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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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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