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                                                                              Distr.: General
                                                                              23 November 2007

                                                                              English only
                 United Nations
Stockholm Convention on Persistent Organic Pollutants
Persistent Organic Pollutants Review Committee
Third meeting
Geneva, 19–23 November 2007
Agenda item 5
Presentation on socio-economic conditions

             Presentation on socio-economic conditions

                      The annex to the present note contains screen captures from a slide presentation on
             socio-economic made by Ms. Hanna-Andrea Rother of the University of Cape Town, South Africa, at
             the third meeting of the Persistent Organic Pollutants Review Committee.
                     It is presented as received and has not been formally edited by the Secretariat.

K0731264    231107


                                     Socio-Economic Impacts of Control
                                         Measures for South Africa

                                             (Hanna-) Andrea Rother, Ph.D.
                                  Invited Expert for Stockholm Convention Secretariat

                                  Occupational & Environmental Health Research Unit
                                      School of Public Health & Family Medicine
                                               University of Cape Town
                                                    South Africa

                                     Overview of Socio-economic
                           • Some current registrations in Africa

                           • Registration, current uses and alternatives in SA
                                   – Pharmaceuticals for humans and animals
                                   – Broad-spectrum insecticide for agricultural applications
                                   – Wood preservative
                                   – Commercial pest control operations (e.g., termites, borers)

                           • Control measures and impacts
                           • Use contexts

                           Angola               Not registered for use.
                           Botswana             Gamma BHC is registered for garden and household use. The two products are
                                                Gamma BHC 200g/l and Gamma BHC 6g/kg.
                           Burundi              Prohibited for use in agriculture.
                           Burkina Faso         Not registered for use.
                           Cameroon             Does not import or use.
                           Cape Verde           Not registered for use.
                           Eritrea              Not registered for use.

                           Gambia               Not registered for use.

                           Guinea Bissau        Not registered for use.

                           Kenya                Restricted for seed dressing only.

                           Malawi               Not registered for use.

                           Mali                 Not registered for use.

                           Mauritania           Not registered for use.

                           Mozambique           Not registered for use.

                           Namibia              Never registered or used.

                           Niger                Not registered for use.

                           Rwanda               Never registered or used.

                           Sénégal              Not registered for use.

                           Seychelles           Only registered product is Aquila skin shampoo for veterinary uses (0.75% gamma-
                                                BHC; Act 4 of 1996). No other registered uses.

                           Tchad                Not registered for use.


 BACKGROUND - Legislation
• Fragmented regulation of Lindane in SA:

   – Department of Environmental Affairs and Tourism
     (DEAT) => Stockholm & PIC Conventions Designated

   – Department of Agriculture (DOA) => regulates main
     pesticide Act (Fertilizers, Farm Feeds, Agricultural
     Remedies and Stock Remedies Act - Act No. 36 of
     1947) => covers ag uses, wood & PCO,s

   – Department of Health (DOH) => regulates Medicines
     and Related Substances Control Act 101 of 1965
       applies to registration of lindane for pharmaceutical
     uses on humans & animals


  BACKGROUND – Registration
        Status in SA
• Use in aerosols & evaporation devices withdrawn
  in 1970 (under DOA).
• All stock remedy registrations were withdrawn in
  1971 (under DOA).
• Disposal of Lindane containing stock remedies is
  prohibited (regulation GNR 1061)
• Disposal prohibited of ag or stock remedies
  containing a mixture of different isomers of BHC
  (regulation GNR 348)
• All registrations under DOA to be withdrawn
  by April 2009 (issued Aug 2007)

       Lindane Insecticide; Household & Industrial Uses in SA
                        (Regulated by DOA)
    Product        USE Examples      Formulation   Concentration   Hazard
     Name                                                          Class

  Bexadust      Seed & bulb          DP               6 g/kg       3
                treatment; various
  Lindaan SP    Various beetles,     5% DP            6 g/kg       4
  (Avi)         maggots & larvae

  Lindaan       Dry seed treatment   20% DS          200 g/kg      2
  200 (Avi)
  Avi-Ant and   General pest         20% EC           200 g/l      1-0
  Garden        control; Various
  Spray         beetles, thrips,
                maggots & larvae;
                surface treatment
                wood borer
  Lindane EC    aphids               EC               200 g/l      2
  Wood Borer Wood preservative       EC               200 g/l      0
  Fumitabs      Wood borer           FT              440 g/kg      2
  Antiborer                          EC               200 g/l      1b


                                    Lindane Insecticide; Household & Industrial Uses in SA
                                                     (Regulated by DOA)
                                  Product Name      USE Examples   Formulation   Concentrati    Hazard
                                                                                    on          Class
                               Lindastof; Lindane

                               Permanol &           Wood           OL             42/85 g/l    1a
                               Woodprufe            preservative
                               Blue Death           Licence not                  30/6 g/kg
                               (carbaryl/gamma-     renewed
                               BHC)                 2007
                               Combat                              EC              200g/l
                               Dyant                thrips, ants

                               Bug Free Enamel      Paint
                               Paint; Bug Free
                               Varnish; Bug Free
                               Acrylic Paint
                               Timberfix            Wood

                               Control Measures - Agriculture
                           • Lindane currently has limited use as broad-spectrum
                             insecticide in SA Agriculture
                           • Cost equivalent & effective broad spectrum insecticide
                             replacements are already available in SA – i.e.,
                           • SA companies already preparing to phase out; many
                             have applied for new registration of products (retain trade
                             name; replace lindane as a.i.)
                           • Job or crop losses as a result of listing Lindane not an
                           • Lindane not a significant ag insecticide in SA; companies
                             not worried about loss of

                                       Control Measures –Wood
                                  – Lindane not used in forestry because of leaching &
                                    inefficient in penetrating wood
                                  – Arsenic used to treat poles
                                  – Boricide penetrates wood better than lindane –
                                    used for wood borers
                                  – deltamethrin household use alternative for
                                    disinfecting wood, & protecting against
                                    wood rot & borer damage


                 Control Measures –
    Commercial Pest Control Operations
 • SA Pest Control Assoc. discouraging use of persistent
   chemicals – eg lindane => most PCO’s do not use it
 • Some companies use methyl bromide for indoor wood
   treatments (not a viable alternative to Lindane; covered by
   another convention
 • Despite new generation chemicals costing a bit more than
   lindane, these are already mostly used
 • PCO’s focus on combining technical expertise with
   chemical control – ie emphasis is on IPM approach

 • Negative and Positive impact:
    – Small unregistered/fly-by-night pest control companies will feel the
      cost effect because of limited IPM technical expertise & resources to
      use pyrethroids - marginalized because of health & safety issues
    these companies are often illegal thus positive effect of
   control could be closures of these unregulated operations

      Current Veterinary Products
 • Regulated by DOH – Act 101 of 1965

 1) Ear drops for ear mites (e.g., cats):
 • Surfacticide Ear Drops
    • Considered archaic; not commonly used; replaced by

 • Oridermyl

 2) Shampoo for fleas, mites and mange:
 • Aquila Skin Shampoo (0.75% gamma-BHC;
 2.5 LT) => sold by 2 companies on internet

  Control Impacts - Veterinary Uses

• Withdrawal will not have a negative impact; cost
  increases from using alternatives is minimal;
  Lindane cheap but viewed by vets as not
  effective and thus not commonly used

• Alternatives currently available:
   – Anti-flea remedies & anti-bacterial    minimally costs
   – dip for mites and scabies (eg trimex, ametraz [OPs]);


                                      Current Pharmaceutical
                                     Products Registered in SA
                               • Regulated by DOH

                                 1. Nittex 50mg

                                 2. Quellada Shampoo 1%

                                 3. Gambex Shampoo - 1g/100ml

                               Pharmaceutical Uses Overview
                         • Registered as a medicine – labelled and handled
                           as an over-the-counter medicine readily available
                           to general public
                         • Not on essential drugs list
                         • Not available or used in public health sector – too
                         • Currently used predominately for lice control in
                           high socio-economic sectors/private health care

                                 Pharmaceutical Alternatives
                     •   LICE (Head and Body)
                           –   Variety of non-chemical products on market
                           –   Oil (e.g., olive, sunflower) & vinegar or essential oils
                           –   Nit combs (an d conditioner)
                           –   25% Benzyl benzoate lotion – used in public health care sector
                           –   1% Permethrin cream (eg Lyclear); permethrin & piperonyl butoxide
                           –   5% Monosulfiram soap (e.g., tetmosol)
                           –   Malathion based shampoos
                           –   Tea tree oil based products
                           –   Shaving hair

                     • SCABIES
                        – Benzyl benzoate lotion (eg Ascabial) – generics cheap
                        – Spregal – permethrin (not avail in public health sector)
                        – Oral invermectin – cheap (controlled sale?)
                        – 5-10% sulphur ointment (esp. for babies under 2mths)
                        – Permethrin cream
                        – Monosulfiram soap (esp. children under 6)
                        – 5% tree tea oil (research proven effectiveness)


  Ivermectin for Scabies Control
• Studies indicate Ivermectin more effective than lindane for
  scabies control (e.g., 82.6% patients showed improvement
  compared to 44.4% of lindane using patients
• not registered for human use in SA despite international
• Doctors can apply for individual approval to use Ivermectin
  at a cost & inconvenience
• Ivermectin cheap & cost effective
• Better body coverage than lindane lotion/shampoo
• Alternative for scabies resistance to lindane & lindane
  neurotoxic effects on infants from long duration exposures

       Control Measures Impact for
          Pharmaceutical Uses
• Positive Impacts
   – Reduce over treatment of lice and scabies with Lindane products
     because of misdiagnosis
   – Reduce unnecessary exposures particularly for immune deficient
     (HIV/AIDS) & malnourished populations
   – Reduce potential long-term health effects associated with
     lindane use as less toxic alternatives are currently available
   – Protect children who are still developing & may be exposed to
     longer than recommended exposures to lindane repeatedly
   – Lindane products expensive (~US$8-10) – some alternatives
     much cheaper (e.g., Benzyl benzoate ~US$1-2 )

• Negative Impacts
   – no obvious negative impacts from listing Lindane with no
     exemptions under Annex A

  Public Awareness, Info Access, Communicating
                     Risks –
                   pharmaceutical example
• Current risk communication vehicle in SA for
  communicating lindane health risks to general
  public – labels and medicine inserts

• Two aspects of communicating risks that need to
  be taken into account:
  1) content of label/insert – info accurate for
  public to protect themselves
  2) comprehension capacity of user (literacy
  level, technical language literacy, visual literacy
  for warning symbols)


                            •Insert old (1976) – info still valid?
                            •Indicates applicatoin on large areas
                            should be avoided, however for
                            scabies treatment the
                            recommendation is to cover the
                            whole body from neck down -
                            •Label indicates that chronic
                            poisoning may occur when patients
                            use the product regularly (misuse)
                            or apply the shampoo regularly to
                            others without gloves
                                 •Label does not say how often
                                 is regular use that would lead
                                 to misuse
                                 •No where on the label does it
                                 tell the person applying the
                                 shampoo to wear gloves!

                       •Warning on label says that total
                       body application can be dangerous.
                       However for scabies treatment the
                       label statess to put a thin layer
                       over the entire surface skin from
                       neck down – contradiction.

                       •South Africa has 11 offical
                       languages & an illiterate/semi-
                       illiterate population. The following
                       words on the label would not be
                           •Lactating women
                           •Luxuriant (i.e. work into a
                           luxuriant lather)
                           •Eradicate the ectoparasite
                           •Respiratory and gastro-
                           intestinal tracts
                           •Gastric lavage

                                       Environmental Issues

                           • Lindane found in Breede River fish eagles

                           • Disposal of pharmaceutical products - down
                             drains, pit toilets, rivers, cannels in informal
                             high density settlements => difficult to control
                             contamination of water and soil


  Important Issues for Socio-economic
 analysis of lindane & control measures

• Synergistic effects with other chemicals population
  exposed to not taken into account
• Lindane & control measures used in a context (often
  unregulated) which needs to be taken into account
• Current toxicological and environmental data not always
  appropriate for regulating pesticides in Africa especially
  for vulnerable populations (malnourished, immune
  deficient)   animal studies extrapolated to European
• Health costs for individulas resulting from exposures to

     Contextual Issues Relevant to
          Lindane Use in SA
• Literacy an issue (language & technical literacy)
  – 11 0fficial languages in SA
• Unregulated use
• Lack of enforcement of current legislation
• General public unaware of lindane present in
  lice & scabies shampoos and that there are
  potential health risks associated with use
• Children apply and buy pesticides
• Containers reused and thrown on ground or in
• Illegal uses and sale of pesticides occurs

   Examples of Health Benefits of
        Control Measures
 • Immune system most sensitive from exposure to
   Lindane at all dose levels (Health Council of the
   Netherlands, 2001) – adult HIV prevalence in SA 2006 18.2% high
   risk group that would be protected from control measures

 • Malnutrition shown to increase effects of
   pesticide poisoning – poverty related
   malnutrition high in SA and control measures
   would protect many people – especially children


                                    Social Costs of Control
                                     Measures for Lindane
                           • All Lindane registered uses already controlled by
                             other means – no cost effect from listing under
                             Annex A without exemptions
                           • Cancelling pharmaceutical uses of lindane will
                             not compromise human health as alternatives
                             are currently more used in SA than lindane
                           • Employment not affected
                           • No company closures will result
                           • Current fragmented legislation does not lend to
                             adequate control & monitoring of Lindane

                                 Negative Impacts of Listing
                            • Belief that other countries will attempt to
                              dump lindane/lindane products on
                              developing countries

                            • SA does not have the means to dispose of
                              current Lindane stocks; disposing of
                              further stocks may be problematic
                              => this could be addressed through
                              applying the polluter pays principle

                           • Lindane not widely registered/used in Africa
                           • Majority people interviewed thought is was already off the
                             market (esp. for public health uses)
                           • SA is preparing for Annex A listing of Lindane by not
                             renewing current registrations promoting sustainable
                             pest control, reducing negative impacts
                           • Current pharmaceutical uses limited to private health care
                             which a small portion of the SA population uses
                             alternatives already in use
                           • Public does not have access to comprehensible info about
                             lindane use risks or recent research findings
                           • Retaining any uses of Lindane would have more negative
                             than positive effects on health and the environment


• Reviews of listing Lindane need to take into
  account use contexts globally and decisions
  should be based on the least regulated use
  context     precautionary approach needs to be
  applied to the discussions to adequately protect
  developing country populations

• Listing Lindane under Annex A with no
  exemptions will benefit developing country
  populations (particularly vulnerable populations),
  protect environment & promote sustainable
  approaches to pest control



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