Long-awaited AO sets 2-year timeline for mercury phase-out

AFTER a wait of almost two and a half years, the Department of Health has finally issued an administrative order phasing out the use of mercury devices in all healthcare facilities in the Philippines over the next two years.

Health Secretary Francisco Duque III signed Administrative Order (AO) 2008-0021 last week mandating the gradual phase-out of thermometers, sphygmomanometers and other mercury-containing devices. As such, all hospitals are required to immediately discontinue the distribution of mercury thermometers in the patient’s admission/discharge kits, and to follow the guidelines for the gradual phase-out of mercury in two years. Besides hospitals, all other healthcare facilities are also required to have a mercury minimization program.

New healthcare facilities applying for a license to operate, meanwhile, are required to submit an inventory of all mercury-containing devices that will be used in their facilities and a corresponding mercury elimination program.

Read AO 2008-0021.

Commonly found in thermometers, elemental or metallic mercury is a known toxic substance that can be absorbed by the skin and can easily penetrate biological membranes, including the blood-brain barrier. When inhaled, mercury vapors can cause neurological and behavioral disorders, and sometimes can lead to death. Even at low doses, these vapors can have harmful effects on the kidneys, and the digestive, respiratory, and immune systems.

In 1991, the World Health Organization (WHO) concluded that there is no established safe level of mercury exposure.

The United Nations Environment Programme (UNEP), on the other hand, identifed mercury pollution as a major environmental and human health problem. In its 2002 report, UNEP tagged the healthcare sector as a significant source of mercury releases, with Asia accounting for over half the global emission of 5,000 metric tons a year.

Aside from the thermometer, medical devices containing mercury include blood-pressure monitors, gastrointestinal tubes, and dental amalgam and other laboratory chemicals. Mercury is also present in some pharmaceutical supplies as vaccines, nasal sprays, and diuretics. Fluorescent lamps, batteries, switches, and thermostats also use mercury.

Despite the more than two-year delay, the Southeast Asian office of Health Care Without Harm (HCWH) commends the DOH for finally coming out with the order. This, says Merci Ferrer, executive director of HCWH-SEA, makes the Philippines the “first in the whole of Southeast Asia — and for that matter the first developing country — to commit to the phase-out of mercury in its healthcare system.”

As part of an international campaign to eliminate mercury in health care globally over the next decade, HCWH-SEA collaborated with the DOH in crafting the administrative order. The global coalition of 473 organizations in more than 50 countries working to protect health by reducing pollution in the healthcare sector has also pledged to work closely with the DOH to provide support to hospitals across the country in their switch to an environment-friendly healthcare system.

It will be recalled that Duque announced in January 2006, on the occasion of the first Southeast Asian Conference on Mercury in Health Care held at the Philippine Heart Center (PHC), the DOH’s commitment to gradually eliminate mercury use in the country’s healthcare system.

If the DOH took time to release the said AO, it was largely because the scope of what the order is trying to address goes beyond the mandate of the health department.

As Engineer Ana Rivera, supervising health program officer of the DOH Environmental and Occupational Health Office, explained then, “we realized that we had to coordinate with partner agencies. Given the scope of the proposed AO, the health department will need the assistance of the Department of Trade and Industry (DTI) in giving accreditation for alternative products based on the criteria that the Bureau of Health Facilities Development will provide.” (see the PCIJ’s 2007 report, There’s Something about Mercury)

As an interim measure, the DOH had to instruct all government-regulated hospitals in Metro Manila to put all mercury thermometers bought for 2008, and whatever orders being planned, on hold.

Yet In the absence of such an AO, more than 50 hospitals in the Philippines have either already begun or expressed intentions of phasing out mercury. These include the Heart Center whose Waste Management Committee was led to seriously consider a phase-out of all mercury devices after hearing Rivera’s account of her personal experience as head of the government response team for the St. Andrew’s School mercury spill in 2006.

At least 24 students, mostly aged 13, of the Parañaque school were hospitalized for mercury poisoning after their exposure to 50 grams of mercury intended for a science experiment. The school was closed for months to give way to the clean-up and decontamination work by local and international experts.

Of these healthcare facilities, HWCH considers the Heart Center and the Manila Adventist Medical Center (MAMC), a 150-bed private hospital, as local pioneers in the switch to mercury-free alternatives. By mid-2006, MAMC successfully replaced all its mercury thermometers and sphygmomanometers. Aside from purchasing non-mercury alternatives, PHC also started training its staff on mercury spill management.

While the DOH acknowledges that the affordability of non-mercury medical devices remains a major issue in the transition to mercury-free healthcare, Rivera says that DOH hospitals will necessarily have to incorporate the budget for non-mercury thermometers in their work and financial plan for 2009, and revise their procurement plan for 2008.

“The costs may be high in the short-term but may be lower in the long-term,” counsels Rivera, arguing that clean-up, disposal and health monitoring costs are much more expensive than buying digital thermometers.

The likes of Engineer Rey Gallarpe, pollution control officer of the San Juan de Dios Hospital, can only agree.

“The non-mercury clinical thermometer (digital type) is almost four times more expensive than the mercury type. But it’s worth considering the cost of materials needed for clean-up and disposal of mercury spill in the event of accidental breakage,” Gallarpe says, noting the very high potential for breakage of the mercury-based thermometer, which requires “shaking down” for almost every use.

“Consider as well the cost of wearing personal protective equipment (PPE) such as face masks and gloves or apron during the clean-up of a spill,” he adds.