J.D. Veltman and J.P.J.J. Hegmans

2001, September 11. The World Trade Centre collapses and an enormous cloud of dust covers the city centre. Besides facing the tragedy of a terrorist attack, the citizens of New York are also exposed to around 400 ton of asbestos fibres, released from the collapsing Twin Towers.

Asbestos

Asbestos is a substance consisting of six naturally occurring long fibrous silicate minerals.. Exposure to airborne asbestos particles can cause serious health problems such as asbestosis, lung cancer and malignant mesothelioma, and therefore its use is banned in the European Union and over fifty other countries. After 9/11 the Mesothelioma Applied Research Foundation was established in the US to fund research, investigating new treatment strategies to cure mesothelioma. Measures like these are a victory for public health activists in western countries, but in developing countries the laws regarding asbestos are usually less strict. So the question is, did we simply transfer the problem of asbestos from our countries to the developing world?

Harmful effect of asbestos

Although the relation between asbestos exposure and occurrence of disease was already reported by the ancient Greek geographer Strabo and the roman naturist Gaius Plinius Secundus in 23 AD, the first scientific report was published in the early sixties by Wagner et al. He reported a strong correlation between the exposure to asbestos and the occurrence of mesothelioma among asbestos-mine-workers in South-African’s Cape Province. Even though the harmful effects of asbestos were already clear in the 1960’s, the commercial use of asbestos peaked during the seventies in the Western world. Tons of asbestos-containing materials are still present in buildings, ships and infrastructures. In The Netherlands, the production and use of asbestos-containing material was maintained until the ban on asbestos-use in 1993. After that, the use of asbestos was also prohibited in other European countries, like France (1996), Belgium, England (1999), Spain (2004), and Greece (2005).

Asbestos in developing countries

While asbestos now is a well-known carcinogen to the majority of people in the Western world, in developing countries most people are still unwittingly exposing themselves to this killing substance. As the Western world attempts to ban the use of asbestos, its use in Asian countries, especially India, is growing. In Alang, India, asbestos is collected in ship breaking yards from Western ships. The high amount of asbestos-containing material causes high costs of safety measurements, making it too expensive to dismantle these ships in developed countries. All collected asbestos-containing material is transferred to factories producing construction materials, where the asbestos fibres are remodelled into asbestos-cement and corrugated roof plates. Most of these plates are used for building activities in the slums and suburbs of Indian cities, exposing the poorest people to the dangerous fibres. Even though several international organisations have tried to stop the dumping of old ships on the beaches of India, Alang remains one of the largest ship-breaking yards in the world. Over  150 ships cover the 50 kilometre long coastline of the Bhavnagar district in India, leading to direct environmental pollution and the exposure of 18 500 thousand people to highly carcinogenic substances (Figure 1).

Canada and the asbestos trade

Besides extracting asbestos from ships, Asian countries also import asbestos on a large scale from Canada. In this country commercial asbestos mines are located in the Appalachian foothills of Quebec. The Canadian government funds an industrial lobby group, the Chrysotile Institute, which promotes the “controlled use” of chrysotile asbestos in developing countries. Chrysotile asbestos is the only form of asbestos still sold today, but is just as carcinogenic as other forms, and therefore its use is prohibited in almost every country besides the developing ones. The distribution of chrysotile asbestos is possible, since chrysotile asbestos was not mentioned in the Rotterdam Convention in the early eighties. The Rotterdam Convention rejected the use of all other types of asbestos, in their effort to ban toxic agents for health or environmental reasons. At that time it was thought that chrysotile is less carcinogenic, since it can be cleared from the lungs more easily. Despite the opposition of the World Health Organisation, Canada increased its asbestos mining activities and exported more asbestos last year. Its total  production is now similar to the peak period in the sixties. Apart from Canada, also Russia, China, Brazil, Zimbabwe and Kazakhstan are mining for asbestos.

Continuing danger

Millions of individuals are still exposed to the carcinogenic fibres of asbestos, with the accompanying undisputable serious health risks. All governments should take up their responsibility to prevent exposure to asbestos to their utmost extent. It is essential that  cancer research is intensified, to provide better treatment options for the millions of people that have inhaled asbestos fibres and are thus at risk for asbestosis or malignant mesothelioma.  In 2010, the United Kingdom’s Ministry of Justice announced that the UK government will take a number of extra measures on asbestos-related disease, like raising the financial compensation for mesothelioma and an increased investment into asbestos-related disease.

Growing concerns

It is a misconception that with a ban on asbestos-use the occurrence of mesothelioma will disappear within the following decades. Many people worldwide are still being exposed to asbestos fibres. In 2006, Greenpeace successfully prevented the dumping of the warship Clemenceau, containing tonnes of asbestos in India, by making the French public aware of these activities by their government. Although the awareness among Western communities is rising, stopping the export of asbestos and asbestos-containing material to developing countries is still problematic, mostly because of the economical interests involved. It becomes increasingly apparent that the ban of asbestos in the Western world only transfers the problem to developing countries.

Box 1: Mesothelioma

Mesothelioma is a highly aggressive form of cancer caused by a neoplastic transformation of the mesothelial cells that line the body’s serous cavities and the internal organs. In a majority of patients mesothelioma is localized within the pleural cavity. Currently, no curative medical procedures are available. With a median survival of nine to twelve months after onset of symptoms,  the prognosis is extremely poor.

Box 2. International activists call on Canada to stop asbestos export

In December 2010, a delegation from several Asian countries asked Quebec’s government to stop supporting the expansion of the Jeffrey Mine. This mine is responsible for a large portion of Canada’s asbestos exports. The mine is almost depleted, but an expansion would keep the mine running for 20 more years, resulting in the exportation of around 150 000 tons of asbestos a year. In Quebec the use of asbestos is illegal, but in Asia, where Canada’s asbestos is shipped to, broken pieces of asbestos cement are used for homes, and children play amongst asbestos rubble. Many people there have never heard of asbestos, but that does not stop it from killing them. Currently, the Canadian government supports the expansion of the mine to ensure continuation of the asbestos export.

About the author

Joris Veltman is a PhD student at the Erasmus Medical Center in Rotterdam, the Netherlands. His research focuses on new therapies for mesothelioma. JPJJ Hegmans volgt.

Further reading

• Barbalace, R.C. et al. History of Asbestos. 1995 www.environmetalchemistry.com
• Burki et al. Health experts concerned over India’s asbestos industry. Lancet 2010.

References 

1. R.C. Barbalace, 1995-10-22; Environmentalchemistry.com; “History of Asbestos”
2. Wagner JC, Sleggs CA, Marchand P. Diffuse pleural mesothelioma and asbestos exposure in the north western cape province. Br J Ind Med 1960;17:260-271.
3. Stumphius J. Mesothelioma incidence in a dutch shipyard. Ann N Y Acad Sci 1979;330:317-322.
4. Ministry of Justice U.K., 27-10-02; Government announces measures on asbestos-related illness
5. Burki T. Health experts concerned over india's asbestos industry. Lancet 2010;375:626-627.
6. D. Allen & L. Kazan-Allen; www.ibasecretariat.org; India’s asbestos time bomb
7. Burki T. Asbestos production increases despite who opposition. Lancet Oncol 2009;10:846.
8. . BBC News. 2006-01-06. http://news.bbc.co.uk/ 2/hi/south_asia/4588922.stm. Retrieved 2007-11-24
9. Battling over asbestos in the third world. Environ Health Perspect 1997;105:1178-1180.