PFAS the ‘Forever Chemicals’ Invisible threats from persistent chemicals

A CHEM Trust Briefing September 2019 @CHEMTrust 1 Executive summary

The chemical industry manufactures tens of thousands of synthetic chemicals, and some of them can persist in the environment for generations. One example is the PFAS (Per- and polyfluorinated alkyl substances), sometimes called ‘forever chemicals’; a family of over 4,ooo highly fluorinated substances.

People and wildlife are exposed to hundreds of PFAS simultaneously from various environmental routes, including drinking water, and via consumer products. Some have proven toxicity, and others haven’t yet been properly studied, but they may well turn out to be toxic once they are properly assessed.

PFAS are also extremely mobile in the environment and are already found in the most remote areas. And because they are virtually impossible to clean up once they have been released, they will go on accumulating in the environment, exposing future generations and wildlife in every corner of the globe.

We must urgently stop emissions of these highly persistent chemicals that are already undermining the health of both humans and wildlife.

Key messages: PFAS are highly persistent and are contaminating the world • PFAS are in everyday products from non-stick pans to coats. • They persist in the environment and some PFAS are known to impact on the effectiveness of children’s immune response to vaccines.

Government action needed • The UK and other governments must act faster to phase out all PFAS, in collaboration with the EU and through global agreements. • The UK and other governments must ensure that the environment is monitored for a wide range of PFAS chemicals. • Governments should work towards new, protective regulation of all highly persistent man-made chemicals.

Industry responsibility • Companies should immediately work to phase out PFAS chemicals, replacing them with safer, non-PFAS alternatives.

Individual action • When shopping, ask for and choose PFAS-free products, for example -free waterproof goods and cosmetics.

2 chemtrust.org Table of contents

Executive summary 2

Introduction 4

PFAS – A family of over 4,000 flourinated chemicals 5

PFAS are in everyday products 5

PFAS have concerning properties 6

P for Persistent 6 B for Bioaccumulative 6 M for Mobile 7 T for Toxic 7

Global exposure of people and wildlife to PFAS 8

Sources of PFAS contamination 8 Contamination is global 8 How do we come in contact with PFAS? 8 PFAS transfer from the mother to the baby 9

The inadequacies of PFAS regulation 9

There are over 4,000 PFAS, but only a handful are currently regulated 9 Regrettable substitution: replacing one problematic chemical with another problematic one 9

Conclusion 10

‘Forever chemicals’ - global contamination affecting future generations 10

What can we do? 11

1) Urge your government to push for stronger global regulation of PFAS 11 2) Urge your government to act nationally 11 3) Ask retailers to stop using PFAS in products 11 4) Reduce your own and children’s exposure 11

References 12

@CHEMTrust 3 Introduction We are surrounded by thousands of man-made chemicals in the products we use every day. They usually serve a function, from flame retardants in furniture and electronics, to stain repellents in clothes or UV filters in cosmetics. Many man- made chemicals are not hazardous to human health and the environment, but some are. These chemicals can go on to contaminate the environment via multiple routes, and some will not break down easily. This leads to lasting pollution, just like with and . But unlike plastic debris floating at the surface of the ocean, chemicals are invisible. This means that hazardous chemicals, and the threat they pose to humans and wildlife, easily escape our perception of pollution. Man-made chemicals that don’t degrade easily in the environment are known as persistent chemicals. Some of them, such as (CFCs) and Polychlorinated biphenyls (PCBs), are infamously known for the large-scale environmental damage they have caused. CFCs are responsible for the destruction of ozone in the stratosphere, while bioaccumulative# and toxic PCBs are responsible, among other things, for jeopardising the survival of killer whale populations around the world1. In both cases, the adverse impacts of these chemicals were discovered decades after mass production started. And because they are highly persistent and extremely hard to remove from the environment, we are still dealing with the negative impacts decades after they have been banned2. High persistence becomes a particular issue when unforeseen adverse effects are demonstrated long after a chemical has been put on the market. In such a scenario it will not be possible to quickly reverse the negative effects, putting the health of future generations at potential risk. This briefing highlights the case of a lesser known group of highly persistent chemicals, PFAS, also known as the ‘forever chemicals’. CHEM Trust is concerned that this group of chemicals could lead to a situation similar to those described above if urgent action, such as a global ban, is not taken. This briefing summarises the current scientific knowledge on this chemical group and the evidence behind these concerns (including the knowledge gaps). We also recommend actions that must be taken to better protect people and wildlife from these chemicals.

# Bioaccumulative chemicals become more concentrated in our bodies over time as they accumulate.

4 chemtrust.org PFAS: A family of over 4,000 fluorinated chemicals Per- and polyfluorinated alkyl substances – abbreviated as PFAS# – are a family of highly fluorinated man-made chemicals that don’t occur in nature. It is a large chemical family with 4,730 identified to date, but more are being identified all the time3. They share the characteristic of having carbon atoms linked to fluorine atoms4. These carbon-fluorine groups can be linked to a wide variety of other chemical groups in various patterns. Some PFAS are made of long-chains of carbon-fluorine groups (long- chain PFAS), others of shorter-chains (short-chain PFAS). Some are made of repetitions of these chains forming polymers. A well-known example of a PFAS plastic polymer is – PTFE – a better known under its trade name TeflonTM – a household name in non-stick cookware. PFAS are in everyday products Since their introduction in the 1940s, PFAS have been used in an increasingly wide range of applications due to the special properties given by their carbon-fluorine bond. PFAS are extremely stable chemicals, they resist high temperature and degradation and most notably, they repel both grease and water. Waterproof coats, swimsuits, non-stick pans and the greaseproof paper around takeaways chips, are just a few of the common uses of PFAS in everyday items. PFAS are also used in cosmetic products such as sunscreen, foundation, hair moisturiser; as coatings for smartphones or on solar panels; as cleaning agents in floor polish and car care products. In non-consumer products they are used in electronics, aviation, oil production and mining and even in some pesticides. Their use in fire-fighting-foams, including in training exercises and to extinguish liquid fires, such as petroleum fires is particularly concerning. This leads to direct emissions into the environment and accounts for a third of global PFAS production5.

# In the past, PFAS were often referred to as PFCs (per-and polyfluorinated chemicals), but this denomination is not in use anymore to avoid confusion with the narrower group of chemicals, the perfluorocarbons.

@CHEMTrust 5 PFAS have concerning properties P for Persistent The carbon-fluorine bond which makes PFAS so useful in a wide range of applications is also what makes PFAS so persistent. This bond is one of the strongest bonds known in nature6, making PFAS extremely resistant to degradation in the natural environment (in the water, the soil, the air, our bodies). To be destroyed, they have to be incinerated at temperatures above 1,100°C7. The persistence of a chemical is described by its half-life – the The half-lives of some PFAS time it takes for the concentration of a chemical in a medium polymers is >1,000 years (water, soil, human body) under certain conditions to have in soil” decreased by 50%. This is not an easily quantifiable parameter and the half-life of all the 4,730+ PFAS is not known. However, for some PFAS polymers, half-lives of over 1,000 years in soil have been estimated8,9 whilst half-life greater than 40 years in water have been estimated for some non-polymeric PFAS10. However, scientists reported that almost no signs of degradation were noticeable during the experiment11. Some PFAS chemicals degrade faster, but their degradation products often include other highly persistent PFAS12. For some perspective on persistence, the criteria for very persistent chemicals in the EU chemical regulation# is a half-life of more than 60 days in water and 180 days in sediments or soil13. The extreme persistence of PFAS is why they are called ‘forever chemicals’. B for Bioaccumulative Bioaccumulative chemicals can build up in the human body and in wildlife because they are absorbed by the organism and are not excreted, becoming more and more concentrated higher up the food chain. PFAS are unusual because they bind to proteins, e.g. in blood14; most bioaccumulative chemicals (for example PCBs) accumulate in fatty tissues. Not all organisms will process PFAS in the same way – differences have been shown between sexes and between species, and because of their varying structure not all PFAS will behave in the same way. For instance, in humans, long-chain PFAS are slowly eliminated, on the scale of years (e.g. PFHxS≠ has a half-life in blood of up to 8.5 years15) and tend to accumulate in protein rich compartments like blood, liver, kidney and bones. In contrast, short-chain PFAS are eliminated more quickly (e.g. PFBS± has a half-life in blood of 26 days16) and appear to accumulate in different organs and tissues such as the lungs, kidneys and the brain17. We know less about PFAS behaviour in wildlife, but there are concerning reports of their bioaccumulation in water birds, wild boars, polar bears, and dolphins18-20.

# REACH for: Registration, Evaluation, Authorisation & restriction of Chemicals, is the EU chemical regulation. ≠ perfluorohexane-1-sulphonic acid ± Perfluorobutanesulfonic acid

6 chemtrust.org M for Mobile Due to the high water solubility of PFAS and the fact that they tend not to bind to many materials, they are extremely mobile in the environment. This is especially the case for the short-chain ones. This means that they migrate quickly through soil, leaching into groundwater21. PFAS can also easily pass through normal drinking water treatment facilities and contaminate drinking water22-24. In addition to migration from soil to ground water, short-chain PFAS can also migrate from the soil to plants and have been shown to accumulate in edible parts of fruits and vegetables like strawberries and lettuce25. T for Toxic PFAS can be toxic to humans and wildlife. The most striking evidence of harm from human exposure to the long-chain PFAS PFOA# comes from the results of an epidemiological study of almost 70,000 people in the context of a lawsuit against DuPont chemical company in the US in 2001. The science panel of the C8≠ Medical Monitoring Program identified a probable link between PFOA exposure and diagnosed high cholesterol, ulcerative colitis, thyroid disease, testicular and kidney cancer and pregnancy-induced hypertension26. Another important study, in the Faroe Islands, found that Many of the thousands of children exposed to higher levels of PFAS during development PFAS in use are lacking had a reduced immune response to routine tetanus vaccination27. toxicological data.” Many of the thousands of PFAS in use are lacking toxicological data, which is of great concern; especially as the well-studied ones, which are mostly long-chain, have been shown to be: • Endocrine disruptors: they interfere with the hormonal system (e.g. contributing to obesity28; associated with thyroid disease29); • Reprotoxic: they impact on reproductive functions in adults and the development of the foetus (e.g. reduced birthweight30; reduced sperm quality31; delayed puberty32,33; early menopause34); • Immunotoxic: they affect the immune system (e.g. reduced response to vaccine in children27); • Possibly carcinogenic: they promote the development of certain cancers (e.g. kidney and testicular cancer35). Less data is available on the toxicity of PFAS to wildlife. However, the available studies show that chronic exposure to PFAS could affect20: • the brain, reproductive system and hormonal system of polar bears; • the immune system and kidney and liver functions of bottlenose dolphins; • the immune system of sea otters.

# ≠ C8 is another appellation for PFOA relating to its 8 carbon atoms.

@CHEMTrust 7 Global exposure of people and wildlife to PFAS Sources of PFAS contamination Contamination of the environment by PFAS occurs throughout the whole life cycle: at the manufacturing stage, during use and via disposal of products containing PFAS. They can also enter the environment indirectly when related chemicals degrade into PFAS7. These parent chemicals are called PFAS precursors. Higher contamination rates of the local environment are PFAS have been found in the correlated with the proximity of industrial sites using PFAS bloodstream of wildlife and (e.g. PTFE manufacturing, the paper and textile industry), and people from all around the the dispersion of PFAS-containing fire-fighting foams at major airports, military sites, or landfills36. However, not all PFAS world.” contamination can be explained by industrial activity, waste disposal or accidental release. PFAS have been detected in some rivers unconnected to PFAS manufacturing sites (e.g. the River Thames37), which indicates emissions from widespread (diffuse) sources. These diffuse sources include consumer products38, e.g. PFAS can be released into the water system from washing stain resistant school uniforms impregnated with PFAS39, or when PFAS-containing hair conditioners are rinsed off in the shower40. Contamination is global Very worryingly, highly persistent PFAS and their precursors contaminate the entire planet. They cause large-scale drinking water contamination in the US41 and have been found in European waters including the UK11. PFAS and their precursors can be transported over very long distances from their source of emission to remote and pristine locations via oceanic and atmospheric currents and precipitations36. They are present in the Arctic, the Antarctic and at high-altitude areas36. Ultimately, ocean waters are likely to be the largest reservoir of PFAS with the deep ocean seafloor as the final sink42,43. How do we come in contact with PFAS? PFAS have been found in the bloodstream of wildlife (e.g. polar bears, harbour porpoise and harbour seals, dolphins, and whales20) and people from all around the world44-46 as well as in breastmilk47. Wildlife is exposed to PFAS mainly via contaminated water, air and food7. In addition to environmental exposure, including through drinking water48-50, people are exposed to PFAS through food, cosmetics, clothes and household dust51-53. Regarding food, there are two types of exposures: The first is related to the migration of PFAS from certain types of food packaging (e.g. greaseproof paper) into the food54. Fast- food is believed to be the main route of exposure in this case55. The second route is when food is already contaminated by PFAS. Highly mobile, short-chain PFAS, have been found in vegetables such as celery and tomatoes grown in contaminated soils56. Another exposure route identified in the US comes via contaminated milk due to farm animals feeding on grass contaminated by PFAS derived from sewage sludge which has been spread on fields57. Finally, a major source of exposure via food is through the consumption of seafood41.

8 chemtrust.org PFAS transfer from the mother to the baby PFAS can transfer via the placenta during development in the womb, and via breast milk58-60. One study in Norway found that the daily PFOA intake of a 6-month-old breastfed infant is 15 times the intake of adults61. However, a Spanish study which measured concentrations of PFAS in breast milk, formula milk and baby food found PFAS in all samples tested62. Even though it is known that breast milk is one route by which bioaccumulative chemicals from the mother are transferred to the baby, breast feeding of babies is acknowledged to be the best option for their health63. The same process of PFAS transfer from the mother to the baby has been identified for several marine species including whales, seals, dolphins and killer whales20. The inadequacies of PFAS regulation There are over 4,000 PFAS, but only a handful are currently regulated Many PFAS are recognised as PBT (Persistent, Bioaccumulative and Toxic). These properties, along with the fact that they have potential for long-range transport, means that they fulfil the criteria for the global treaty regulating persistent organic pollutants (POPs), the Stockholm Convention (2001)64. This is the convention that regulates and bans the most harmful and worrying chemicals in the world. However, among the several thousands of PFAS currently in use, only PFOS# and PFOA are globally regulated64. Regrettable substitution: replacing one problematic chemical with another problematic one In response to regulatory pressure, the strategy adopted by the industry has been to substitute the regulated PFAS with unregulated ones, especially short-chain PFAS65. The good news is that concentrations of legacy PFAS are decreasing in the environment, people and wildlife, but unfortunately concentrations of newer PFAS are rising20,36,41. The industry claims that the alternative PFAS are ‘safer’66 but the truth is that environmental and toxicological data are often lacking for these emerging PFAS67,68. Recent studies are starting to reveal that some alternative PFAS could be as toxic as the ones they replace14,69,70 and could equally become dispersed worldwide71. This untenable situation has led scientists and experts to raise the alarm through a series of statements72-74. Over 200 scientists signed the Madrid Statement in 2015 calling “on the international community to cooperate in limiting the production and use of PFASs and in Among the several developing safer nonfluorinated alternatives”73. thousands of PFAS currently in use, only PFOS and PFOA are globally regulated.”

# Perfluorooctane sulfonic acid

@CHEMTrust 9 Conclusion ‘Forever chemicals’ – global contamination affecting future generations People and wildlife are exposed to hundreds of PFAS simultaneously from various environmental routes, including drinking water, and via consumer products. Some have proven toxicity, and many haven’t yet been properly studied, but they may well turn out to be toxic when the analysis is done. The special carbon-fluorine The cost of inaction on PFAS structure of PFAS mean that “these are the most persistent chemicals we are facing today”75 according to Dr. Zhanyun Wang has been estimated at 67 €52 – €84 billion annually for of the ETH Zürich, a leading scientist in the field . the EEA.” High persistence of PFAS means that the past and continuous production and use of PFAS will lead to a build-up in the global environment. The clean-up of PFAS in contaminated sites is extremely challenging5 at best and impossible when it comes to the vast ocean. Because of their extreme persistence, they will last decades or centuries, even after emissions have ended, exposing future generations and wildlife in every corner of the globe. Not acting on highly persistent and harmful chemicals also has an economic cost to society. The cost of inaction on PFAS has recently been estimated at €52 - €84 billion annually for health-related costs for all countries of the European Economic Area and at €46 million - €11 billion annually for environment-related costs for the European Nordic countries76. It is unknown what consequences will arise from the global exposure of people and wildlife to increasing level of PFAS, but lessons learnt from the past77,78 tell us not to wait decades to see what happens, and to urgently stop emissions of these highly persistent chemicals that may well undermine the health of both humans and wildlife. It’s time that governments around the world moved to phase out these chemicals, while companies should stop using them and move to safer, non-fluorinated alternatives.

10 chemtrust.org What can we do? Individuals and organisations can help to build the pressure for these chemicals to be phased out. Here are some ideas: 1) Urge your government to push for stronger global regulation of PFAS PFAS are global contaminants and have the potential to be transported far from their source of emission, therefore they need to be regulated at global level. The Stockholm Convention is the global treaty best suited to regulate PFAS, but it is not currently strong enough. Any government that is part of the Convention, such as the UK, could help change this. Write to your MP and/or to the Environment Minister (Secretary of State for the Environment in the UK), calling for your government to push for stronger global rules, in particular: • A grouping approach in the regulation of PFAS. The Stockholm Convention is too slow at the moment as it regulates one type of PFAS at a time (PFOS and related compounds in 200964; PFOA and related compounds ten years later in 201979). Adopting a grouping approach to regulate PFAS as a class would accelerate regulation processes, prevent regrettable substitution80, stop the building up of these highly persistent chemicals in the environment and better protect people and wildlife. • Push for stronger regulation of all highly persistent man-made chemicals. The current framework does not regulate chemicals just on their high persistence alone. In CHEM Trust’s view, high persistence should be sufficient criteria for stringent regulation of these chemicals. 2) Urge your government to act nationally • Ask your government to add PFAS (legacy and emerging PFAS) to monitoring programs. For instance, PFAS are currently not part of the contaminants monitored in the context of the UK Marine Strategy81. The exact scale of the PFAS contamination is not known in the UK and Europe in general because there is currently no comprehensive PFAS monitoring in EU waters11. These data are crucial to inform risk management policies. • Ask your government to be proactive in addressing the PFAS issue by banning PFAS in consumer products. Denmark is preparing a national ban on all PFAS in paper and cardboard used in food contact materials by July 202082. 3) Ask retailers to stop using PFAS in products Retailers should follow the steps of Kingfisher (owner of B&Q and Screwfix in the UK) who announced a phase-out on PFAS in their own-brand products by 202583. 4) Reduce your own and children’s exposure Here are some recommendations to reduce your exposure to PFAS via everyday products: Food: Avoid PFAS coated non-stick cookware, favour non-coated stainless-steel pans. Limit your consumption of fast-food that could have been in contact with PFAS impregnated greaseproof paper or cardboard. Textiles: PFAS are used to waterproof outdoor clothes and tents but fluorine-free alternative exists, check for PFAS- or PFC-free labels. PFAS are also used to provide stain resistance to a wide range of textiles including school uniforms, carpets and furniture. Be wary of stain resistant labels and visit the PFASfree website hosted by the Scottish NGO FIDRA for PFAS-free school uniforms options. Cosmetics: PFAS can be present in cosmetics, check the ingredient list to avoid product containing chemicals with “fluoro” or PTFE in their name. Also avoid dental floss with PTFE coatings.

@CHEMTrust 11 References 1. Desforges, J.P., 2018. Predicting global killer whale population collapse from PCB pollution. Science, 361(6409), pp. 1373-1376. https://doi.org/10.1126/science.aat1953 2. Cousins, I.T. et al., 2019. Why is high persistence alone a major cause of concern? Environmental Science: Processes & Impacts, 21, pp. 781-792. http://doi.org/10.1039/C8EM00515J 3. OECD, 2018. Toward a new comprehensive global database of per-and polyfluoroalkyl substances (PFASs): summary report on updating the OECD 2007 list of per-and polyfluoroalkyl substances (PFASs). Series on Risk Management No. 39 http://www.oecd.org/officialdocuments/publicdisplaydocumentpdf/?cote=E NV-JM-MONO(2018)7&doclanguage=en 4. Buck, R.C. et al., 2011. Perfluoroalkyl and polyfluoroalkyl substances in the environment: terminology, classification, and origins. Integrated Environmental Assessment and Management, 7, 4, pp. 513–41. https://doi.org/10.1002/ieam.258 5. IPEN, 2019. Stockholm Convention COP-9 White Paper: The Global PFAS Problem: Fluorine-Free Alternatives As Solutions. 120p. https://ipen.org/sites/default/ files/documents/the_global_pfas_problem-v1_5_final_18_april.pdf 6. Siegemund, G. et al., 2016. , Organic. Ullmann’s Encyclopedia of Industrial Chemistry. Weinheim, Germany: Wiley-VCH Verlag GmbH & Co. KGaA https://doi.org/10.1002/14356007.a11_349.pub2 7. OECD, 2013. Synthesis paper on per- and polyfluorinated chemicals (PFCs). OECD/ UNEP Global PFC Group. Environment, Health and Safety, Environment Directorate, OECD Publishing, Paris, France. 60p. https://www.oecd.org/env/ehs/risk-management/PFC_FINAL-Web.pdf 8. Russell, M.H. et al., 2008. Investigation of the biodegradation potential of a fluoroacrylate polymer product in aerobic soils. Environmental Science & Technology, 42, 3, pp. 800-807. https://doi.org/10.1021/es0710499 9. Washington, J.W. et al., 2009. Degradability of an acrylate-linked, fluorotelomer polymer in soil. Environmental Science & Technology, 43, 17, pp. 6617-6623. https://doi.org/10.1021/es9002668 10. UNEP, 2006. Perfluorooctane Sulfonate Risk Profile. Adopted by the Persistent Organic Pollutants Review Committee at its second meeting. November 2006. UNEP/POPS/POPRC.2/17/Add.5 http://chm.pops.int/Implementation/ IndustrialPOPs/PFOS/Overview/tabid/5221/Default.aspx 11. Goldenman, G. et al., 2017. Study for the strategy for a non-toxic environment of the 7th EAP. Sub-study d: Very Persistent Chemicals. Milieu Ltd, Brussels, 123 p. http://ec.europa.eu/environment/chemicals/non-toxic/pdf/Sub-study%20d%20 very%20persistent%20subst.%20NTE%20final.pdf 12. Wang, Z. et al., 2015. Hazard assessment of fluorinated alternatives to long- chain perfluoroalkyl acids (PFAAs) and their precursors: status quo, ongoing challenges and possible solutions. Environment International, 75, pp. 172–179. https://doi.org/10.1016/j.envint.2014.11.013 13. ECHA, 2017. Guidance on Information Requirements and Chemical Safety Assessment. Part C: PBT/vPvB assessment. Version 3.0. 22p. https://echa. europa.eu/documents/10162/13643/information_requirements_part_c_en.pdf

12 chemtrust.org 14. Gomis, M.I. et al., 2018. Comparing the toxic potency in vivo of long-chain perfluoroalkyl acids and fluorinated alternatives. Environment International, 113, pp. 1–9. https://doi.org/10.1016/j.envint.2018.01.011 15. Olsen, G. W. et al., 2007. Half-life of serum elimination of perfluorooctanesulfonate, perfluorohexanesulfonate, and perfluorooctanoate in retired fluorochemical production workers. Environmental Health Perspectives, 115, 9, pp. 1298-1305. https://doi.org/10.1289/ehp.10009 16. Olsen, G.W. et al., 2009. A comparison of the pharmacokinetics of perfluorobutanesulfonate (PFBS) in rats, monkeys, and humans. Toxicology, 256, 1-2, pp. 65-74. http://doi.org/10.1016/j.tox.2008.11.008 17. Pérez, F. et al., 2013. Accumulation of perfluoroalkyl substances in human tissues. Environment International, 59, pp. 354– 62. https://doi.org/10.1016/j.envint.2013.06.004 18. Vierke, L. et al., 2012. Perfluorooctanic acid (PFOA) – main concerns and regulatory developments in Europe from an environmental point of view. Environmental Sciences Europe, 24:16. https://doi.org/10.1186/2190-4715-24-16 19. Walker, L.A., et al., 2015. (PFC) concentrations in northern gannet eggs 1977-2014: a Predatory Bird Monitoring Scheme (PBMS) report. Centre for Ecology & Hydrology, Lancaster, UK. 18pp. https://pbms.ceh.ac.uk/ sites/default/files/PBMS_Gannet_PFCs_report_2013.pdf 20. Fair, P.A. and Houde, M., 2018. Chapter 5 - Poly- and Perfluoroalkyl Substances in Marine Mammals. Marine Mammals Ecotoxicology. Impacts of Multiple Stressors on Population Health. pp. 117-145. https://doi.org/10.1016/B978-0-12-812144-3.00005-X 21. Gellrich, V. et al., 2012. Behavior of perfluorinated compounds in soils during leaching experiments. Chemosphere, 87, 9, pp. 1052-1056. https://doi.org/10.1016/j.chemosphere.2012.02.011 22. Sun, M. et al., 2016. Legacy and emerging perfluoroalkyl substances are important drinking water contaminants in the Cape Fear River Watershed of North Carolina. Environmental Science & Technology Letters, 3, 12, pp. 415–419, https://doi.org/10.1021/acs.estlett.6b00398 23. Kaboré, H.A. et al., 2017. Worldwide drinking water occurrence and levels of newly-identified perfluoroalkyl and polyfluoroalkyl substances. Science of the Total Environment, 616-617, pp. 1089-1100. https://doi.org/10.1016/j. scitotenv.2017.10.210 24. Brendel, S. et al., 2018. Short-chain perfluoroalkyl acids: environmental concerns and a regulatory strategy under REACH. Environmental Science Europe, 30:9. https://doi.org/10.1186/s12302-018-0134-4 25. Blaine, A.C. et al., 2014. Perfluoroalkyl acid uptake in lettuce (Lactuca sativa) and strawberry (Fragaria ananassa) irrigated with reclaimed water. Environmental science & technology, 48, 24, pp. 14361-14368. https://doi.org/10.1021/es504150h 26. C8 Medical Monitoring Program. http://www.c-8medicalmonitoringprogram.com 27. Grandjean, P. et al., 2012. Serum vaccine antibody concentrations in children exposed to perfluorinated compounds. (Clinical report). JAMA: the Journal of the American Medical Association, 307, 4, pp. 391-397. https://doi.org/10.1001/jama.2011.2034

@CHEMTrust 13 28. Halldorsson, T.I. et al., 2012. Prenatal Exposure to Perfluorooctanoate and Risk of Overweight at 20 Years of Age: A Prospective Cohort Study. Environmental Health Perspectives, 120, pp. 668– 673. https://doi.org/10.1289/ehp.1104034 29. Kim, M.J. et al., 2018. Association between perfluoroalkyl substances exposure and thyroid function in adults: A meta-analysis. PloS one, 13(5), p.e0197244. https://doi.org/10.1371/journal.pone.0197244 30. Fei, C. et al., 2007. Perfluorinated Chemicals and Fetal Growth: A Study within the Danish National Birth Cohort. Environmental health perspectives, 115, 11, pp. 1677-1682. https://doi.org/10.1289/ehp.10506 31. Vested, A. et al., 2014. Persistent organic pollutants and male reproductive health. Asian Journal of Andrology, 16, 1, pp. 71-80. https://doi.org/10.4103/1008-682X.122345 32. Lopez-Espinosa, M.-J. et al., 2011. Association of Perfluorooctanoic Acid (PFOA) and Perfluorooctane Sulfonate (PFOS) with age of puberty among children living near a chemical plant. Environmental Science & Technology, 45, 19, pp. 8160−8166. https://doi.org/10.1021/es1038694 33. Kristensen, S.L. et al., 2013. Long-term effects of prenatal exposure to perfluoroalkyl substances on female reproduction. Human Reproduction, 28, 12, pp. 3337−3348. https://doi.org/10.1093/humrep/det382 34. Taylor, K.W. et al., 2013. Evaluation of the Association between Persistent Organic Pollutants (POPs) and Diabetes in Epidemiological Studies: A National Toxicology Program Workshop Review. Environmental Health Perspectives, 121, 7, pp. 774-783. https://doi.org/10.1289/ehp.1205502 35. IARC, 2016. Perfluorooctanoic acid. IARC monographs on the identification of carcinogenic hazards to humans. Monograph 110, 74p. https://monographs.iarc.fr/wp-content/uploads/2018/06/mono110-01.pdf 36. OECD, 2015. Working Towards a Global Emission Inventory of PFASs: Focus on PFCAs-Status Quo and the Way Forward. OECD/UNEP Global PFC Group. Environment, Health and Safety, Environment Directorate, OECD Publishing, Paris, France. 85p. https://www.oecd.org/chemicalsafety/risk-management/ Working%20Towards%20a%20Global%20Emission%20Inventory%20of%20 PFASS.pdf 37. Pan, Y. et al, 2018. Worldwide Distribution of Novel Perfluoroether Carboxylic and Sulfonic Acids in Surface Water. Environmental Science & Technology, 52, 14, pp. 7621-7629. https://doi.org/10.1021/acs.est.8b00829 38. Ahrens, L., 2011. Polyfluoroalkyl compounds in the aquatic environment: a review of their occurrence and fate. Journal of environmental monitoring, 13, 1, pp. 20-31. https://doi.org/10.1039/c0em00373e 39. PFASfree.org https://www.pfasfree.org.uk 40. The Danish Environmental Protection Agency, 2018. Risk assessment of fluorinated substances in cosmetic products. 118 p. https://www2.mst.dk/Udgiv/ publications/2018/10/978-87-93710-94-8.pdf 41. Sunderland, E.M., et al., 2019. A review of the pathways of human exposure to poly- and perfluoroalkyl substances (PFASs) and present understanding of health effects. Journal of Exposure Science & Environmental Epidemiology, 29, 2, pp. 131-147. https://doi.org/10.1038/s41370-018-0094-1 42. Prevedouros, K. et al., 2006. Sources, fate and transport of perfluorocarboxylates. Environmental Science & Technology, 40, 1, pp. 32–44. https://doi.org/10.1021/es0512475

14 chemtrust.org 43. Cousins, I.T., Kong, D. and Vestergren, R., 2011. Reconciling measurement and modelling studies of the sources and fate of perfluorinated carboxylates. Environmental Chemistry, 8, pp. 339–354. https://doi.org/10.1071/EN10144 44. Hansen, K.J. et al., 2001. Compound-specific, quantitative characterization of organic fluorochemicals in biological matrices. Environmental Science & Technology, 35, 4, pp. 766–770. https://doi.org/10.1021/es001489z 45. Vestergren, R. and Cousins, I.T., 2009. Tracking the pathways of human exposure to perfluorocarboxylates. Environmental Science & Technology, 43, 15, pp. 5565- 5575. https://doi.org/10.1021/es900228k 46. Ye, X. et al. 2018. Per- and polyfluoroalkyl substances in sera from children 3 to 11 years of age participating in the national health and nutrition examination survey 2013-2014. International journal of hygiene and environmental health, 221, pp. 9-16. https://doi.org/10.1016/j.ijheh.2017.09.011 47. Macheka-Tendenguwo, L.R. et al., 2018. Per-and polyfluoroalkyl substances in human breast milk and current analytical methods. Environmental Science and Pollution Research, 25, 36, pp. 36064-36086. https://doi.org/10.1007/s11356-018-3483-z 48. Eschauzier, C. et al., 2012. Impact of Treatment Processes on the Removal of Perfluoroalkyl Acids from the Drinking Water Production Chain. Environmental Science & Technology, 46, 3, pp. 1708-1715. https://doi.org/10.1021/es201662b 49. Post, G.B., Cohn, P.D. and Cooper, K.R., 2012. Perfluorooctanoic acid (PFOA), an emerging drinking water contaminant: A critical review of recent literature. Environmental research, 116, pp. 93-117. https://doi.org/10.1016/j.envres.2012.03.007 50. Rahman, M.F., Peldszus, S. and Anderson, W.B., 2014. Behaviour and fate of perfluoroalkyl and polyfluoroalkyl substances (PFASs) in drinking water treatment: A review. Water research, 50, pp. 318-340. https://doi.org/10.1016/j.watres.2013.10.045 51. Tittlemier, S.A. et al., 2007. Dietary Exposure of Canadians to Perfluorinated Carboxylates and Perfluorooctane Sulfonate via Consumption of Meat, Fish, Fast Foods, and Food Items Prepared in Their Packaging. Journal of Agricultural and Food Chemistry, 55, 8, pp. 3203-3210. https://doi.org/10.1021/jf0634045 52. Björklund, J.A., Thuresson, K. and De Wit, C.A., 2009. Perfluoroalkyl compounds (PFCs) in indoor dust: concentrations, human exposure estimates, and sources. Environmental science & technology, 43, 7, pp. 2276-81. https://doi.org/10.1021/es803201a 53. Schultes, L. et al., 2018. Per-and polyfluoroalkyl substances and fluorine mass balance in cosmetic products from the Swedish market: implications for environmental emissions and human exposure. Environmental Science: Processes & Impacts, 20, 12, pp. 1680-1690. https://doi.org/10.1039/C8EM00368H 54. Begley, T.H. et al., 2008. Migration of fluorochemical paper additives from food- contact paper into foods and food simulants. Food additives & contaminants. Part A. Chemistry, analysis, control, exposure & risk assessment, 25, 3, pp. 384-390. https://doi.org/10.1080/02652030701513784 55. Trier, X. et al., 2017. PFAS in paper and board for food contact -options for risk management of poly- and perfluorinated substances. Copenhagen K, Denmark: Nordic Council of Ministers. TemaNord; No. 573, Vol. 2017. https://core.ac.uk/download/pdf/13673878.pdf

@CHEMTrust 15 56. Mengelers, M. J. B. et al., 2017. Risicobeoordeling van GenX en PFOA in moestuingewassen in Dordrecht, Papendrecht en Sliedrecht. Bilthoven. (abstract in English) https://www.rivm.nl/publicaties/risicobeoordeling-van-genx-en- pfoa-in-moestuingewassen-in-dordrecht-papendrecht-en 57. Valdmanis, R. and Schneyer, J., 2019. The curious case of tainted milk from a Maine dairy farm. Reuters, 19 March 2019. https://www.reuters.com/article/us-usa- dairy-chemicals/the-curious-case-of-tainted-milk-from-a-maine-dairy-farm- idUSKCN1R01AJ 58. Fromme, H. et al., 2010. Pre- and postnatal exposure to perfluorinated compounds (PFCs). Environmental Science & Technology, 44, pp. 7123–7129. https://doi.org/10.1021/es101184f 59. Thomsen, C. et al., 2010. Changes in concentrations of perfluorinated compounds, polybrominated diphenyl ethers, and polychlorinated biphenyls in Norwegian breast-milk during twelve months of lactation. Environmental Science & Technology, 44, pp. 9550 –9556. http://doi.org/10.1021/es200682w 60. Gützkow, K. B. et al., 2012. Placental transfer of perfluorinated compounds is selective--a Norwegian Mother and Child sub-cohort study. International Journal of Hygiene and Environmental Health, 215, pp. 216–219. https://doi.org/10.1016/j.ijheh.2011.08.011 61. Haug, L. S. et al., 2011. Characterisation of human exposure pathways to perfluorinated compounds--comparing exposure estimates with biomarkers of exposure. Environment International, 37, pp. 687–693. https://doi.org/10.1016/j.envint.2011.01.011 62. Lorenzo, M., et al., 2016. Perfluoroalkyl substances in breast milk, infant formula and baby food from Valencian community (Spain). Environmental Nanotechnology, Monitoring & Management, 6, pp. 108-115. https://doi.org/10.1016/j.enmm.2016.09.001 63. World Health Organization. Nutrition. Breastfeeding. https://www.who.int/nutrition/topics/exclusive_breastfeeding/en 64. UNEP, Stockholm Convention. All POPs listed in the Stockholm Convention. http:// chm.pops.int/TheConvention/ThePOPs/AllPOPs/tabid/2509/Default.aspx 65. Wang, Z. et al., 2013. Fluorinated alternatives to long-chain perfluoroalkyl carboxylic acids (PFCAs), perfluoroalkane sulfonic acids (PFSAs) and their potential precursors. Environment International, 60, pp. 242–248. https://doi.org/10.1016/j.envint.2013.08.021 66. ENVIRON International Corporation, 2014. Assessment of POP Criteria for Specific Short-Chain Perfluorinated Alkyl Substances. FluoroCouncil, Washington, DC, 144p. https://fluorocouncil.com/wp-content/uploads/2017/03/ENVIRON- Assessment-of-POP-Criteria-Resources-1.pdf 67. Wang, Z. et al., 2017. A never-ending story of per- and polyfluoroalkyl substances (PFASs)? Environmental Science & Technology, 51, 5, pp. 2508–2518. https://doi.org/10.1021/acs.est.6b04806 68. Patlewicz, G. et al., 2019. A Chemical Category-Based Prioritization Approach for Selecting 75 Per- and Polyfluoroalkyl Substances (PFAS) for Tiered Toxicity and Toxicokinetic Testing. Environmental Health Perspectives, 127, 1. https://doi.org/10.1289/EHP4555 69. Wang, Z. et al., 2016. Comparative assessment of the environmental hazards of and exposure to perfluoroalkyl phosphonic and phosphinic acids (PFPAs and PFPiAs): current knowledge, gaps, challenges and research needs. Environment International, 89–90, pp. 235–247. https://doi.org/10.1016/j.envint.2016.01.023

16 chemtrust.org 70. Cheng, W. and Ng, C.A., 2018. Predicting Relative Protein Affinity of Novel Per- and Polyfluoroalkyl Substances (PFASs) by An Efficient Molecular Dynamics Approach Environmental Science & Technology, 52, 14, pp. 7972–7980. https://doi.org/10.1021/acs.est.8b01268 71. Gomis, M.I. et al., 2014. A modeling assessment of the physicochemical properties and environmental fate of emerging and novel per- and polyfluoroalkyl substances. Science of the Total Environment, 505, 1, pp. 981–991. https://doi.org/10.1016/j.scitotenv.2014.10.062 72. Scheringer, M. et al., 2014. Helsingør Statement on poly-and perfluorinated alkyl substances (PFASs). Chemosphere, 114, pp. 337-339. https://doi.org/10.1016/j.chemosphere.2014.05.044 73. Blum, A., et al., 2015. The Madrid statement on poly-and perfluoroalkyl substances (PFASs). Environmental health perspectives, 123, 5, pp. A107-A111. https://doi.org/10.1289/ehp.1509934 74. Ritscher, A. et al., 2018. Zürich statement on future actions on per-and polyfluoroalkyl substances (PFASs). Environmental health perspectives, 126, 8, p.084502. https://doi.org/10.1289/EHP4158 75. Lim, X., 2019. Tainted water: the scientists tracing thousands of fluorinated chemicals in our environment. Nature news features, 06 February 2019. https://www.nature.com/articles/d41586-019-00441-1?fbclid=IwAR36Bnl6PEhj lWWhN26MflvvXwdb16jDpJSFKBpNDKrwPJ2-Qv6-MUYc67I 76. Goldenman, G. et al., 2019. A socioeconomic analysis of environmental and health impacts linked to exposure to PFAS. TemaNord, ISSN 0908-6692 ; 2019:516. http://dx.doi.org/10.6027/TN2019-516 77. EEA, 2001. Late Lessons from Early Warnings: The Precautionary Principle 1896- 2000. European Environment Agency, Copenhagen. https://www.eea.europa. eu/publications/environmental_issue_report_2001_22 78. EEA, 2013. EEA, Late lessons from early warnings II: Science, precaution, innovation. European Environment Agency, 2013. https://www.eea.europa.eu/publications/late-lessons-2 79. Bloomberg Environment, 2019. UN Chemical Regulators Approve PFOA Ban, With Exemptions. 3 May 2019. https://news.bloombergenvironment.com/environment-and-energy/un- chemical-regulators-approve-pfoa-ban-with-exemptions 80. CHEM Trust, 2018. From BPA to BPZ: a toxic soup? How companies switch from a known hazardous chemical to one with similar properties, and how regulators could stop them. 46p. https://chemtrust.org/toxicsoup/ 81. CHEM Trust, 2019. UK Government must act now to protect UK seas from chemical pollution. https://chemtrust.org/uk-act-now-protect-seas/ 82. Food Packaging Forum, 2019. Denmark to ban PFAS in paper & board in 2020. 3 September 2019. https://www.foodpackagingforum.org/news/denmark-to-ban- pfas-in-paper-board-in-2020 83. Kingfisher, 2019. Kingfisher pledges to phase out three chemical families from its supply chain. Press release, 23 January 2019. https://www.kingfisher.com/en/ media/news/sustainability-news/2019/kingfisher-pledges-to-phase-out-three- chemical-families-from-its.html

@CHEMTrust 17 Written by Dr Julie Schneider, July 2019 This briefing was produced by CHEM Trust, a charity working at UK, EU and International level to protect humans and wildlife from harmful chemicals. CHEM Trust’s particular concerns are endocrine disrupting chemicals, the cocktail effect of chemicals and the role of chemical exposures in the early life of wildlife and humans. CHEM Trust engages with scientific, environmental, medical and policy communities to improve the dialogue concerning the role of adverse effects of chemicals in wildlife and humans and to harness a wide coalition to drive improved chemicals policy and regulation. For more about our work, including our regularly-updated blog, see chemtrust.org Further copies of this briefing can be downloaded from chemtrust.org/PFASbrief @CHEMTrust This briefing should be cited as: CHEM Trust, 2019. PFAS – the ‘forever chemicals’, Invisible threats from persistent chemicals. A CHEM Trust briefing. This briefing was designed by Deborah Thompson www.debthompsondesign.com

Photo credits Cover photos: clockwise from top left: Burger and fries with greaseproof paper: Free-photos/Pixabay; Fire fighters using : Benedict Rottmann/Pixabay; Non-stick frying pan: Leo_65/Pixabay; Seals: skeeze/Pixabay; Waterproof coat: Jose Soriano/Unsplash; Mother and baby: Monkey Business Images/ Shutterstock; Sea otter: Kirsten Wahlquist/Shutterstock; Dolphins: joakant/Pixabay Page 4: Dolphins underwater: Free-photos/Pixabay Page 5: Clockwise from top to bottom: Non-stick frying pan: Leo_65/Pixabay; Burger and fries with greaseproof paper: Free-photos/Pixabay; Waterproof coat: Jose Soriano/Unsplash; Fire fighters using firefighting foam: benerott/Pixabay; Man applying sunscreen: Creative Family/Shutterstock Page 6: Northern Gannets: suju-foto/Pixabay Page 7: From top to bottom: Drinking water: sonsart/Shutterstock; Sea otter: Kirsten Wahlquist/Shutterstock Page 8: Girl eating fish: Chubykin Arkady/Shutterstock Page 9: From top to bottom: seals: skeeze/Pixabay; Mother and baby: Monkey Business Images/Shutterstock Page 10: Girls drinking water: Pezibear/Pixabay