Paul Fisher
Head of Policy, Programmes, and Compliance at the British In Vitro Diagnostics Association (BIVDA)The pandemic shone a light on the environmental cost of health solutions. But how deep is the relationship between health, wealth, and the environment?
Along with the unseasonably warm weather during the first lockdown, one of everyone’s memories of the recent pandemic will be the waste. From masks discarded seemingly everywhere to bins bulging with used LFD test kits and children questioning which bin which bit went into, reminders of the environmental impact were all around. Being responsible for delivering a major diagnostic programme as part of NHS Test and Trace, this question was asked of me daily at the macro level. So, how can the diagnostic industry save lives, sustainably?
The Diagnostic Environment
In vitro diagnostics support 70 per cent of clinical decisions in the NHS. The UK blood-screening service tests each of the 4,300 daily donations for infection[1]. Testing was and will always be a key component of a global pandemic response. It is no exaggeration to say diagnostics are a central pillar of any health system. But these potentially complicated tests may include single-use components for patient safety, involve chemicals that pose environmental hazards, and/or be at the end of a global supply chain.
The link between environmental health and physical health is inextricable. Climate change brings tropical infections to the UK.[2] Warmer global temperatures stress health systems – increasing respiratory admissions to hospital and skin cancer cases[3], and even discouraging exercise and increasing obesity. This creates a cycle of poor service delivery impacting health – increasing the demand for health services, which in turn, fuels further resource consumption and related emissions.
So how can this challenge be overcome? There is a temptation to legislate – the NHS, for example, intends to require suppliers to publish carbon reduction plans for[A1] one to three emissions by 2027 or be prohibited from selling into the NHS.[4] Laudable in intent, but will this be effective? Does the NHS have the capacity to rigorously monitor and review these plans, and enforce non-compliance? It seems unlikely, with the other challenges they face.
Because of the cost and complexity of developing MedTech, many products are globally delivered. Putting the UK out of step with the rest of the world disincentivises the UK as a priority market, and risks delaying or even stopping entry to the UK market. Restrictive policy is not the answer – particularly with the Government’s clear focus on growth and the life sciences.
Legislate to Innovate
The answer is innovation and collaboration. The UK’s diagnostic industries are well aware of their social responsibilities and are actively innovating solutions. Under development, in the UK, are paper-based lateral flow tests – with digital capabilities yet no batteries, these offer a truly sustainable solution to mass testing. Composite packaging that is fully recyclable is available and deployed. Microbial fuel cells generate electricity by harnessing microorganisms’ metabolic activity. These are now small enough to be incorporated into IVDs – from wearable monitors checking daily health to being incorporated into lateral flow devices.
The UK’s political landscape needs to reflect commercial reality. MedTech products are heavily regulated for safety, but post-Brexit, the UK’s regulatory regime is slightly out of step with the rest of the world again. The MHRA’s IDAP (Innovative Devices Access Pathway) is designed to channel innovative products into the NHS more quickly. These principles – unmet need, safety, and support for innovation – are just as crucial for sustainability.
With sustainability a global issue in every sense of the word, positioning the UK as a world leader for sustainable IVDs requires incentivising research and development, building on our position as a scientific world power, and enabling commercial success to drive growth and support NHS reforms. The pandemic showed what can happen when industry, the NHS, and government come together to tackle global health emergencies. But we must take these lessons forward and apply them to our environmental health and wealth.
BIVDA is the trade association for in vitro diagnostics. As our staff have held senior positions in industry, the NHS, and government, we can offer practical support and advocacy for industry members. We have a dedicated sustainability workstream, and we actively partner with others to deliver successful outcomes.
[1] Testing, testing, testing! – NHS Blood Donation
[2] Exploring the rise of vector-borne diseases – APHA Science Blog
[3] Climate change and skin cancer: urgent call for action – The Lancet Oncology
[4] Scope 3—from data to action (economist.com)
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