The Indian government issued a mandate

The Indian government issued a mandate in 2008 for the use of AD syringes in all government health facilities, for both curative and immunising purposes.¹⁰⁴ Despite the phasing out of sterilizable and disposable syringes by some international organizations and governments, both continue to be used instead of AD syringes.¹⁰⁵ The most recent study found the percentage of non-industrialised countries using AD syringes for routine immunisation had increased since the previous study to 62 percent. However, exclusive use of AD syringes was still low at 38 percent.¹⁰⁶ Sterilizable syringes rely on the safe practice of the user, which can fluctuate in response to other factors. For example, sterilization may be overlooked during busy periods, such as mass vaccination campaigns, or when access to resources is limited, such as fuel to boil water.

Medical waste is routinely collected for resale.

Unsafe practices such as only rinsing needles between vaccinations have been recorded. For example in Gudamb, India, a rural health worker who carried out such a procedure stated, "for sterilization we are supposed to carry kerosene and a cooking stove with us... but for six months there has been no kerosene supply... for me, immunizing the children is a bigger priority".¹⁰⁷ Disposable syringes can also be reused and generate large amounts of waste, which often fuels the demand for cheap injection equipment and can be associated with the transmission of HIV.

However, AD syringes are safe irrespective of the environment they are being used in and only cost 2 cents more than traditional syringes (since they were first introduced, the cost of AD syringes has declined from US15 cents to US6 cents).^{108 109} UNICEF mass vaccination campaigns can vaccinate an estimated 10 million children in one week and they use only AD syringes.¹¹⁰

Waste disposal is a problem if correct facilities are not in place (incinerators) - but AD syringes cannot be collected and sold for reuse. Access to AD devices in remote areas may be problematic. However, if governments accept the need for injection safety and AD syringes become readily available, it is likely that the disposal of and access to AD syringes will cease to be a problem - as will HIV transmission through injections.

Whereas the reuse of medical equipment occurs predominantly in developing countries, healthcare facilities in developed countries are still not 100 percent risk averse, despite the overall high level of conformity to safety guidelines. In 2008, a health clinic in Las Vegas in the United States was closed following evidence that syringes were being reused and equipment used for colonoscopies was not being cleaned between patients. ^{111 112} This resulted in 40,000 people requiring tests for HIV, hepatitis C and B.¹¹³ The CDC campaign slogan "One Needle, One Syringe, Only One Time" is aimed at health workers in America to raise awareness of the importance of new equipment.11