A British inventor helped save millions from HIV – now he wants to do it all over again

At the age of 23 Marc Koska came up with an invention credited with saving millions of lives. Forty years later, he thinks he can do it all over again.

The single use auto-disable syringe, designed by Mr Koska in 1987, played a major role in limiting the spread of HIV and other diseases in the decades that followed by dramatically reducing the re-use of dirty needles.

Mr Koska’s design, and others like it, were backed by the World Health Organisation, Unicef and the UNFPA at the turn of the millennium. Since then, he claims, millions of people around the world have been saved from dying as a result of blood borne infections.

More recently, one in five of all the syringes used in the Covid-19 vaccination campaigns around the world were Mr Koska’s design.

Now, he is working on a new, even more ambitious innovation. If it works, he believes that it will go a long way to solving the issue of a chronic lack of access to health care in many parts of the developing world.

The Telegraph visited him in his south London offices, Apilabs, where he explained the next issue he is tackling.

The problem in large swathes around the globe, says Mr Koska, isn’t that there are not enough drugs, but not enough medics to administer them.

In 2021, for example, about 4.5 billion people – more than half of the world’s population – did not have access to essential healthcare. In Sierra Leone, one of the world’s poorest countries, there are only about 22 physicians for every million people.

“We need to get over this doctor and nurse interaction, because it has killed a lot of people; we need to get to the point where people can say ‘all right, I can do this myself,’” he tells The Telegraph.

Mr Koska says the inspiration for his latest invention came to him as a bee flew past his head in the garden.

“That’s how to do it,” he said. “Why don’t we give injections like a bee? They carry around a measured dose, they’ve got a stinger, they’ve got everything built in.”

The new syringe is called Apiject (Api being Latin for ‘bee’), and like the previous one is single use and can be used for any injectable medicine. However, he has designed a revolutionary new way of preloading these self-injecting syringes with the medication required, so that they can be more effectively mass produced.

“You can take this home because it’s pre filled,” says Mr Koska, holding a row of single Blow-Fill-Seal containers, also used for eye drops. 

Self-injectable syringes are already common for products including blood thinners, weight loss drugs such as Ozempic, and other injections which patients have to take daily.

However, they are not easy to produce meaning they are only economically viable in the west and even then, only for a limited number of injectable products.

Reinventing the wheel

Where Mr Koska believes he has made a breakthrough is in the manufacturing process, patenting a mechanism for safely attaching needles to the soft plastic vials used in a mechanism called Blow Fill Seal (BFS).

The process, he says, will help make disposable self-injecting syringes available to people all around the world and for the vast majority of medicines, while also reducing the potential for product exposure and contamination.

“If there is another pandemic, we can start manufacturing overnight, as soon as the [vaccine] drug is approved,” he says. “This is a much simpler process that gives us a much faster reaction time to demand.”

The new system can fill and seal 25 syringes in one continuous motion that takes just a second. It can fill up to 30,000 units in an hour, 15 million units a month and 180 million units a year, says Mr Koska.

It means that should 10,000 injections suddenly be needed to stop an outbreak of Mpox from bubbling over, the vials could be quickly manufactured and used in the premade syringes, before being rapidly distributed to those who need it. A process that Mr Koska says could be done in days rather than months.

Because the process also does away with the need for glass ampules, it will also be “much greener” than the traditional manufacturing process.

He has also done away with the delicate and potentially lethal business of carefully loading the device from a glass ampule.

“Nearly every drug recall in the world is because of glass delamination,” says Mr Koska.

Glass delamination can occur in drug containers when the glass surface breaks down and sheds thin flakes into the solution, which can be costly for manufacturers.

The syringes and the process for filling them can be used with any drug, with only the disposable vials which sit within the syringe changing depending on the necessary injection.

“We are on the edge of that transition,” says Mr Koska. “When that transition happens, it will make manufacturing cheaper, it’s going to be faster to get the equipment, and [companies] will have less risk in taking it on….that’s a world apart, that’s a completely different industry.”

Mr Koska pulls out a thick book and begins to flick through the pages containing designs of the “roughly 200 patents” that ApiLabs have filed in the past two years, spanning multiple methods of injection: intravenous, intramuscular, subcutaneous and intradermal.

“These are some of the drawings and ideas that we’ve come up with,” he says enthusiastically. “Whether it’s for high-end cancer drugs in America, essential drugs delivery during war, or immunisation campaigns in Africa.”

The crisp white walls of his Apiject ‘lab’ – more resembling a modern hipster coworking space – are plastered with intricate sketches of their creations.

Mr Koska ushers me over to the office’s back wall, which is covered with mounted plastic containers detailing a visual timeline of syringes from the mid 19th-century to his latest inventions. At the end is an empty plastic box with a laminated note that reads: “2024 – coming to a future near you!”

His latest jab will “complete the portfolio,” said Mr Koska. “They’re all ready to go to the next stage.”

He is aiming to once again transform the face of global healthcare. Not all great ideas can be pushed over the line, and the jury’s still out on this one, but the inventor from East Sussex has a record of persistence. 

Mr Koska’s story is four decades in the making. In 1984, he was a long-haired, 23-year-old public school graduate, struggling to find his calling in life. 

Avoiding university because he “didn’t see any value in it”, he instead headed for the Caribbean, where he took up sailing and eventually found himself building models of murder scenes for lawyers in the region to use in court. “That was really emboldening, because I was doing something with my hands which made a difference,” he recalled.

Mr Koska’s path took a turn when, as the world reeled from the outbreak of the HIV epidemic, he was “stopped in [his] tracks” by an article predicting that the reuse of syringes, along with sexual contact, would be an unstoppable force in the spread of the disease.

“How can HIV be spread by the thing that’s meant to be making people better? That’s like saying cars kill more people than they transport,” he said. Within “one minute,” he knew he had found his calling.

He immediately returned to England and spent three years doing what amounted to a self-taught degree in syringe manufacturing. Until one day he woke up and drew the design that became the final product.

But Mr Koska’s invention was at first met with derision and pushback. Manufacturers and global governments, entrenched in their ways and fearful to stray from the status quo, didn’t want to listen to the emphatic Englishman with a big idea. 

It was 14 years before he had his breakthrough. In 2001, Unicef (the UN’s children fund) bought 20 billion syringes for their child immunisation programme, igniting a global boom that has only continued to flourish. He was later awarded an OBE in 2006 for his contribution to global healthcare.

‘Things are starting to accelerate’

Now, the launch of Mr Koska’s latest invention is beginning to gain pace. 

Apiject has already racked up a hefty $250 million (£189 million) in investments – $100m (£75,000) from private investors and the US government has poured in several grants totalling $150m (£114 million) for Apiject to lead pandemic preparedness research.

“They’re all ready to go to the next stage,” he says. “The next step is licensing. We already have a lot of machines that make [BFS containers].”

“We’re talking to companies and customers on every continent, but there are some early movers…when something like a new malaria vaccine comes up…our attention pricks. We wonder if that’s something, if there’s an opportunity to launch,” he added.

“You’re going from an established manufacturing base to a new one…so [manufacturers] have got to re-equip and at that point, those are one opportunity that we have.” 

Mr Koska said that they are “very close” to putting the design into practise. “Within [the next] two years. Definitely,” he says.

“The end result is the possibility of safer injections for everyone everywhere. I think that if I can prove, deliver and execute the possibility, it’s then up to the world,” says Mr Koska. 

“If even 10 per cent of the world changed to this system, we would save millions of lives a month…It’s laying the blueprint, because it may take longer than I’ve got to deliver it,” he adds.

“Things are happening at a different pace now. In the last couple of months, [compared to] the last five years. All these things are starting to accelerate…I think we can smell the coffee.”

Protect yourself and your family by learning more about Global Health Security