7 January 2026
A new open-access paper is calling for urgent global, national, and procurement-level reforms to address persistent policy barriers limiting access to needle and syringe programmes (NSPs). This is despite decades of evidence showing their effectiveness in preventing hepatitis C and HIV.
Published in The Lancet Global Health, the paper, Addressing policy barriers to scaling up needle and syringe programmes: a global call to action, is the result of an international working group and policy day convened for our annual Policy Day held in Athens, Greece, in October 2024.
NSPs are among the most effective and cost-effective public health interventions for reducing blood-borne virus transmission among people who inject drugs. Yet global coverage remains critically low. The paper highlights that only two percent of people who inject drugs live in countries with high NSP coverage, while more than half of low- and middle-income countries have no NSP at all.
Led by a multidisciplinary group of researchers, policy makers, programme implementers, procurement specialists, and community-led organisations, the paper applies implementation science approaches to identify six priority barriers and co-design 11 actionable strategies to scale up NSPs globally. These barriers span global funding and policy frameworks, restrictive national regulations, and weak procurement and forecasting systems that result in inadequate and inappropriate supply of sterile injecting equipment.
The work draws directly on a year-long process of multisectoral engagement, including the in-person policy day during our 2024 conference. Participants from all six WHO regions contributed to structured discussions and exercises focused on aligning policy, funding, and procurement systems with the needs and preferences of people who inject drugs.
Among the key findings is the absence of global guidance on community-preferred NSP commodities, leading many countries to procure limited or unsuitable equipment. The paper also identifies restrictive access policies, such as one-for-one syringe exchange rules and identification requirements, as major constraints on coverage, alongside chronic underfunding and political reluctance to prioritise harm reduction.
The authors outline practical actions for global funders, national governments, procurement agencies, programme implementers, community networks, and researchers. These include introducing dedicated NSP budget lines, adopting WHO coverage targets, reforming restrictive access policies, strengthening quantification and forecasting tools, and embedding community leadership in procurement and policy design.
The recent instability in global health funding makes action even more urgent. Without sustained investment and reform, NSPs remain vulnerable to stock-outs, service disruptions, and declining coverage, particularly in low- and middle-income countries.
Scaling up NSPs is not only a public health necessity, but also a human rights obligation. With the evidence, tools, and strategies now clearly articulated, the paper calls on governments, funders, and global institutions to move decisively from evidence to implementation.
The full paper is available open access in The Lancet Global Health.
