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360 www.thelancet.com Vol 381 February 2, 2013
World Report
organisers of the Kiev conference.
IARCs published response to therequests that it avoid the conference
makes a passing reference to IARCs
decision to collaborate with the SRIOH
on a study of cancer in chrysotileworkers in Asbest, Russia, the full
title of which is: Historical cohort study
of cancer mortality following exposureto chrysotile asbestos at the Uralasbest
plant in Asbest, Russian Federation. The
lead author on this paper is Evgeny
Kovalevskiy, and it is IARCs decisionto work with Kovalevskiy and the
SRIOH in particular that has given rise
to the gravest concerns within WHO,and the most vehement criticism
from outside the organisation.
In a letter to IARCs Director-
General Wild signed by RichardLemen (retired US Assistant Surgeon
General and adjunct professor at
the Rollins School of Public Health,Emory University, Atlanta, GA, USA),
Arthur Frank (Drexel University
School of Public Health, Philadelphia,PA, USA), and Barry Castleman
(author of Asbestos Medical and Legal
Aspects), the authors argue thatKovalevskiy is a leading promoter of
use of chrysotile asbestos. He testified
before the Supreme Court of Brazil
in August 2012, as witness on behalfof the Brazilian Chrysotile Institute.
He testified that there is no evidence
whatsoever to justify banning theuse of chrysotile asbestos; that he
opposes placing chrysotile asbestos
on the Rotterdam Conventions List
of Hazardous Substances; that, in thepast, harm to health was caused by
the use of amphibole asbestos and
excessive, prolonged exposure levelsto chrysotile asbestos, but that, today,
chrysotile asbestos is causing no harm
to health in Russia. We consider that it
is unacceptable that a scientist, who isa promoter of chrysotile asbestos use,
should be a lead scientist on an IARC
research project regarding chrysotileasbestos.
The authors then go on to point
out that several years ago, WHODirector-General Margaret Chan
withdrew the SRIOHs designation as
a WHO collaborating centre because
of its promotion of continued useof chrysotile asbestos and conflicts
of interest endangering WHOscredibility. According to IARCs
Gaudin, the request to consider the
study first came to IARC from Russian
scientists, who approached IARCshortly after the offi cial signature of
a Memorandum of Understanding
between IARC and the RussianFederation in 2007. The Lancet
understands that the request was
supported by the Russian member of
IARCs Governing Council. 2007 wasthe year that the Russian Federation
resumed financial contributions
to IARC, including full payment ofarrears, after what Gaudin terms an
interruption in assessed financial
contributions dating back to the
early 1990s. However, Gaudin assertsthat the study on the quantitative
cancer risks of chrysotile in Russia (in
Asbest) was not discussed during thesessions of the Governing Council,
and was not a condition of the
resumption of participation [in IARC]
or financial contributions by theRussian Federation.
The timing of both IARCs atten-
dance at the conference andthe decision to collaborate with
Kovalevskiy and the SRIOH is especially
sensitive, coming as it does on the eveof the sixth meeting of the Conference
of the Parties to the Rotterdam
Convention, which will take place
in April. Among other things, theconference will discuss the proposed
listing of chrysotile asbestos in
Annex III of the Convention (panel 2).All other forms of asbestos are already
listed, and were chrysotile to be listed,
exporters would need to obtain prior
informed consent from importingstates, and take steps to ensure that
importing governments are able to
assess adequately the risks posed bythe chrysotile in a local context. It will
be the fourth time that the listing of
chrysotile has been considered and, as
before, there is expected to be strong
Panel :The shifting burden of chrysotile
Asbestos minerals have been prized for centuries for their ability to withstand heatand mechanical and chemical damage, and were most widely used as additives in
construction materials throughout the 20th century, particularly in the post-war
construction boom in developed countries. However, mounting evidence of the
carcinogenicity of asbestos led to the banning of amosite and crocidolite from the
1980s onwards in many developed economies, followed by bans on chrysotile
throughout the 1990s and the early part of this century. Now, more than
50 countries ban the use of all forms of asbestos, including the entire European
Union, and a de-facto ban exists in many other countries such as the USA and
Canada. Almost all of the worldwide consumption of asbestos is now concentrated
in developing economies. According to United States Geological Survey figures, just
over two-thirds of the worlds asbestos consumption is accounted for by the rapidly
developing BRIC nations: China (30% of world consumption), India (15%), Russia
(12%), and Brazil (9%).
Measuring the exact burden of disease caused by asbestos is notoriously diffi cult, inpart because of the often long time lag between exposure and the onset of the
disease, and in part because of problems with the diagnosis and coding of cases. As a
result, most surveys are likely to underestimate the number of cases of asbestos-
related disease. Nevertheless, WHO estimates that over 107 000 people die each year
from asbestos-related lung cancer, mesothelioma, and asbestosis from occupational
exposure alone, with the figure likely to be far higher once environmental exposures
are taken into account. WHO also estimates that 125 million people in the world are
still exposed to asbestos at the workplace, although the monitoring of the use of
asbestos is almost non-existent in many of the countries that still allow its use.
For the Rotterdam
Conventions Annex IIIsee
http://www.pic.int/
TheConvention/Chemicals/
AnnexIIIChemicals/tabid/1132/
language/en-US/Default.aspx
For more on Canadas role in the
global asbestos tradesee
World ReportLancet 2010;
376:197374
For WHOs fact sheet on
asbestos see h ttp://www.who.
int/mediacentre/factsheets/
fs343/en/index.html
For the reporton the WHO
European regions 2010 Parma
summitsee World Report
Lancet 2010; 375:969
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World Report
www.thelancet.com Vol 381 February 2, 2013 361
opposition from parties aligned with
the asbestos industry.
The listing of chrysotile wasfirst proposed in 2006, after a
comprehensive review of evidence bythe Rotterdam Conventions Chemical
Review Committee (CRC), composed
of 31 scientists nominated by various
countries. At that time, Canada wasone of the largest producers and
exporters of chrysotile in the world,
despite operating a de-facto ban ondomestic usage, and was the largest
producer with the power to veto the
listing of chrysotile in Annex III; Russia
was only an observer state at thattime. The Canadian representative
exercised the veto, with the support
of Kyrgyzstan, Iran, India, Ukraine,and Peru, and chrysotile became the
first and only substance to have been
recommended for listing in Annex IIIby the Conventions CRC to be blocked
by parties to the conference. It has
remained in that state of limbo ever
since.At the most recent Conference
of the Parties in 2011, the parties
seemed on the cusp of consensusafter Kazakhstan, Kyrgyzstan, Ukraine,
India, and Vietnam (with Russia again
an observer) reversed their initial
opposition to the listing of chrysotileduring the course of negotiations.
But in a move widely condemned
at the time, just as agreement wasimminent, the Canadian delegation,
which had until that point been silent,
stood and declared that although
they had no disagreement with thescientific case for listing chrysotile in
Annex III, they would nevertheless
oppose its listing. The Canadianparty offered no justification for their
opposition and the listing of chrysotile
was again blocked, this time with
Canada as the sole dissenting voice.As of late 2012, Canada is no longer
in the asbestos business, after the
incoming Quebec Premier PaulineMarois cancelled a US$50 million
government loan originally intended
to reopen the Jeffrey asbestos mine,and pledged to put the money toward
economic diversification in the area.
As a direct result, Canada reversed
its position and announced that itwould no longer oppose the listing
of chrysotile in Annex III. However,in 2013 Russia will, for the first time,
have the power to veto chrysotiles
listing, and campaigners argue
that the Kiev conference and IARCcollaboration are key planks in its
ongoing strategy to legitimise its
opposition to the listing.The Kiev conference came out of
an initiative to destroy the Rotterdam
Convention, says Kathleen Ruff, a
Canadian human rights campaignerand senior adviser to the Rideau
Institutean independent research
and advocacy organisation based inOttawa. In 2011, those opposing
the listing said they wanted a new
conference to look at the modern
data to counteract the ChemicalReview Committees ruling. Kiev
is the result. It is not a bona fide
conference, its a sham conference, aweapon to undermine the integrity
of science, and its about more
than chrysotile now, its about the
gutting of a UN convention. Theconsensus statement issued after
the Kiev conference concludes that
in the light of data presented inthe conference, participants of the
conference are of the opinion that
under the current circumstances, theissue of including (or not including)
chrysotile in Annex III to the
Rotterdam Convention is premature.
Although IARC is at pains to make itclear that it was not involved in the
discussion of the resolution, and was
not a signatory to it, the fact thatIARC attended the conference lends it
a veneer of respectability, says Ruff.
According to a WHO source who
wished to remain anonymous,recent manoeuvres by the Russian
asbestos industry are just the latest
in a decades-long campaign to resistinternational pressure for tighter
controls on asbestos, using tactics
that owe a great deal to the tobacco
industry. On WHOs fact sheet on
asbestos, the organisation says thatit recognises the most effi cient
way to eliminate asbestos-related
diseases is to stop the use of all typesof asbestos. And yet on the same
page, it states that with Resolution
60.26, the World Health Assembly
requested WHO to carry out a globalcampaign for the elimination of
asbestos-related diseases bearing
in mind a differentiated approach toregulating its various formsin line
with the relevant international legalinstruments and the latest evidence
for effective interventions. Thatfinal clause was inserted at the last
minute, without any previous
international negotiation afterRussia and its allies threatened to
block the whole resolution, the
source says. In 2010, The Lancet
reported in these pages on theRussian veto of a proposed asbestos
ban at WHOs European region
summit in Parma, Italy, where Russia
also staged a last minute attemptto derail an agreement among
all members to beef up European
health and environment planningpowers. Kovalevskiy was part of the
Russian delegation at the time, and
told The Lancet that NGOs in theprocess might not be really non-
governmental, but acting as stooges
for some government.
David Holmes
A chrysotile asbestos quarry in Sverdlov, Russia
RiaNovosti/SciencePhotoLibrary