This blog is part of a series of reflections on covid-19 and the circular economy. For previous blogs in the series, please see here.
The high risk of contagion of covid-19 has resulted in exponential numbers of patients worldwide — numbers that, in many parts of the world, are still increasing as we speak today. Hospitals globally have been bursting at the seams. In the Chinese city of Wuhan, officials went so far as to build a new hospital to account for the large number of patients, while many other cities, such as London, fashioned makeshift hospitals out of event spaces. Health services have found themselves short on vital medical supplies and we are still seeing these struggles playout globally. How could circular design strategies help us both better prepare for, and alleviate current supply woes?
Both the pressure on healthcare workers and the demand for personal protective equipment (PPE) and ventilators has grown rapidly. While some doubt arose around ventilator’s efficacy in treating covid-19, demand remains high and estimates total the number of ventilators needed to care for US patients as being between several hundred thousand and a million. And demand is not only among covid-19 patients; those fighting other diseases cannot be forgotten.
However, the covid-19 pandemic has led to healthcare supply shortages due to supply chain disruptions, existing supplies being exhausted and manufacturers struggling to meet heightened demand.
The shortages can partially be attributed to supply chain disruptions caused by lockdowns, transportation issues and the slowing down of production due to the pandemic. Further, it is doubtful whether countries facing shortages today were sufficiently prepared. Who ever invested in PPE to prepare for a potential pandemic in the long-term? Today’s healthcare supply shortages expose both the short-term focus of many leaders and the fragility of our dominant economic system and in turn, our health system.
The circular economy allows us to collectively reimagine and redesign our systems to ensure a safe and just place for all. It brings our attention to all stages of the value chain, since only a systemic shift of all links can weave off the dominant linear system and its drawbacks. Further, it requires us to redesign everything, from products to business models. Therefore, design sits at the heart of the circular economy.
An example that aptly captures the need to not only be attentive to all stages of the value chain, but also that short-term fixes can go awry, comes from the Netherlands. In an attempt to alleviate shortages of healthcare equipment, the Dutch government imported mouth masks from China. However, after conducting tests, hospitals rejected about 600,000 of these masks due to insufficient quality and safety: They did not comply with medical standards and put the health of doctors and nurses at risk. Short-term supply fixes are not sufficient to safeguard our health during crises.
In light of the above mentioned shortages, ‘we’d be wise to apply circular economy principles to address it with materials and technologies already in existence’, says Stephanie Potter, Senior Director, Sustainability and Circular Economy at the US Chamber of Commerce Foundation. For example, a focus on reuse, repair and remanufacture can make supply chains more resilient by minimising reliance on import and availability of raw materials, and shifting away from ‘just-in-time’ supply chains.
In the following sections, we will explore how (amongst others) three aspects of circular design — reuse, repair, refurbish — can especially help to prevent shortages in medical equipment and make our healthcare system more crisis-proof in the long-term.
Single-use has become an almost integral part of today’s dominant linear economic system. In healthcare, it is certainly true that some devices cannot be used more than once due to the clinical challenges of safety and sterility that the reuse of products or materials brings. Concerns about germs and infections are not unjustified. There has been, however, an increase in single-use labelled items that causes some to question whether single-use medical device manufacturing has become akin to what is common practice in other industries: planned obsolescence. Planned obsolescence describes the practice of artificially shortening product life spans. Especially in consumer industries, products are deliberately made to become obsolete and in turn, need to be replaced. Now, is it possible that this practice has also entered the medical sector? According to Lars Thording, Ph.D., Vice President of Marketing and Public Affairs at Innovative Health, the answer is yes. He highlights that some single-use labelled medical devices can well be reused after going through strict reprocessing procedures to ensure they meet quality standards. To him, the single-use label is often a matter of driving manufacturer revenue. However, when design decisions put human health at risk, planned obsolescence has gone too far. Medical device manufacturers need to find the right balance between profitability and utilization impact.
Planned obsolescence has no place in a circular economy. Here, reuse trumps single use. And indeed, reuse can support societal functioning during crises. Facing healthcare supply shortages, the covid-19 pandemic has inspired many to explore novel approaches to enable the reuse of medical devices. Researchers at TU Delft and Van Straten Medical found that the single use of face masks, which has become common practice among hospitals, might not at all be necessary. According to them, face masks can safely be reused up to five times after going through the right sterilisation processes. At the European scale, this would make a difference of 100,000 masks not ending up at landfill every day. The researchers point out that every hospital has the necessary equipment and can start the process tomorrow. Meanwhile, researchers at Pennsylvania State University have developed a plasma-based sterilization process that uses room temperature plasma to sterilise devices like plastic face shields which in turn, allows for their reuse.
Successful circular product designs require us to consider use, reuse and post-use. During the first stages of the pandemic, we saw businesses with good intentions transforming existing products for another use to tackle healthcare supply shortages. Sporting goods retailer Decathlon, for example, worked with a research institute to convert snorkelling masks into ventilator masks. A welcome collaborative approach. Yet, what happens to these masks once demand declines? If businesses do not consider how their products can be circled back into the loop, such hacking of products for another use marks a mere reflection of the linear model. Ultimately, it may add to the mountain of landfilled waste. To alleviate extended risks of future crises, it is essential to consider how products are used, reused and processed at the end of use.
When concerns about healthcare supply shortages started rising amidst the covid-19 pandemic, Nathan Proctor, Head of the Right to Repair campaign at the US Public Interest Research Group, called on healthcare manufacturers to release all repair information for essential medical kits. To him, addressing supply shortages is all about the right to repair: While demand for healthcare kits is rising and new supply is dwindling, hospitals rely on products that are already in use. But what if a ventilator breaks down and cannot be replaced, nor be repaired? Where access to new equipment is limited, the ability to repair used devices could mean the difference between death and life, says Proctor.
Currently, many manufacturers do not provide easy options to repair. Using copyrights, they limit consumer access to this information. What is more, critics like Lars Thording, as mentioned before, argue that manufacturers sometimes deliberately shorten product life spans.
The circular economy aims to extend and preserve what is already made. Suppliers are encouraged to limit and simplify repairs and to enable users to engage in repairments themselves. A classic example, Fairphone’s modular design allows users to acquire spare parts for do-it-yourself repairs. These are facilitated through the use of screws that are identical in size and marked by a blue circle, allowing easy identification. Fairphone found that offering reparability pays off because sustainability conscious consumers are willing to put the extra effort into replacing parts and caring for their device. The company has released video tutorials for replacing modules and works together with the open-source wiki-based site iFixit. iFixit offers a platform for individuals to upload repair guides and share their technical knowledge with each other. In light of the covid-19 pandemic, iFixit has further extended its repair guide library to medical equipment.
The impact of covid-19 on human health goes beyond hospital halls. Belgium-based startup ASmartWorld realised that quarantine measures especially isolate people living in elderly homes and offered them refurbished smartphones to reconnect with their family members. Such refurbishments not only alleviate shortages, they also contribute to societal challenges by reducing waste, conserving resources and offering economic benefits from extending the life cycle value of manufactured equipment.
The case for refurbishment is also strong in the medical sector. Many devices, including MRI and CT scanners, are made from precious metals that are getting more scarce and expensive. Netherlands-based electronic company Philips recognised this development early on and introduced its circular Diamond Select Program in 1990 to refurbish used devices and to sell them back into the market, with reduced price but full warranty and circular economy marking. Philips’ program has become core to the company’s business strategy and obtained strong status internally, due to its role in providing both revenue and impacting internal circularity ambitions.
Observing that refurbishment ensures a restored product is updated to relevant safety standards and can serve its original functions in good condition, it can be argued that refurbished products do not always guarantee original performances. While this may be secondary in many consumer electronics, it matters in the context of life-saving medical devices. Here, remanufacturing — the use of parts of discarded products in a new product with the same function — may offer a solution.
A look at the current situation under covid-19 reveals that the healthcare industry may be facing many new questions once the pandemic draws to a close. What to do with the high amount of new devices that have been acquired? Where does all the equipment go once demand is declining? How can we make sure it is not being discarded, but can be reused, repaired or refurbished to stay within the loop?
Long-term strategic approaches are needed to make sure product value is kept at its highest level for as long as possible. Circular design approaches like design for reuse and repair, amongst others, must guide the production of new healthcare equipment to ensure sufficient supply emerges within a healthy and resilient ecosystem — a system that is prepared for future disruptencies and crises. This is especially important considering that the biggest crisis — the climate crisis — may only lie ahead of us. The application of circular design is not an obstacle, it is our opportunity to prepare for the future.