One man's campaign to eradicate the dirty needles that kill 1.3 million a year

It was 1984 and Marc Koska was working in
the Caribbean, building forensic models to
support murder cases, when he read a
newspaper article about HIV/Aids that
changed his life.
“All the media could talk about was this
new killer disease that was going to wipe
out the planet,” the Briton recalls. The
story predicted that reusable needles
would soon become a major way of
spreading the infection, and more than 30
years later, the prediction has come true:
260,000, or 5% of all the world’s HIV
infections, are caused by unsafe injections.
For Koska, that article was the beginning of
a 30-year campaign to create safe syringes.
Now, finally the rest of the world seems to
have caught up with him.
Today the World Health Organisation
(WHO) starts a global campaign to
eradicate the dirty needle, which is
responsible for the deaths of 1.3 million
people every year. New guidelines
announced in Geneva today will mean that
every injection given in the world will
have to come under scrutiny and be safely
engineered. If the programme is
successful, it will have dramatic
consequences across the world, potentially
wiping out more than $1bn in Africa’s
healthcare bills alone.
For many decades the reusable syringe was
seen as the best option, and as recently as
1998 WHO was still advocating that
syringes and needles be reused up to 200
times as part of vaccination programmes.
But opinion began to change, and a study
by WHO in 2000 found that of the 16.7
billion injections carried out worldwide
that year, almost 40% were unsafe.
The figures associated with illnesses
caused by using reusable syringes are
astonishing. According to WHO estimates,
21 million hepatitis B infections are caused
by unsafe injections, along with 2 million
hepatitis C infections, or 40% of all the
documented cases in the world.
In Cambodia, a doctor currently faces
murder charges after infecting more than
100 people with HIV by reusing a syringe
multiple times. And Peter Piot, a
microbiologist famous for discovering
Ebola in the 1970s, stated recently that the
reuse of syringes in west African hospitals
was a major cause of the spread of the
virus at the tail end of last year.
During our discussion, Koska repeatedly
pauses to show me video clips shot
undercover of doctors and nurses in the
developing world going around their
wards, shoving blunt needles into patients
without pausing to change syringe or to
sterilise, even though sterilisation itself
has long been viewed as an ineffective
means of stopping the spread of infection.
More on this topic
The world needs free healthcare for all,
says ex-NHS boss
Using existing technology Koska came up
with a syringe that falls apart after one
use, and sold his first one in 1997. Even
though he’s sold more than 4 billion auto-
disable syringes since, he has been
repeatedly frustrated in his attempts to
make the world aware of the problem
caused by reusable syringes. “It’s been a
very frustrating journey. Thirty years to get
WHO turned around. Thirty years to get
the manufacturers turned around. You’ve
got too many parts to expect it to be a three
year journey.”
“There is a very basic reason why it hasn’t
happened and that is because the
manufacturers haven’t had a market,” he
argues. “If the manufacturers could sell a
product and it was identified where they
were going to sell it and who was going to
pay for it, they would make it.
“The core of it is that manufacturers have
no incentive. Manufacturers control all
this, as they have all the money. Syringes
are a commodity. There is a very low
margin on disposable medical products. So
you say to the manufacturer, ‘let’s all make
better products’, and they say ‘why?’
because there’s no guarantee that anyone
is going to buy them.”
More on this topic
Seven breakthroughs that will transform
global health
Koska’s efforts to enter the market have
been blighted by a series of unfortunate
events. His new invention was simple,
used existing technology and was cheap,
costing the same as regular syringe at 5
cents. All this meant it posed a threat to
rival companies.
His first licensee in the developing world
was bought out by another company and
then had its premises bulldozed. On
another occasion, a successful deal with a
government fell through after the order
was mysteriously cancelled.
Now the delay from both the medical
industry and global organisations in
embracing the single-use syringe not only
means that millions of people have died
needlessly from injection-born infections;
it also means that Koska stands to lose out
on making money from his invention.
With 30 syringe manufacturers around the
world, earning $2m in revenue, you would
expect Koska to benefit from today’s
announcement, but his patent on the K1
runs out in 2017. “If this had happened 15
years ago we would have been richer than
God,” he says.
“But I don’t really care about the money, I
care about whether we’re going to solve
the problem. The money will come later.”
Of medium build, with slightly greying
hair and the natural confidence that comes
with an English public school education,
Koska, 53, is a determined man. He has
needed to be.
After intense education efforts in the
developing world through his charity
SafePoint, established in 2005, and years of
lobbying WHO director-general Margaret
Chan for the introduction of guidelines
promoting auto-disable technology, Koska
is well aware that today’s announcement
will only be the next step in efforts to
make the single-use syringe widely used
across the globe.
More on this topic
Corporations have rights. Now we need a
global treaty on their responsibilities
WHO will embark on a global campaign to
tell of the benefits of single-use syringes,
and the dangers of reusable needles, with
the goal of using WHO-approved syringes
across the globe by 2018. Local and
international manufacturers will be
encouraged to create safely engineered
syringes. Ministries of health and
international donor programmes run by
the likes of Unicef and USAID will be
targeted by the campaign.
“Today, Chan is a hero, but I think the next
chapter might be just as challenging as the
first bit,” he says.
“My gut feeling is that the ministries of
health will be most resistant, because
they’ve been saying for so long that they
don’t have a problem of reuse in their
countries. They’re never going to say that
‘we’ve got a terrible problem with
hepatitis C because I can’t be bothered to
buy enough syringes’. So now ministers
have got to change their position and say,
from Tuesday, we’re only going to buy
auto-disable syringes.”
Even if takes another three decades, you
would back Koska to win out in the end.
While working in the Caribbean, his team
won every case.
“There is no excuse left,” he says of the
impact of today’s announcement. “That’s a
nice way of explaining my feelings. It takes
us over a bridge. Up until now people
could manipulate the story and come up
with lots of different excuses. Now, they
won’t be able to.”