Tanzania is to become the first country in the world to move exclusively to using syringes that self-destruct after a British entrepreneur played the health minister undercover footage of children being injected with used needles.
Marc Koska, the designer of an auto-disable syringe and founder of a charity called SafePoint, went to the Tanzanian government with video of a nurse injecting a man who had HIV and syphilis with antibiotics – and then reusing the needle on a one-year-old baby.
"I went to see the minister of health in Tanzania and showed her the film. She was so distraught and said: What are we talking about here? She said, What's the solution? Let's get on with it. A meeting scheduled for 10 minutes went on for two hours," Koska told the Guardian.
Koska is a man on a mission. He hopes to persuade four other countries in east Africa to follow suit – Kenya, Uganda, Burundi and Rwanda – before he takes on the rest of the world.
The stakes are higher than most people imagine. Some 1.3 million people die every year because of the reuse of syringes, according to the World Health Organisation. That's more than malaria kills, Koska points out. "This is not mosquito-borne disease. This is man-made," he said. There are 23m transmissions of hepatitis, which cost $119bn (£74bn) every year in medical and lost production costs. In Africa, around 20m injections contaminated with HIV are given every year. In the developing world, every syringe is used on average four times. That's Russian roulette, he says.
Koska goes to health ministries armed with figures. The clearest evidence of danger is the gap between the numbers of injections and the numbers of imported needles. "Tanzania has 45 million people and they are importing 40m syringes. With an average of five injections each a year, they need 220m," he said.
This is not about routine childhood immunisation, for which safe syringes such as Koska's are provided along with the vaccines, usually by Unicef, the biggest procurer. But "they forgot the other 90%", he said. Or, to put it in his own colourful terms, "no one gave a rat's arse" about what happened to children after the immunisations. In developing countries, treatment is often by injection rather than pills.
"The village quack has one syringe for 200 people," he said. "I've seen him take it out of his hair, use it and then stick it back in the roof of the hut where the insects are." The healthy start to life that children are given is so easily undermined.
There is a commercial conundrum at the heart of the problem. At 3p each, syringes are very cheap to make. They are manufactured by a small number of big companies which use them as a loss leader – they package the syringe together with blood bags or catheters and charge more. Although auto-disable syringes are now as cheap to make, it involves changing over the production process, which is expensive. Companies also sell fewer syringes in the long run – because people get well.
Koska has his own company, but his charitysupports the use of any quality-assured brand of auto-disable syringe. Koska hopes to persuade families to demand safe injections from needles carrying a LifeSaver kitemark. In Tanzania, health workers will ask people given such injections to send a free text to the health ministry. Health workers who get 500 text "votes" receive congratulations and a status-conveying badge. Koska tells of seeing parents asked to choose the needle to be used on their child from a tray of reused ones. If families understood the danger, they would insist on a new one, Koska believes.
Twenty-seven years ago, he was kicking his heels in the Caribbean after a privileged upbringing, looking for something interesting to do with his life. "I had first-class honours in beach bumming," he said. "Then in May 1984, I read an article – in the Guardian as it happened – predicting in the future, syringes would be a major transmission route for HIV. Immediately I knew that was my calling."
It took years of studying the problem and learning about plastics, before he hit on his design, in which the plunger breaks as soon as it is pulled back for reuse. He has now sold 3bn of them and last month, he finally signed a contract with the world's biggest syringe-maker to produce his auto-disable design.
Next in his sights are the UN and aid agencies that provide medicines to the developing world, such as the Global Fund for Aids, TB and Malaria and Pepfar, the US president's emergency plan for aids relief. They do not specify to the countries they help that the drugs must be safely injected, he says. But no doubt they soon will.