If reducing greenhouse gas emissions (GHG) as part of a longer-term quest to hit net zero is a universal objective, some industries, such as healthcare, face the added complication of waste disposal while protecting the health of patients at the same time.

The scale of the problem can be seen in North America, for example, where Practice Greenhealth – the sustainable healthcare organisation – estimates that the 1,500 hospitals it services produce more than five million tons of waste annually, equivalent to 29lbs per hospital bed.

In the UK, meanwhile, NHS providers produce approximately 156,000t of clinical waste annually that is either sent to high-temperature incineration (HTI) or for alternative treatment (AT), which is equivalent to over 400 loaded jumbo jets of waste.

Unsurprisingly, Adalbert Jahnz – EU Commission spokesperson for environment, maritime affairs, transport – notes that the industry is increasingly focusing on eco-friendly materials for medical packaging, developing recyclable alternatives and promoting waste reduction initiatives. That means collaboration between medical device manufacturers, recycling companies and regulatory bodies, by fostering innovation in packaging design and waste management practices, in order to mitigate environmental impacts, while ensuring patient safety and regulatory compliance.

“There is a growing emphasis on educating healthcare professionals and consumers about proper disposal methods and the importance of recycling to address the specific challenges posed by medical waste,” says Jahnz, adding: “However, the medical packaging sector remains cautious about sustainability aspects as regards packaging, due to the critical importance of ensuring the integrity and safety of medical products.”

Ultimately, this comes down to employing rigorous testing, selecting eco-friendly materials and adhering to EU regulatory requirements. Hence, manufacturers can, in theory, ensure packaging remains robust and protective, while also reducing their ecological footprints. This approach ensures safety for consumers, maintains product efficacy and contributes to sustainable practices in healthcare, according to Jahnz.

PPWD looms large

Looming large in this particular space is the European Commission’s Packaging and Packaging Waste Directive (PPWD). Against the backdrop of packaging waste inside the EU rising by an estimated 20% between 2009 and 2020, the PPWD lays down measures to prevent the production of such waste, and to “promote reuse of packaging and recycling and other forms of recovering packaging waste”.

It also sets out the requirements that all packaging placed in the EU market must meet, which are designed to reduce the disposal of packaging waste and to promote a more circular economy. However, a proposal outlined by the European Commission in November 2022 potentially puts the cat among the proverbial pigeons.

As Jahnz describes it: “The commission’s proposal for the PPWD took into account the specific needs of medical packaging by exempting packaging for medicinal products from the recyclability requirements and recycled content obligations.

“However, no exemptions from the recycling targets for various packaging materials are provided for in the current and proposed rules. The European Parliament and the Council are currently negotiating the final version of this regulation.”

The sustainable packaging challenge

For the medical industry this presents obvious challenges in terms of creating sustainable medical packaging that ensures compatibility with stringent safety and regulatory requirements. Moreover, as Jahnz notes, it means “maintaining product integrity throughout the product life cycle, sourcing eco-friendly materials without compromising performance, managing the complexity of multimaterial packaging (which has an impact on efficient recycling), and addressing logistical and cost considerations associated with sustainable practices”.

The Association of the British Pharmaceutical Industry (ABPI) has similarly pointed out that while recycling medicine packaging is essential, there are challenges to consider, including prioritising patient safety above all, while also adhering to regulations set by health authorities such as the MHRA, FDA and EMA, as well as international standards-setting bodies.

Moreover, additional factors include the cost of collecting and sorting used packaging for recycling; the cost of the recycling process; assessing the technological capability to efficiently recycle these materials; and evaluating whether the energy used in recycling outweighs the environmental benefits.

A practical example of an initiative in action can be seen in an ABPI case study focusing on inhaler recycling. It also shows what can be done. Take Air (Action for Inhaler Recycling) was a scheme allowing people to dispose of and recycle empty, unwanted, or out-of-date, inhalers through the post. The first and only such scheme, it started in February 2021 and was supported by University Hospitals of Leicester NHS Trust (UHL) and Leicestershire and Rutland Local Pharmaceutical Committee (LPC), and funded by Chiesi, the UK arm of Italy-based global pharma firm Chiesi Group.

After researching recycling schemes in pharmaceuticals and other industries, it was decided to test the feasibility of a postal model, with pharmacies providing pre-paid, pre-addressed envelopes to patients. Patients then filled each envelope with up to four unwanted inhalers and posted them via Royal Mail post boxes directly to a specialist recycling facility.

As the case study notes, all inhaler types could be returned including the predominant pressurised metered-dose inhalers (pMDIs). These were dismantled, with aluminium canisters crushed and suitable plastic pelletised, ahead of recycling. Remaining propellant gas was extracted for reuse in non-pharmaceutical industries, such as refrigeration and air conditioning. Using predictive modelling, carbon emission savings from recycled pMDIs were estimated. Other inhaler types, meanwhile, were incinerated at high temperature and converted into energy through a process called energy-from-waste.

Across the two years the scheme ran (February 2021 to February 2023) 14,060 envelopes containing 52,148 inhalers were returned, with most inhalers (75.5%) being pMDIs. During this time, Take Air saved the equivalent of an estimated 305.3t of carbon dioxide emissions from entering the atmosphere.

A robust sustainability strategy

At the coalface, meanwhile, Medtronic, the medical technology, services and solutions provider, has a “robust” sustainable packaging strategy in place that looks at a wide variety of factors, including recyclability – a matter all the more urgent given that less than 1% of medical devices get recycled globally due to environmental hazards, regulatory approval challenges, lack of infrastructure required for medical device reprocessing, and education, according to Medtronic’s Samantha Smith, engineering director – Product Stewardship.

As she puts it: “To that end, we are focusing on design changes to minimise the packaging impact and amount of waste to our customers. We are removing paper booklets, where allowed by regulators, which will have a large environmental impact. We are evaluating in-market packaging and implementing redesigns that reduce waste from packaging.”

To address this challenge long-term though, says Smith, the company will be incorporating sustainable design criteria into its packaging design process as a key performance indicator (KPI).

“To specifically address recyclability, we are investigating material alternatives to some of the more commonly used medtech materials that can be difficult for hospitals to recycle, such as sterile trays and flexible packaging.

“This will allow countries that are currently able to recycle some packaging to expand their programmes. For countries still building out that capability, this initiative could make it easier to begin a recycling programme,” she notes.

One of the biggest trends is the potential to incorporate advanced recycled content to medical packaging. Currently, ISO 11607 requirements do not allow mechanically recycled content due to the need for complete traceability, according to Smith. “With advanced recycling and similar technologies, the ISO requirement could be met as it essentially puts the recycled material into the process so far upstream in the polymer manufacturing process that it becomes the same as any other feedstock. This could be a big win for the industry to be able to use a type of recycled content,” she notes.

Many healthcare facilities are asking for packaging that contains recycled content, yet they don’t have the knowledge of the regulations requiring specific content in the sterile barrier packaging, for example. This can create the perception that the medtech industry is not using or will not use recycled content when in fact it cannot, according to Smith.

“There are a host of challenges the industry faces to make sure our packaging is eco-conscious; luckily, with the broader push for all industries to find solutions to this problem, more and more options are becoming available.”

As Smith reiterates: “We are looking to other industries to see what materials have been developed that could be adopted into our medical devices and technologies. This will be a multi-year process, but the landscape has expanded rapidly over the last few years and will only continue to accelerate.”

Yet recyclability, for now, is but a small part of the answer for the medtech industry, due to the lack of global infrastructure in place for medical packaging recycling. Like most things, according to Smith, recycling is about access and a large portion of the world has limited ability to recycle municipal solid waste (globally its around 14–20%). “We must focus on minimising all packaging until a global infrastructure is in place. When your sink is overflowing you first turn off the tap. The same principle must apply here,” she says.

And therein lies the problem. Recycle-ready packaging, where packaging materials can repeatedly be moved through recycling streams is one thing; having the necessary global infrastructure in place to achieve that objective is entirely another.