Birmingham bin strikes: a threat to public health

The bin workers’ strike in Birmingham – which began on March 11 – is set to continue after the latest pay offer was “overwhelmingly” rejected.

Not only are the growing mountains of refuse unsightly and creating foul odours, they could pose significant threats to local residents’ health. Birmingham city council has declared the situation a “major incident”. This enables council leaders to request extra support from central government.

This is not the first time bins have gone uncollected in the UK, though. Glasgow experienced a major refuse strike in 2021, while Birmingham previously saw significant disruption to refuse collection in 2017.

Internationally, one of the most infamous garbage crises occurred in Naples, Italy, where mismanagement and mafia involvement led to a waste buildup that lasted over a decade. It finally ended in 2008.

Surprisingly, studies on the health effects of the build up of domestic refuse in towns and cities are scarce. The few studies that do exist tend to be in developing countries or in people living close to waste treatment centres.

Several studies have suggested increased deaths, cancer rates and birth defects associated with the Naples garbage crisis. However, these were associated with exposure over several years.

The most comprehensive review that I can find dates back to 1967 before several of the major infectious concerns were even discovered.

Rats

Probably the most apparent danger from the Birmingham crisis is the reported appearance of rats – which some locals have described as being “bigger than cats”.

Rats can transmit several diseases to humans. The infection of most concern is Weil’s disease, which can severely damage the liver and kidneys and can cause neurological problems. It can even be fatal.

This infection is transmitted in rats’ urine and gains entry to the human body through cuts and grazes on the skin. Infections are mostly acquired during immersion in water contaminated by rats’ urine. There have been outbreaks associated with swimming in contaminated water or during flooding.

Another infection is rat bite fever, a bacterial infection acquired following rodent bites. Both these infections are rare but can be fatal if not promptly treated.

Then there is Seoul hantavirus, a viral infection that is mainly caught from breathing in aerosols (fine sprays) of rat urine and faeces. All of these rat-associated infections are quite rare. But even excluding these infections, rat bites can be severe and, like all animal bites, can become infected.

Bacteria

Another worry is stomach bugs such as Salmonella, Campylobacter and E coli, as well as bacteria that are resistant to antibiotics. Wild animals, such as birds and foxes, might tear open bin bags, pick up these germs and then spread them to people through food or water. Even contact with pet dogs or cats can be a risk, since they can carry some of these bacteria.

Seagulls can pick up Salmonella and Campylobacter from waste dumps and then pass that infection onto humans. At least one outbreak of Campylobacter was caused by birds pecking through milk bottle tops.

Flies breed in rubbish and can also spread Campylobacter infections.

Needles

Finally, there is the issue of clinical waste such as needles being inappropriately disposed of in domestic refuse. Such clinical waste could include needles that could cause injury and spread blood-borne viruses, especially HIV and hepatitis B.

Figuring out the likelihood of these harms is not that easy, though. But top of my list of concerns would be sharps injuries from contact with inappropriately discarded clinical waste. I would be particularly concerned about children playing around collections of waste. Bites from rats and other vermin attracted to waste would also be high on my list.

Until the piles of refuse can be removed, children and pets must be kept away from them. If you need to move refuse sacks, make sure you wear a mask, strong gloves and as much protective clothing as possible.

Paul Hunter consults for the World Health Organization and sits on a science advisory committee for Suez. He receives funding from National Institute for Health Research and has received funding from the World Health Organization and the European Regional Development Fund.