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 certain types of 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.

There is a global black market in reusable syringes, some of are found in rubbish tips. Photograph: Mark Clifford/Barcroft Media

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.”

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.

WHO will embark on a global campaign around the benefits of syringes that have re-use prevention features - meaning they self-disable after a single use - as well as the dangers of reusable needles, with the goal of using WHO-approved syringes across the globe by 2020.

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.”

• This article was amended on 3 March 2015 to clarify WHO’s policy on re-usable and single-use syringes.

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