Unloved, but a life-saver – we must value PPE

04 October 2021 by Jeremy Farrar and Peter Sands

No item has come to signal the era of COVID-19 like the face-mask. Now a common sight and a necessity for daily life, this simple yet effective device is the unsung hero of the COVID-19 response, playing a crucial role in helping protect health workers and reducing community transmission.

Thus far, the world has spent billions of dollars on personal protective equipment (PPE), which has saved millions of lives. Yet no one loves it: mask mandates generate political controversy; wearing PPE can be hot and uncomfortable; we all like to see each other’s faces.

While much of the noise around PPE revolves around its use in reducing community transmission, perhaps its most vital role is in protecting health workers. Repeatedly exposed to the virus as they care for others, health workers have suffered much higher rates of infection and death than the population as a whole. Some studies have suggested health workers have been 10 times as likely to be infected with COVID-19 compared to the public and that severe and potentially deadly infections are seven times as likely among health workers.

Quite apart from the moral imperative to protect those who risk their lives to care for us, there’s a compelling practical argument. If health workers are infected, health facilities become super-spreading locations. In the early phases of the pandemic close to half of people infected by COVID-19 were infected in a health facility. Moreover, if a large proportion of a health facility’s staff become infected, care standards drop and mortality soars. You simply can’t run a hospital properly if a quarter or more of your staff are off sick or isolating. As the Delta variant causes new devastating waves of infection across the globe, it is vital that we don’t forget the crucial role of PPE in protecting health workers, even when fully vaccinated.

Whether to protect health workers or reduce community transmission, enabling people to go to work or schools to open, hygiene measures, good ventilation and PPE continue to play a crucial role in our response to the pandemic.

Yet the PPE value-chain or ecosystem has multiple weaknesses. There’s been little serious innovation. Most countries have experienced acute shortages and widespread quality issues. There have been examples of price gouging and corruption in procurement. Deployment of PPE has been inequitable and inefficient. Unsafe disposal of PPE is creating both environmental and health hazards.

Underlying these problems is simply a lack of focus and appreciation of the vital role PPE plays. While governments and agencies have high-powered taskforces on vaccines, oxygen and other components of the COVID-19 response, very few have devoted significant effort or resource to thinking about PPE. Whether at the G7 or G20 or at the level of national governments, PPE is very rarely considered.

Right now, the immediate priority is to help countries protect their health workers as the Delta variant drives new waves of infection. A recent survey of healthcare facilities in Africa revealed that 60%-80% lacked sufficient PPE for their health care workers. To avoid health systems becoming overwhelmed, and a consequent surge in deaths, we must urgently scale-up provision of PPE to such countries.

However, we must also fix the underlying problems with how PPE is developed, manufactured, regulated, supplied, used and disposed of. That’s why, as part of the Access to COVID-19 Tools Accelerator (ACT-Accelerator) we launched an initiative we called ‘Rethinking PPE’.

Together with a wide range of partners engaged in the global COVID-19 response, we’ve just produced a report examining current problems and offering solutions, focusing specifically on the protection of healthcare workers. Transforming the PPE ecosystem will require five sets of actions: catalyze PPE innovation; improve PPE quality standards; expand and diversify regional manufacturing capacity; strengthen procurement practices; and optimize utilization and safe disposal. Done together, such actions would make a massive difference in our ability to protect healthcare workers across the world.

While far from glamorous, masks, gloves and aprons are vital tools in responding to COVID-19, saving lives, and making us safer from future infectious disease threats. So when we invest and act on vaccines, treatments and tests, we must also invest and act on PPE.

Sir Jeremy Farrar is the Director of Wellcome, a global charitable foundation which supports science to solve urgent health challenges.

Peter Sands is the Executive Director of the Global Fund.

Read the “Transforming the Medical PPE Ecosystem” paper.