Adverse Health Effects Caused by Paraquat
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Report | February 2017 Adverse health effects caused by paraquat A bibliography of documented evidence FOREWORD BY THE PUBLISHERS 3 SUMMARY: ADVERSE HEALTH EFFECTS CAUSED BY PARAQUAT 5 1 OCCUPATIONAL AND ACCIDENTAL EXPOSURE TO PARAQUAT 7 1.1 – Synopsis: Acute health effects 7 1.2 – Acute poisoning and fatalities – occupational or accidental exposure 8 1.3 – Skin irritation and burns; skin absorption 19 1.4 – Eye injury and impaired sight 20 1.5 – Exacerbation of respiratory related illness 21 1.6 – Inadequate diagnostics and absence of treatment 21 2 CHRONIC HEALTH EFFECTS OF PARAQUAT 24 2.1 – Synopsis 24 2.2 – Parkinson’s disease 25 2.3 – Dermal toxicity and dermatitis 34 2.4 – Impaired lung function 35 2.5 – Depression related to exposure to pesticides, including paraquat 36 2.6 – Immunotoxicity and genotoxicity/cancer 37 2.7 – Reproductive toxicity and kidney damage 38 3 SELF-HARM AND PARAQUAT – PREVENTIVE ACTION URGENT 39 3.1 – Synopsis 39 3.2 – Global prevalence 40 3.3 – Africa 40 3.4 – Asia 41 3.5 – Europe 47 3.6 – Middle East 48 3.7 – South America 48 3.8 – Studies on self harm/suicides and pesticides (paraquat not directly specified) 49 4 LIMITED WORKER PROTECTION IN AGRICULTURE 51 4.1 – Synopsis: Absence of effective protection for workers 51 4.2 – Unintentional exposure of handlers to paraquat 51 4.3 – Practical limitations of personal protective equipment 54 5 BIBLIOGRAPHY ON PARAQUAT AND PESTICIDE POISONING 56 5.1 – International organizations and national agencies 56 5.2 – Non-governmental organizations (publications sorted by year) 57 5.3 – Scientific publications – 2010 to 2015 59 5.4 – Scientific publications – before 2010 71 ENDNOTES 81 PUBLISHERS 87 IMPRINT Poisoning and adverse health effects caused by paraquat among agricultural workers and the public – A bibliography of documented evidence – February 2017 | PUBLISHERS Public Eye, Pesticide Action Network UK and Pesticide Action Network Asia-Pacific | COMPILED BY RICHARD ISENRING | WITH ACKNOWLEDGEMENT TO Barbara Dinham, François Meienberg, Laurent Gaberell and Stephanie Williamson | PHOTO COVER © Adobe Stock | LAYOUT Karin Hutter ADVERSE HEALTH EFFECTS CAUSED BY PARAQUAT | February 2017 3 Foreword by the publishers In 1985, the Pesticide Action Network launched the global Dirty Dozen Campaign. It was the first global effort of PAN International to take action on some of the most harmful pesticides – including paraquat. Fourteen years ago, the Berne Declaration (today Public Eye) launched its campaign calling for Syngenta to stop selling its herbicide paraquat. Paraquat is now banned in over 40 countries, including in the European Union and Switzerland, Syngenta’s home country, because of its adverse health effects. Paraquat was recently banned in Serbia, South Korea, Togo and Zimbabwe. In March 2016, the US Environmental Protection Agency announced its proposal to further restrict the use of paraquat and, among other measures, prohibit application from hand-held and backpack equipment as well as to restrict the use to certified pesticide applicators only. In addition, many labelling organisations such as the Fair Trade Inter national, the Forest Stewardship Council, the Rainforest Alliance, and food corporations like Chiquita, or retailers like Migros and Coop in Switzerland, have all volun- tarily prohibited paraquat. Yet paraquat is still the third most widely used herbicide in the world. Syngenta continues to sell it in many developing countries, where its safe use has proven to be impossible. And still too many people die – or are severly injured – each year because of paraquat poisoning. Paraquat is highly toxic and there is no antidote. One small accidental sip can be fatal. Paraquat is about 28 times more acutely toxic than glyphosate. Acute poisoning may occur through contact with skin, eyes, or via inhalation. There is now also increasing evidence that chronic exposure to paraquat is linked with adverse effects, for example, on the respiratory system, in reproductive problems, and increased risk for Parkinson’s disease. Agricultural workers and farmers are regularly exposed to this toxic substance during handling and mix- ing, spraying and working in recently sprayed fields. As the UN’s Food & Agriculture Organisation has demonstrated, training in proper pesticide use is not a solution for risks associated with the use of highly hazardous products such as paraquat. Users in developing countries often do not have access to the required Personal Protective Equipment (PPE). Moreover, expecting users to wear full protective clothing in warm and humid climates is unrealistic. And even in the European Union, where PPE is widely available and used, paraquat was considered too dangerous for users and therefore banned. Safe use of paraquat in developing countries is simply not happening on the ground. We have provided numerous reports with evidence of that. Just to mention our latest reports, in 2015 we published together with a NGO coalition two reports1 on conditions of paraquat 4 ADVERSE HEALTH EFFECTS CAUSED BY PARAQUAT | February 2017 use in India in which we documented that: most workers and farmers apply paraquat without any personal protective equipment and have never received any training; in some places paraquat is sold in plastic carrying bags; many users cannot read the label; it is mixed with other ingredients that are not recommended; it is sprayed with leaking knapsack sprayers; it is applied on crops for which its use has not been approved; and containers are re-used for drinking water. This literature review updates the scientific information provided in the report Paraquat, Unacceptable risks for users, published by the Berne Declaration, Pesticide Action Network Asia Pacific and Pesticide Action Network UK in its third edition in 20112. Therefore this report provides first of all an update on literature published since 2011. While older studies referenced in the 2011 report are not mentioned again, several studies published before 2011 but not cited in the 2011 report are now included. We would like to warmly thank the author of this report, Richard Isenring, for his excellent work and commitment and especially Barbara Dinham for her active support. As this new report shows, evidence of the negative health effects of paraquat and its link with chronic diseases, such as Parkinson’s disease or cancer is increasing. This report also clearly documents the positive health effects in countries that have implemented a ban on paraquat, or stricter regulations. As the report clearly shows, the case for a global phase out of paraquat is stronger today than ever. Laurent Gaberell, Public Eye, Sarojeni Rengam, PANAP, and Stephanie Williamson, PAN UK, February 2017 ADVERSE HEALTH EFFECTS CAUSED BY PARAQUAT | February 2017 5 Summary: Adverse health effects caused by paraquat Paraquat is very toxic to workers applying the chemical, on an Additionally, a very high number of pesticide occupational poi- acute basis. In many countries paraquat remains the pesticide sonings are not reported, especially those occurring in rural ar- active ingredient responsible for more fatal poisonings than any eas. Although the available data is limited, a large proportion of other pesticide substance. The EU has banned paraquat as the paraquat poisonings occurs from accidental intake and through potential exposure of workers is considered too high. Even occupational exposure. For example, in Burkina Faso, of 922 when workers wear personal protective equipment (PPE) as re- pesticide poisoning cases reported between 2002 and 2010, quired, exposure to pesticides during spraying cannot be elimi- 53 % were non-intentional, and 19 % occurred during agricultur- nated. Eye injuries from spill or splashes can result in impaired al work (UNEP & FAO 2010). sight. Exposure of skin to the diluted product or concentrate Instructions on the product label can be difficult to under- will cause irritation or skin burn and this leads to an increased stand and may be inadequate. In many countries the necessary absorption. Exposure can also occur through inhalation or in- protection is not available or affordable. In hot and humid cli- gestion. No antidote is available. mates it is difficult or impracticable to wear the correct PPE. A Chronic exposure can have adverse effects on the respirato- FAO study in Burkina Faso (2010) found that less than 1 % of ry system, e.g. reduced lung function. Workers who are exposed farmers use the personal protective equipment recommended. to paraquat over a longer period have been found to be at an Another study in Ghana found that virtually no farmers use all increased risk of developing Parkinson’s disease later in life. the recommended equipment (NPAS 2012). Such conditions eas- Paraquat has endocrine and immunotoxic effects. In epidemio- ily lead to acute paraquat poisoning via occupational exposure. logical studies paraquat exposure was associated with increased In several countries paraquat has been misused for suicide, incidence of leukaemia, lymphoma, skin and brain cancer. or self-harm, causing such high numbers of fatalities that it has Toxicologists have questioned the World Health Organisation been banned or severely restricted. Approaches aimed at im- (WHO) categorization of paraquat as WHO Class II (‘Moderately proved safety, such as new formulations and recommendations hazardous’) and have argued that “it would be appropriate to assign for safer storage, have had limited impact. Of 250 patients who paraquat to class I” (Nagami et al 2005). Dawson et al (2010) em- attempted suicide by drinking paraquat in South Korea in 2007 phasize that human toxicity data should be incorporated into reg- only 38 % had chosen this particular pesticide knowingly, while ulatory decisions and the WHO’s toxicity scheme and have urged two of three patients ingested paraquat merely as it was avail- the WHO to immediately reclassify certain pesticide formula- able at the time (Seok et al 2009). tions, including paraquat, which are several times more lethal Studies observed that suicides decreased significantly in than other pesticides in the same chemical class or functional South Korea after paraquat was banned, and many medical ex- type.