion syringes used worldwide were meant for vaccination and immunization, said Prashant Yadav, a senior fellow at the Center for Global Development, a think tank in Washington, and an expert on health care supply chains.
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The World Needs Syringes. He Jumped In To Make 5,900 Per Minute. More

The World Needs Syringes. He Jumped In To Make 5,900 Per Minute.

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  • "the syringes have to be the right type. Japan revealed last month that it might have to discard millions of doses of the Pfizer-BioNTech vaccine if it couldn't secure enough special syringes that could draw out a sixth dose from its vials."

    Talk about your major clusterfucks. And naturally pointing fingers at everyone else rather than ensuring required syringes were included with the product, is what is going to happen.

    • Talk about your major clusterfucks. And naturally pointing fingers at everyone else rather than ensuring required syringes were included with the product, is what is going to happen.

      What if the problem is the vials that the vaccine is shipped in and not the standard syringes that the country was using?

      • Talk about your major clusterfucks. And naturally pointing fingers at everyone else rather than ensuring required syringes were included with the product, is what is going to happen.

        What if the problem is the vials that the vaccine is shipped in and not the standard syringes that the country was using?

        That is exactly why I suggested this burden be on the manufacturer. If your product requires specialized hardware to extract it, then include it. It's that damn simple.

        • Re:Charlie Foxtrot (Score:4, Informative)

          by bws111 ( 1216812 ) on Wednesday March 10, 2021 @11:17AM (#61144068)

          The product does not require specialized hardware. Normal syringes have a 'dead space', which leaves some medicine still in the syringe. The 'special' syringes are 'low dead space', so less of the medicine gets wasted. The requirement for low dead space syringes comes from a desire to use every available drop of vaccine, not from any special requirement the vaccine manufacturers have.

          • The product does not require specialized hardware. Normal syringes have a 'dead space', which leaves some medicine still in the syringe. The 'special' syringes are 'low dead space', so less of the medicine gets wasted. The requirement for low dead space syringes comes from a desire to use every available drop of vaccine, not from any special requirement the vaccine manufacturers have.

            Since a planet is in need of this shot to save many lives, any desire to avoid waste, becomes a mandate rather quickly.

            In other words, we should have probably thought about and solved this low dead space problem, long ago.

            • We did, which is why they exist.

              We are in an unusual situation where the demand outstrips supply by orders of magnitude and so every dose lost to the inherent waste of any process is precious. For most drugs and vaccines that is not the case and the impact of waste is not as severe.

              There is no such thing as a zero-waste manufacturing process.

        • There is nothing simple at all about forcing Vaccine producers to include the needles as well.
          1. These needles can be used for other products as well. So most healthcare organizations already have/had a supply of these, which they get supplied from a trusted source and meets what ever crazy local regulations they require. Also they are often able to get them at bulk price.
          2. How many needles do you need to provide for a lot? If you are shipping 500 doses in a lot do you ship 500 needles and what will happe

    • Re:Charlie Foxtrot (Score:5, Interesting)

      by Immerman ( 2627577 ) on Wednesday March 10, 2021 @10:46AM (#61143966)

      Why would you expect a vaccine manufacturer to ship syringes? Are you asking for inefficient price gouging?

      Hospitals get vaccines and other medications from the various pharmaceutical companies that make them. And they get syringes from the various medical supply companies that make those. Having the supply companies ship syringes to the pharmaceutical companies who have no history of dealing with them is just asking for larger clusterfucks.

      Really, this whole ordeal has shown just how bad hospitals are at dealing with even the most basic requirements of a pandemic. They had a year to stockpile syringes and make plans for efficiently distributing vaccines - months since they knew *exactly* what they'd be dealing with. Instead we're still seeing shortages, and multi-hour waiting lines for a scheduled appointment because they couldn't be bothered to set up scheduling systems that were efficient for anyone but themselves. I shudder to think of the hundreds of millions of man-hours that will be wasted by people waiting in line, just in the US alone. Billions of dollars of productivity just tossed out the window.

      • Billions of dollars of productivity just tossed out the window.

        Implying there's productivity to be lost. Isn't part of the point of vaccination is so people can start socializing, and go back to work?

    • The vials were sold as containing X doses

      Hospitals have found that they can get X+1 doses out by using specific syringes

      • Re: (Score:2)

        by gweihir ( 88907 )

        The vials were sold as containing X doses

        Hospitals have found that they can get X+1 doses out by using specific syringes

        Actually, the only requirement for X+1 doses is enough precision. Any standard 1CC syringe will give you that.

        • Re: (Score:2)

          by bws111 ( 1216812 )

          No, the requirement for X+1 doses is not leaving any of the vaccine in the syringe after the shot. The low dead space syringes do that.

          • Re: (Score:2)

            by gweihir ( 88907 )

            It actually is both. But the "low dead space" 1ccm syringes are in no way special or rare. In fact, here German-made ones cost about half of what the 3 part (regular) ones cost and my usual online supplier even has them on offer at 20% off right this time, so around 13EUR/100. I find it hard to believe any kind of shortage is happening here in particular as they have a shelf-life of 5 years for medical use and every manufacturer has known for while they will be needed.

            • Re: (Score:2)

              by torkus ( 1133985 )

              Straw man.

              A sale at your local supplier who may have a few thousand in the warehouse probably approaching expiration date (hence sale) in not any kind of indicator regarding global availability in the ~10-billion-unit quantity.

              They're not made with magic pixie dust, but they're not currently the standard syringe type. To speculate on why - one could imagine manufacturers WANT waste so they can sell more drugs. This aligns well with the covid vaccine distribution and the extra dose (or 2) per vial - a 20%

              • Re: (Score:2)

                by gweihir ( 88907 )

                The "low dead space" 1ml ones are the standard for tuberculosis vaccination ("Tuberkulin syringes") and they are not a new or particularly difficult or rare design. They are in regular production. The ones I use for technical applications are made from Polypropylene/Polyethylene, hence no special materials used.

                Incidentally, my usual supplier is a national one. Hence they would be affected by any national shortage of these syringes. Did not happen though, there are enough of the right syringes available, be

    • Re: (Score:2)

      by gweihir ( 88907 )

      Sounds more like somebody in Japan does not know what they are talking about or it is about them not wanting to use some "foreign" produced syringes. There really is not shortage of the 1cc syringes you need. At least not in Europe. They are like $15 for 100 for a quality product, e.g. made by B.Braun in Germany. Shelf life for medical use is 5 years, much longer for technical use. The only additional requirement is "must not be usable 2x", but that is a 3rd World requirement.

      I use them for precision mixing

    • No win scenario.

      For absolutely stupid reasons the COVID response had became crazy political showing a major flaw in leaders around the world to jump into action to solve a problem that can not be fixed with warfare.

      So you are giving these people heat for not giving the drug with the proper equipment. However if these places were to improvise and say use needles that will not have the safety feature of breaking on being used twice, or getting the extra dose in the bottle. Then they are going to be under pre

    • Apparently it's possible, although I expect it's not as simplistic or efficient as simply turning the vial upside down, as this article implies. https://www.stuff.co.nz/nation... [stuff.co.nz]

    • They aren't required syringes they're just ideal syringes.

      Imagine you have a very valuable drug that costs $1,000/vial and can medicate 5 people with $1 syringes or 6 people with $10 syringes.

      Total cost $1 syringe: $1,000+$5 = $1005 \ 5 = $201/dose
      Total cost $10 syringe $1,000+$60 = $1060 \ 6 = $176/dose

      The $10 syringe is absolutely worth the cost! It reduces the cost per dose by about 15%. So you of course exclusively use the $10 syringes since they overall save you $25/dose. Great investment. You're us

      • The only reason we're talking about it being worth the more expensive syringe is because we're completely production constrained. The "$100" vial of vaccine is essentially priceless since it results in thousands of lives saved and trillions of dollars of economic activity being re-opened. So the "expensive" syringe is a means of virtually boosting production by 20% which at this moment in time is an enormous value.

        Which is exactly why the proper syringe should have been prioritized in manufacturing and distribution a year ago. No matter when the vaccines were going to be approved, one thing was known long ago; every single drop of it was going to be critical at this moment in time.

        I grow tired of listening to the excuses of Greed, especially when that $100 vial of vaccine costs $10 to make, and will be corruptly reimbursed through the taxpayer wallet at $1000/vial, providing many an executive bonus in the Medical I

  • Have to prevent second use? (Score:4, Interesting)

    by JoeRobe ( 207552 ) on Wednesday March 10, 2021 @10:19AM (#61143872) Homepage

    I looked at the article and couldn't find it - does anyone know what the mechanism is to prevent a second use? How does it "break" if used a second time? I had never heard of that, although it makes complete sense.

    • Re:Have to prevent second use? (Score:4, Insightful)

      by guruevi ( 827432 ) on Wednesday March 10, 2021 @10:27AM (#61143900)

      There are various options:
      - You have "smart" syringes, which is what the UN has been asking for (chips on syringes basically)
      - You have mechanical locks (such as a one-way ratcheting system)
      - You have passive/active disables which either automatically after use or at the flick of a lever covers or bends the pointy end into a piece of plastic

      The biggest problem is the enormous addition of cost to each of these types of syringe which is a reason regular syringes are re-used in the first place. The problem is that each of these solution comes from organizations whose whole goal is to sell to NGO's and big government organizations like the UN with no regards to cost.

      • How does a ratcheting system substantially increase the cost? That doesn't make any sense. It's a change in the molding, which already has to be produced. It's not like you need new parts, only modifications to existing parts. Is the problem a patent or something?

      • >- You have mechanical locks (such as a one-way ratcheting system)
        I don't think that would work - after all the syringe needs to move both directions to be filled then used. You need something a bit more clever to only allow it to be used once. Maybe a single ratchet right at the very end so the syringe would start with an air bubble in it, and once it's expelled and the shot fully given, then it can't be reused?

      • There are various options:

        Okay, dumb question. If the point is to make sure syringes can't be used again, why not just break the syringe with a hammer or some type of crushing device, similar to the one we have at work which crushes SSDs since they can't be degaussed.

        • That's like saying if the goal is to stop the neighbour getting drunk and beating their wife you yourself should not drink. The issue here is the very people they are giving these to are the ones likely to re-use and spread disease. The only way to stop this is to stop the widespread availability of reusable syringes through flooding the market with single use ones, or by providing syringes for free to remove the incentive to reuse. Many western countries opt for the latter.

        • Re: (Score:2)

          by cusco ( 717999 )

          Because staff can't be trusted to do it everywhere every time. People are fallible, and some are incompetent. This is especially true when you're dealing with a crash program where a large amount of people have to be hired rapidly and on a temporary basis.

        • Re: (Score:2)

          by tlhIngan ( 30335 )

          Because the people who reuse the syringes know not to smash them in order to reuse them.

          In general though the ratchet is on the needle and not on the syringe itself - the syringe locks the needle in and attempts to remove the needle to reuse the syringe will break the syringe.

          Another mechanism is the retractable needle - the injection happens and you break the syringe which pulls the needle in and turns a sharp pointy thing into a less sharp pointy thing so its easier to discard. Single dose vaccines can be

    • I looked at the article and couldn't find it - does anyone know what the mechanism is to prevent a second use? How does it "break" if used a second time? I had never heard of that, although it makes complete sense.

      Doubtful that the wording is correct. Seems like it would simply break upon the first use rather than appear to be just fine until you try to reuse it.

      • I looked at the article and couldn't find it - does anyone know what the mechanism is to prevent a second use? How does it "break" if used a second time? I had never heard of that, although it makes complete sense.

        Doubtful that the wording is correct. Seems like it would simply break upon the first use rather than appear to be just fine until you try to reuse it.

        A syringe has two motions: pulling the plunger out, and pushing the plunger in, which are done in that order.
        You "break" it by having the motion of pushing the plunger in break the mechanism allowing you to pull the plunger out.

    • My guess would be the plunger latches after being inserted and any tampering will cause damage.

    • There are various types of safety syringes, some pull the needle into the syringe with a spring after the plunger has been pushed down once. Kind of like a pen, except you can only click it once. No chance of anyone accidentally poking themselves with a used needle that way.

  • Maybe check with their local drug pusher. They should have plenty of syringes.

  • Air Injection (Score:2, Informative)

    by fred911 ( 83970 )

    Aside from the fact that each vial needs to be reconstituted with saline before use, why hasn't anyone designed distribution via an air injection device? They were very effective in the past when properly administered and they were safe and waste free. If you are a needle phobic they're a dream come true.

    Surely there's an expert here to provide further data.

    • Doesn’t the military use these to vaccinate people?

      • They did. Then they discovered that the backsplash of minute amounts of blood onto the air gun tip could spread Hep-C.

    • If you are a needle phobic they're a dream come true.

      Sure, if your dream is a big fucking bruise on your arm.

      They use air hypos in the military. It helps them hide what they're injecting into enlisted, who give up the right to refuse injections AND to know what's in them when they sign on the line. And they're much faster and easier than using needles, and who cares if soldiers are bruised and their arm hurts for a week?

      • they're much faster and easier than using needles, and who cares if soldiers are bruised and their arm hurts for a week?

        Aww come on, he at least wins a drink from the fire hose.

      • If you are a needle phobic they're a dream come true.

        Sure, if your dream is a big fucking bruise on your arm.

        Stop moving. You won't end up with a big fucking bruise on your arm. It's really that simple.

        They use air hypos in the military. It helps them hide what they're injecting into enlisted, who give up the right to refuse injections AND to know what's in them when they sign on the line. And they're much faster and easier than using needles, and who cares if soldiers are bruised and their arm hurts for a week?

        Well, that's quite the rant. Care to explain how the hell you know exactly what's being injected into your arm, and are magically affording the right to refuse, all based on the syringe type? Give me a break. You don't really know what's going in your arm unless you literally concocted it yourself. That doesn't change with an air hypo.

        Air hypos are safe and efficient and been around for decades now. That's ab

      • I think even the military stopped using them due to contamination concerns ... you actually had tiny amounts of blood backsplashing onto the head of the air gun, which could then spread Hep-C or other nasties.

      • You are putting a negative spin on this.

        If you are enlisted in the military, you are called at a moment notice to be anywhere in the world, to help fight and defend your country. When going abroad you need a set of Vaccines to help your immunity deal with viruses at that location. Refusing to take them, will put the rest of your unit at risk, as if you spread the virus other in your unit may too (as most vaccines are not 100% effective) and giving each serviceman a choice in the matter would often lead t

    • Re: (Score:3)

      by cusco ( 717999 )

      Not all solutions are air injectable, it could be that the vaccine is too thick, the particles don't aerasolize (sp?) well, or simply that the vials aren't compatible with that sort of equipment (don't they use a bigger bottle with more doses?)

      • Liposomes in the mRNA vaccines might not be robust in high pressure spray. The reconstitution (Pfizer/Biontech) and thawing (Moderna) instructions both indicate gentle inversions or swirling, and warn against shaking.

    • One thing that is important for a Health Care Emergency like a Pandemic is to try to make sure you keep the KISS (Keep It Simple Stupid) engineering principals in effect.

      There is already enough stupid people out there who are Anti-Vaxers, Conspiracy Nuts, and Social Media Opportunist who push confusion and doubt about the Vaccine already. To have alternate methods of injections, will just add to that.

      Also it is easier to train people to use the drug one way, vs having someone trained with the Air Pump vs a

      • Re: (Score:3)

        by cusco ( 717999 )

        Well, we were much better prepared for a pandemic or bio-terrorism (which we're even less prepared for) before Shrub killed off the Clinton Administration "Push Packs", slashed the budget, and moved the planning and preparation from the CDC to FEMA under "Heck of a job Brownie". Even under FEMA they at least had some expertise and organization, until Rump disbanded that group as well.

        As Grover Norquist told a group of neo-conservative congresscritters in the 1990s, "The best way to convince voters that gov

    • Re: (Score:2)

      by realxmp ( 518717 )

      They're called jet injectors and the big problem with them is they tend to get contaminated. One of the things the 21st century has brought is ultrafast cameras so now we can actually now see this happening. Interestingly this is fine if you're the only user (like diabetics), you are not likely to catch something from yourself that you do not already have. At some point, someone will probably perfect the tech, which will make me happy as whilst I don't mind needles my veins automatically contract and make

  • With the incredible skill of directing other people to sign cheques to pay people to actually do the work involved in making these syringes.

  • It's been a goddamn year.

  • As a heroin addict, I use syringes daily, and I've received the first Moderna COVID-19 Vaccine shot.
    The most common syringe is a so-called "insulin" syringe. This is not considered a Low Dead Space (LDS) syringe. The 1-milliliter (or 1 cc) kind is the most popular. The amount of liquid wasted is tiny - less than a hundredth of a milliter.
    I didn't notice how big the vaccination was, but I imagine it was around half a milliliter. I don't see how you could squeeze another full dose from the wasted liquid of 5

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