This is an excerpt from the March 11, 2021 edition of Medically Necessary, a health care supply chain newsletter. Subscribe here.

Good afternoon. Medically Necessary is a newsletter by Matt Blois about the health care supply chain — how we get drugs, devices and medical supplies to health care providers and patients.

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Demand surge, supply shortages complicate COVID-19 waste management

(Photo: Flickr/Fuzzy Gerdes CC BY-SA 2.0)

The challenge: The COVID-19 pandemic instantly increased demand for some types of medical waste management, such as the disposal of personal protective equipment and testing supplies.

• Waste management companies say they met that challenge last year, but it required a lot of flexibility.

Now there's a new test. Health care providers must dispose of hundreds of millions of needles and empty vaccine vials.

• A shortage of sharps containers, the plastic buckets in which clinicians throw away old syringes and vials, has made that harder.

Waste managers are also trying to predict the pandemic's long-term effects on medical waste management and reshape their companies to meet future needs.

The net effect: Stericycle, one of the country's largest medical waste management operators, reported that the pandemic slightly increased the demand for medical waste management.

• "Elective surgeries have been completely closed … and yet we're still able to see growth," CEO Cindy Miller said on a February conference call. "We've got an uptick from COVID, whether it's the testing and the vaccinations and all of that. But we also are confident as we continue to win new hospitals."

It's the same story for smaller operators. Matthew Cruz, president of a family-owned waste management company in Tennessee called BioWaste, said lots of his health care customers closed their doors last year. Some have since recovered.

But testing at long-term care facilities generated lots of waste, and cleaning companies started asking for help with coronavirus-related jobs. Now county health departments need help getting rid of used syringes. 

• "It was kind of a wash at the end of the day," Cruz told FreightWaves. 

Medical waste manager Sharps Compliance, with its biggest customers pharmacies, reported a similar trend in its most recent quarterly earnings report. The company installed more cleaning equipment and added warehouse space last year to increase its capacity. CEO David Tusa expects that to pay off this spring.

• "While the COVID-19-related orders we've received today are very significant, we do believe we're just getting started as the country works to immunize Americans against the virus," he said on a January conference call.

Flexibility is key: The pandemic brought medical waste outside of the normal health care setting. Testing and vaccine clinics opened up in parking lots, and waste management companies have had to adapt. 

Jim Anderson, Stericycle's VP of product management and innovation, wrote in an email that patients usually get vaccines in doctors' offices or pharmacies. For COVID-19 vaccines, mass vaccination sites and hospitals are playing a bigger role. 

CEO Miller said the pandemic has also made waste management less of a commodity. Previously, health care providers cared primarily about price. Now, she said, they're looking for a company that can help them respond to the twists and turns that come along with a pandemic.

• "The pandemic certainly brings a lot of regulation, a lot of uncertainty to many of those smaller, independent doctor facilities," Miller said on the Stericycle conference call. "We've enhanced our consulting services. We've targeted it toward what's happening today and what do people need to be aware of as opposed to just a package deal of just the basics."

However, the fundamentals of waste management haven't changed. In an email, Anderson wrote that the current vaccine rollout is similar to immunization efforts during the flu season.

• "However, unlike other vaccines, the development and distribution of the COVID-19 vaccine can change very quickly as new versions become available, and this may vary by states," he wrote. "The sheer number of COVID-19 vaccinations and the ever-shifting information of when vaccines will be available has made vaccination administration and waste management challenging."

David Skinner, executive vice president of business development at the medical waste company Daniels Health, agreed. Daniels Health saw an increase in demand, but Skinner said the main challenge has been reacting quickly.

• "Operationally, it's the same," Skinner told FreightWaves. "We just have to set up a lot of sites at very quick notice … for people who needed assistance to set up a COVID vaccination waste stream." 

Sharps container shortage: As the demand for needle disposal is spiking, some health care providers are having trouble ordering sharps containers. 

A fire at a chemical plant serving two major manufacturers, Becton, Dickinson and Company (BD) and Cardinal Health, disrupted the supply of resin needed to make sharps containers. 

• In emails, representatives from both companies said the fire has made it harder to meet demand, but they're working to address the problem.

Meanwhile, competitors are stepping in. OakRidge Products, which makes plastic items for health care and other industries, has seen a surge in new customers. Daniels Health, which provides reusable sharps containers, has also seen increased interest after the fire. 

OakRidge CEO Conor O'Malley said sharps container sales were already up by about 20% before the fire, which he attributed to the vaccine rollout.

• "Our production facilities are super busy, but we're managing to take in every order that comes in," O'Malley told FreightWaves.

That means there are likely enough sharps containers to meet demand, but health care providers will need to search for them. After a year of chasing down PPE in unusual locations, health care supply chain professionals are getting used to that.

The future: Managing waste through the end of the COVID-19 pandemic and the rest of the vaccine rollout is job one for medical waste managers, but the coronavirus outbreak could also have longer-term impacts.

During the pandemic, corporate offices started conducting COVID-19 tests and distributing PPE to employees. Stericycle has turned some of those non-health care companies into customers, and that could continue.

• "Although this strategy is not required … it can give employers and employees peace of mind," Anderson wrote in an email. "To support companies in their efforts to prevent the spread of COVID-19, we developed a PPE disposal solution that includes both pickup and mail-back options."

Sharps Compliance is betting the focus on vaccines during the COVID-19 pandemic will lead to more seasonal flu shots and a bigger waste stream, according to a recent quarterly earning report.

CEO Tusa also told investors he believes patients will need booster shots to keep up with virus variants, and he wants Sharps Compliance to play a big role in the ongoing distribution.

• "You could see a booster in the fall. … They're conducting clinical trials right now for children," he said on a conference call. "We feel reasonably confident that this kind of vaccine activity is going to continue for some period of time. I don't believe it's just going to be, get two shots and you're done."

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Wishful thinking: One wish to improve COVID-19 vaccine rollout

Wishful thinking is a section of the newsletter in which I give experts one wish to improve the health care supply chain. Send your wishes to mblois@freightwaves.com.  

"I would wish for a vaccine that came in a prefilled syringe. … That's a logistical nurse wish." 

— Heather Norman, chief nursing officer for Nashville, Tennessee-based corrections health care provider Wellpath.

Standard procedure: Most vaccines, especially in high-income countries, are delivered in prefilled syringes to make them easier to administer, according to a report from The BMJ.

However, manufacturers opted to package COVID-19 vaccines in multidose vials to speed up production, according to a blog from BD. 

A guidance document from the CDC details 10 different steps to simply prepare Pfizer's COVID-19 vaccine. A prefilled syringe would eliminate those steps.

• "The method is unchanged from Jonas Salk's polio vaccinations over 70 years ago," David Whitaker, chair of the patient safety committee of the European Board of Anaesthesiology, told The BMJ. "It's as if people are being made to use fountain pens and bottles of ink instead of Biros."

Coming soon? The federal government awarded ApiJect Systems America a $138 million contract and a massive loan to produce hundreds of millions of syringes prefilled with COVID-19 vaccines. 

• However, the FDA hasn't even approved the product yet. It's not clear if or when those investments will pay off.

BD has already received orders for 1 billion unfilled needles and syringes to administer COVID-19 vaccines. In December, the company announced a $1.2 billion investment in infrastructure for prefilled syringes.

• That investment is supposed to build up capacity for future pandemics and won't immediately help with COVID-19 vaccines. A new manufacturing site in Europe won't come online until 2023.

For now, health care providers will still need to rely on old-fashioned glass vials. But the research and investment in prefilled syringes spurred by the pandemic provides hope. 

That technology could facilitate the distribution of COVD-19 booster shots, COVID-19 vaccines for children or immunizations needed during a future pandemic.

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Reading list: The best stories about the health care supply chain

• Pfizer's Newest Vaccine Plant Has Persistent Mold Issues, History of Recalls — Kaiser Health News
• Covid-19 Vaccines Targeting Multiple Variants Are in the Works at Moderna, Novavax — The Wall Street Journal
• What stimulus means for the pandemic — The New York Times
• CDC, Dollar General exploring partnership to speed up COVID-19 vaccine rollout — USA Today

Thanks for reading. Please send an email to mblois@freightwaves.com if you have questions, praise or grievances. If this email was forwarded to you, sign up here.

Matt Blois