30 october 2011 mercury instrument: health aspects carolyn vickers public health and environment...
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30 October 2011
Mercury Instrument: Health Aspects
Carolyn VickersPublic Health and Environment
David WoodImmunization, Vaccines and Biologicals
Mercury Instrument: Health Aspects
Carolyn VickersPublic Health and Environment
David WoodImmunization, Vaccines and Biologicals
30 October 2011
Presentation OutlinePresentation Outline
Role of the health sector in addressing the health impacts of mercury, with some WHO examples
Addressing health in the mercury instrument
INC2 request for information on mercury in pharmaceuticals. UNEP(DTIE)/Hg/INC.3/6 Annex 1: Mercury in human vaccine preservatives
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Role of the health sector in addressing health impacts of mercury
Role of the health sector in addressing health impacts of mercury
1. Providing the health evidence and raising public awareness about the health implications of mercury exposure
2. Setting health-based guidelines and targets for mercury exposure
3. Providing clinical management and educating health workers
4. Reducing health sector use of mercury-added products
5. Working with other sectors in advocating effective health-positive interventions and safer alternatives, with special emphasis on vulnerable populations
6. Sharing knowledge and participating in international mechanisms to solve problems
7. Assessing impacts of policies through monitoring and evaluation
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Health in the mercury instrumentHealth in the mercury instrument
Objective: protect human health and environment by reducing mercury
releases .
In subsistence fishing populations, between 1.5/1000 and 17/1000 children showed cognitive impacts
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Greatest health gains will be made by addressing the main sources of mercury
Greatest health gains will be made by addressing the main sources of mercuryUNEP para 29 study
Coal combustion in power plants and industrial
boilers
Non-ferrous metals
Large scale gold production
Cement production
Waste incineration
Residential heating/other combustion
Pig iron and steel, secondary steel
Mercury production
Artisanal and small-scale gold production
Chlor alkali industry
Other waste
Dental amalgam (cremation)
Other
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Corresponding to these annexes in the draft text
Corresponding to these annexes in the draft text
A. Supply
E. ASGM
F. Emissions
OtherC. Products
D. Manufacturing Processes
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Coal-fired power plantsCoal-fired power plants
Coal consumption has significant detrimental health impacts.
While moving to cleaner energy sources, BAT to reduce mercury emissions must also address other coal pollution, including PM10 which is a major cause of premature death.
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Residential Coal Combustion for Cooking & Heating Improving health through cleaner household energyResidential Coal Combustion for Cooking & Heating Improving health through cleaner household energy
Problem: Incomplete combustion of coal in households for cooking and heating releases indoor high levels of mercury, sulfates, high levels of carbon monoxide and other health damaging pollutants.
Interim solutions for health:
Coal stoves with flues (e.g. chimneys)
Improved coal stoves
Coal processing (e.g. briquetting)
Ultimate solutions for health:
Clean fuels (e.g. Liquefied Petroleum Gas, biogas)
Advanced biomass stoves (e.g. fan-assisted gasifier stoves) where appropriate
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ASGMASGM
17% of emissions to air, plus additional emissions and personal exposures of serious concern
All-hazard industry management practices are needed, to prevent exposure to mercury and other hazards.
Multi-stakeholder approaches, e.g. national Task Force established to address Zamfara lead poisoning outbreak due to ASGM.
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Health sector use of mercury: Dental amalgam
Health sector use of mercury: Dental amalgam
Almost all countries use dental amalgam: Alternatives are more expensive and have technical limitations
WHO 2009 technical meeting, co-supported by UNEP, recommended a phase down be pursued by:
– Promoting disease prevention and alternatives to amalgam
– Research and development of cost-effective alternatives
– Education of dental professionals and raising public awareness
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Mercury thermometers and blood pressure measuring devices (BPMD)
Mercury thermometers and blood pressure measuring devices (BPMD)
Breakage results in exposure of patients, health care workers, etc and creates hazardous waste
WHO recommends use of mercury-free thermometers and BPMD in health-care and domestic settings.
Validated and affordable alternatives are available, including for calibration in clinical setting.
Thermometers are cheaper and have a shorter life than BPMD
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Momentum growing to phase out mercury BPMD and thermometers
Momentum growing to phase out mercury BPMD and thermometers
European Union policy; policies in most U.S. States
WHO-HCWH Global Mercury Free Health Care Initiative reports on developing countries:
– Argentina, Philippines, Chile, Mongolia implementing national policies
– India Central Government Health Services Mercury Phase-Out Guidelines included in Indian Public Health Standard
– Major provinces in South Africa and Brazil phasing-out– Implementation in hospitals in many other countries including:
Costa Rica, China, Ecuador, Indonesia, Lebanon, Mexico, Nepal, Thailand, Nicaragua, Tanzania, Vietnam
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New WHO publications since INC1: see UNEP(DTIE)/Hg/INC.3/INF/4 for complete list
New WHO publications since INC1: see UNEP(DTIE)/Hg/INC.3/INF/4 for complete list
Replacement of mercury thermometers and sphygmomanometers in health care (2011)
Future use of materials for dental restoration (2011)
Estimating the Global Public Health Implications of Electricity and Coal Consumption (2010)
Health in the Green Economy: Household Energy Sector in Developing Countries (2011)
Children's Exposure to Mercury Compounds (2010)
Mercury in skin-lightening products: Fact sheet (2011)
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INC2 request for information on mercury in pharmaceuticals
INC2 request for information on mercury in pharmaceuticals
INC2 “information on mercury use in pharmaceuticals, particularly vaccines.”
Vaccines are already highly regulated (by medical health regulators assessing safety, efficacy and quality of medical products before granting marketing authorization/ registration)
WHO TRS 926 (2004)Thiomersal in Vaccines; regulatory expectations
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Thiomersal containing vaccines and global public health
Thiomersal containing vaccines and global public health
Thiomersal containing vaccines are essential medicines
- used in over 120 countries to immunize at least 64% of global birth cohort each year
- protect against four major killers; diphtheria, tetanus, pertussis, and Haemophilus influenzae type b disease
- estimated to avert at least 1 400 000 child deaths per year
Thiomersal-containing vaccines are also used by developed and developing countries to protect their populations against pandemic (influenza) and epidemic (eg meningitis in Africa) threats
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Thiomersal and vaccine safetyThiomersal and vaccine safety
High-quality population-based studies conducted in several countries since 2000 conclusively show that vaccines that contain thiomersal are very safe
There is no credible scientific evidence that thiomersal-containing vaccines cause autism
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Alternative preservativesAlternative preservatives
There is very little evidence that a range of vaccines can be preserved with alternatives such as 2 phenoxyethanol
Extrapolation from a few examples (such as injected poliovirus vaccines) that all vaccines can be switched to an alternative preservative is not supported by evidence
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Thiomersal-free vaccinesThiomersal-free vaccines
Thiomersal-free vaccines would have to be available in 1 or 2 dose presentations, rather than the 10-dose products currently used by most countries
This would double the cost of vaccines and the global immunization effort; as immunization will need to continue in the long term, this will be an additional cost long into the future
A switch to single-dose vials alone would require more raw materials, more energy for manufacturing processes and transport, and more waste
The environmental impact of thiomersal-free vaccines is not negligible
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International distribution of vaccines
International distribution of vaccines
Vaccines that contain thiomersal are manufactured in no more than 40 countries but used in over 120 countries
Vaccines require import permits to be traded across international borders
The introduction of new provisions on vaccines that contain thiomersal will introduce potential technical barriers to trade which may inhibit access to life-protecting products
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WHO response on the use of thiomersal in human vaccinesWHO response on the use of thiomersal in human vaccines
The amount of mercury involved with thiomersal use in vaccines is very small compared to other sources of mercury
There is no evidence that suggests a possible health hazard with the amounts of thiomersal currently used in human vaccines
WHO recommends multi-dose vaccine vials for routine immunization programmes in many countries because they are safe and effective, they limit the required storage capacity and help reduce vaccine costs
Alternative presentations would incur significantly higher costs in manufacturing procedures and new regulatory approvals, thereby limiting the ability to offer affordable vaccines
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Further InformationFurther Information
WHO INC3 Submission: INC3 website
WHO chemical safety website www.who.int/ipcs/en/
Global Tools for substitutionof mercury thermometers and BPMD in health care.
WHO HCWH project website www.mercuryfreehealthcare.org
WHO Immunization, biologicals and vaccines website: www.who.int/immunization/en/