The topic
areas for the panel discussions include:
• The path forward in disaster preparedness
since WTC – exposure characterization and mitigation: substantial
unfinished business
• Bridging human and ecological exposure sciences: a window
of opportunity
• Exposure issues in developing countries, including the application
of new technologies
********************
"The
Path Forward in Disaster Preparedness Since WTC -
Exposure Characterization and Mitigation: Substantial Unfinished Business!"
Background:
The 9/11/01 disaster at the World Trade
Center has captured and held the spotlight in the lay and technical
press like no other single non-war event in modern times.
The post-analyses of the health and environmental consequences
have rightfully dominated these discussions and are gradually allowing
the full ramifications of the event itself and the aftermath exposures
to become clear.
However, not all reviews suggest
satisfactory progress has being made since 9/11.
The lack of adequate scientific knowledge and technology
underpinnings to formulate appropriate scenarios for timely protection
from acute and chronic exposures, and the paucity of timely and
representative exposure data for those exposed without protection have
made retrospective causality assessments of adverse health outcomes
difficult or impossible. The
challenge remains for new funding policies to be aimed at supporting
the development of scientific knowledge and new technology to fill an
apparent void in dealing with disasters of this nature.
A very recent paper (Lioy,
Pellizzari and Prezant, ES&T, 2006) reviewed the WTC
experience from the perspective of Learning Through Human-Exposure
Science, and suggests that a number of critical exposure science
research needs have yet to be addressed to produce a suitably robust
disaster preparedness toolbox. They
framed the issue and challenges as ".how to evaluate past
inadequacies, establish credible, realistic exposure-response
evaluations for the future, and develop effective prevention
strategies, including when and where avoidance or respirator use is
mandatory for the local community as well as responders."
The adequacy of our 2007 exposure
characterization and mitigation toolbox could be highlighted by
considering a much smaller, but more contemporary disaster, with the
inadequacies identified for the WTC disaster.
A huge fire at a hazardous waste facility in Apex, NC in
October, 2006 destroyed the facility and its contents and posed
potentially severe community and responder acute exposures.
Five years after the WTC disaster, were we really better
prepared to characterize disaster exposures and protect the public and
responders with appropriate mitigation and avoidance tools?
Adverse health outcomes from the initial minutes and hours of
the Apex disaster resulted in avoidable acute exposures for both the
public and responders. The
adequacy of subsequent chronic exposure estimates for the public also
raised concern that short and long-term health risks were uncertain.
Approach:
It seems
clear that ISEA should be a key player in addressing these critical
exposure science issues, and a specialty conference to address
disaster preparedness is already in the planning stages.
But some issues deserve immediate attention to define critical
exposure and mitigation research need gaps that should be addressed as
soon as possible in preparation for future disasters.
Recognizing
that to be effective, such a panel cannot address all needs, a
nationally recognized panel of experts on policy and science for the
ISEA 2007 conference will attempt to identify and to foster a
discussion on the most critical current research and technology gaps.
It would also identify the broader range of issues (e.g.
exposures by other routes such as dermal, the potential role played by
ultrafine and super-coarse aerosol exposures, ecological protection,
etc.) to be covered in a subsequent specialty conference sponsored by
ISEA that can identify critical research needs to be completed in the
next 5 years.. The
fundamental approach would be whether we
have adequately applied the lessons-learned from the WTC disaster in prospectively
addressing the most critical future disaster preparedness needs?
Discussion Questions:
1)
How should we evaluate past inadequacies, establish credible,
realistic exposure-response evaluations for the future, and develop
effective prevention strategies, including when and where avoidance or
respirator use is mandatory for the local community as well as
responders.
2)
What are the best ways to advance exposure science to better address
future disasters?
3)
How adequate is our current disaster preparedness tool box for
exposure assessments?,
4)
Importantly - how do we support new exposure research initiatives to
provide the best possible protection of health for the community and
responders from future disasters?.
Panel
Participants:
Co-Chairs:
Charles E.
Rodes, PhD
RTI, moderator and Michael J. Dellarco, USEPA, rapporteur
Keynote
Presentation:
Honorable
David E. Price,
NC 4th district representative, chair, Homeland Security house
appropriations subcommittee (Congressional schedule permitting)
Presenters:
Paul J. Lioy,
PhD, SPH/UMDNJ, WTC implications and resulting policy and science
recommendations; Edo
D. Pellizzari, PhD, RTI, acute and chronic stressor exposure
issues; Dori B. Reissman, MD, CDC/NIOSH, defining responder
exposures and linking to personal protection requirements; (to be determined), USEPA, defining community
exposures and linking to protection requirements;
Mitchell Erickson, PhD, DHS/EML, exposure
characterization needs for threat scenarios.
Discussants:
Bernard D. Goldstein, MD, UPitt/Graduate
SPH, Morton Lippmann, PhD, NYU Medical Center, and Thomas A. Burke, PhD, Bloomberg
SPH, Johns Hopkins
Bridging Human and Ecological Exposure
Sciences:
A Window of Opportunity
In
Tucson in 2005, the ISEA membership revisited the importance of ecological
exposure and the unmet need to link exposure sciences to address both
human populations and ecosystems. This challenge was addressed in
Paris in 2006 with sessions dedicated to ways to leverage expertise
and research for both receptor groups. This included discussions of:
•
Lessons learned and potential rapprochement of successes in earlier
decades, when lines between ecological and human exposure were not
so tightly drawn
• Evaluation of exposure methodologies from human to ecological
and from ecological to human (e.g., Bayesian decision theory, human
activities compared to ecological time series)
• Comparison of cumulative and aggregate exposures, and
• Lifecycle perspectives on ecosystem insults that lead to human
exposures, such as disease vectors.
In
2007, ISEA will take the next step in presenting a panel of experts
who have advanced the states of science in both human and ecological
exposure who will recommend concrete steps to be taken by exposure
scientists. The topics (with discussant leads) to be addressed will
be:
•
Reconstruction of dose and exposure from human and ecosystem biomarkers
(Florence Fulk/Panos Georgopoulos/Miles Okino)
• New tools to link human and ecosystem exposures: Models and
decision support systems
Discussion
Questions:
The purpose of the panel is to elicit ideas about next steps in ways
to approach exposure science more comprehensively. We hope to begin
to answer the following questions:
1.
Where are the greatest uncertainties in ecological exposure and human
exposure?
2. What are the most beneficial collaborations between ecological
and human exposure scientists – either in terms of specific
projects – e.g., such as mercury, or in terms of development
of models/information?
3. What model frameworks are transferable across human and ecological
exposure? Can a model framework be used by both groups and at different
scales – e.g., 3MRA or FRAMES, or MIMS?
4. When is it appropriate to combine ecological and human exposure
assessments? And, when is it inappropriate?
5. What can ISEA do to facilitate linkages between the two areas?
6. What lessons can toxicologists share with ecologists and others
who characterize ecological exposures and risks? Likewise, what can
toxicologists learn from the ecological exposure experts?
7. How do scale and complexity differ in ecosystems versus human populations?
8. Does it make sense to combine ecological and human exposure metrics
in large scale studies? If so, what are the criteria and measures
of success of such studies?
Exposure
issues in developing countries, including the application of new technologies
This panel will focus
on exposure issues in developing countries, including the application
of new technologies in those developing countries. These new
techniques could range from measurement methods to the use of models
(including fate, transport, GIS, etc.) to assess the potential impact
of exposure on humans and the ecosystem.
The considerations over
exposure issues are different in developing countries. For example,
DDT is still sprayed to control malaria despite its known adverse
effects on humans and animals. However, saving of life is a higher
priority than environmental and health consequences that do not
materialize right away and are more subtle, on a relative scale.
Similarly, economic development is important yet it often takes place
at the expense of the environment and regard for longer-term
consequences. Examples can be found in air pollution (particulates,
volatile chemicals, etc.) and discharges into the water system from
activities such as manufacturing, recycling of electronic items, etc.,
without the types of regulations as in the US and Europe. Government
and cultural aspects comeinto play as well.
The following questions
will be considered during the discussion.
1. What are the drivers
for exposure science in developing countries?
2. What considerations
are given to the tradeoffs between economic development, disease
eradication activities, etc., and potential harm to the environment
and to the human population as developing economies chart their path?
3. What are the major
scientific information needs? Do they matter? What tools could be
employed?
4. What partnerships
could help make a difference?
5. What strategies are
optimal to overcome limited access to data, a lack of systems to
capture data, and irregular quality?
6. External resources
are a major part of most public health systems in the developing
world. Many external funding agencies, and their recipients, focus on
prominent diseases (HIV/AIDs, malaria, TB). What advocacy methods
might be deployed to increase attention to environmental exposure risk
on the environment & human health?
7. What countries in
the developing world offer good examples of innovation and best
practices in exposure science?
The following
researchers will both present and serve as discussants for this panel:
- Dr.
James Raymer of RTI International will serve as the Panel Chair.
- Dr.
Jim Zhang, EOHSI, School of Public Health UMNDJ - RWJMS,
Piscataway, NJ
- Dr.
Luke Naeher, Environmental Health Science, College of Public
Health, The University of Georgia, Athens, GA
- Dr.
Miles Elledge, Director, International Development Group, RTI
International, RTP, NC
- Dr.
Gary Winston, Director, National Center for Water Quality
Research, Heidelberg College, Tiffen, OH; formerly of the Ministry
of Health, Israel
- Dr.
Chang-Chuan Chan, Professor of Institute of Occupational Medicine
and Industrial Hygiene, College of Public Health, National Taiwan
University, Taipei City, Taiwan
