The pandemic of COVID-19 and its implications for the purity and authenticity of alcohol-based hand sanitizers: The health risks associated with falsified sanitizers and recommendations for regulatory and public health bodies.

With the beginning of the pandemic of COVID-19 throughout the world, the demand and consumption of hand sanitizers has increased, which had led to a sharp crunch in these products at all levels. This shortage has led to an increase in the prevalence of falsified alcohol-based hand sanitizers, including the illegal addition of methanol to hand sanitizers and the production of hand sanitizers with an alcohol concentration of less than 60%. These findings indicate that regulatory and public health bodies should take an active role in ensuring the safety and quality of antimicrobial products such as alcohol-based hand sanitizers at every stage of the products' lifecycle, including distribution, manufacture and import.

The emergence of novel virus strains has always posed a serious challenge for the global community. Severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2, more commonly and simply known as coronavirus and the cause of COVID-19, first emerged at the close of 2019 in Wuhan, a city in Central China. Sufferers may be asymptomatic or suffer mild to life-threatening respiratory symptoms. In mid-March 2020, the disease's spread across the globe was such that the World Health Organization (WHO) officially labelled the COVID-19 outbreak a pandemic. To control the spread of the virus, it is essential to implement strict preventative measures, including repeated hand-washing with water and soap.

In healthcare settings and within communities, alcohol-based hand sanitizers are a popular alternative to washing one's hands with water and soap. In the context of the COVID-19 pandemic, routine use of hand sanitizer is a favoured method of cleaning one's hands and stopping the spread of infection. , A range of sanitizers is available, but alcohol-based sanitizers are the most effective and enjoy a higher rate of compliance for use in healthcare contexts. Made with n-propyl alcohol, isopropyl alcohol, ethanol, or a combination of alcohol types, these sanitizers are also less irritating to the skin and can be applied quickly. , Given the popularity of hand sanitizers and their importance in preventing the spread of COVID-19, falsified alcohol-based sanitizers pose a significant public health risk.

There are two key types of falsified alcohol-based hand sanitizers: 1) sanitizers that contain methanol, an additive that would typically not be listed as an ingredient; and 2) sanitizers with an alcohol content below 60%. First, methanol should not be used in hand sanitizers because it is highly toxic and can cause severe reactions when exposed to the skin, lungs or mouth. Exposure to methanol can result in systemic toxicity and, in some cases, death.8, 9, 10, 11, 12, 13, 14 The substance's elevated intrinsic toxicity, its ready availability and its widespread use make poisoning from undeclared methanol in hand sanitisers an important public health concern. Second, a hand sanitizer that contains less than 60% alcohol would be ineffective as a germicide and offer users no biocidal effect, leaving the public vulnerable to contracting and spreading COVID-19.

Recently, inspections to authenticate antimicrobial product safety (including alcohol-based hand sanitizers available locally) have been carried out by the Dubai Municipality. In this safety survey, 6 of the 102 alcohol-based hand sanitizers tested were found to contain undeclared/unlisted methanol, while others were found to have an alcohol content of less than 60% despite their labels claiming an alcohol content of 70%.

The above discussion identifies falsified alcohol-based hand sanitizer as a serious public health risk, especially in the context of the outbreak of COVID-19. The popularity of alcohol-based sanitizers in healthcare and community settings coupled with the risk of methanol poisoning and ineffective hand antisepsis posed by falsified sanitizers demands a response. It is recommended that regulatory and public health bodies take an active role in ensuring the safety and quality of antimicrobial products such as alcohol-based hand sanitizers at every stage of the products’ lifecycle, including distribution, manufacture and import. Specifically, the following recommendations are made:

The introduction of regulatory and monitoring mechanisms throughout the manufacturing process to verify the purity of alcohol-based hand sanitizers.

The use of good manufacturing practice (GMP), research, reporting (of usage and any adverse effects), education and regulatory control to increase inspection and oversight of alcohol-based hand sanitizers' quality and safety.