The battle to ban asbestos
Its health risks are well documented, but some Thai industry leaders insist the material can be used safely and are digging in against a push to outlaw it
Depending on which medical expert you listen to, Thailand has either recorded just five cases of asbestos-related illness in its history, or use of the controversial material is a lurking menace affecting up to 1,000 people every year.
After seven decades of widespread asbestos use across the country, the Industry Ministry has announced it will resubmit a plan to outlaw the material, which has been linked to a range of serious health issues including lung cancer.
If it goes ahead, the ban would add Thailand to the list of more than 50 countries that have outlawed asbestos. By 2020, Thailand would no longer see production of any form of asbestos fibre, according to the Industrial Works Department.
Anti-asbestos groups began campaigning heavily against its use in 2006, resulting in a cabinet resolution three years ago banning asbestos.
But industry groups have continued to oppose the ban, using slogans such as “toothpicks are more dangerous than asbestos”. The ban has never been implemented or enforced, stalled by lobbying from manufacturers and investors.
With such a huge amount of money involved in the asbestos industry in Thailand — imports alone are worth almost 500 million baht annually — there is no guarantee the fight is over.
Tough to crack: 'Bangkok Post' reporter Paritta Wangkiat attempts to break asbestos tiles.
A LONG STRUGGLE
Opposition to the 2011 cabinet resolution came not only from manufacturers but also the commerce and industry ministries, with the former concerned about its effects on international trade, and the latter unwilling to lose a cheap raw material. But from a public health standpoint, activists say the costs of treating asbestos-related illnesses outweigh any economic benefits.
“Our position is quite clear that we want [to stop asbestos use], but it’s beyond our authority,” said Disease Control Department deputy director-general Nopporn Cheanklin, referring to the Industry Ministry’s draft plan.
There are two general types of asbestos — amphibole and chrysotile. Amphibole is banned in all countries, but chrysotile is still used widely in Thailand for roofing materials and floor tiles.
In the Industry Ministry’s bill to ban asbestos, which will be submitted to the cabinet for approval, asbestos in rubber tiles and flat sheets would be phased out in three years. In roof tiles, high-pressure water pipes and vehicle brakes and clutches, its complete removal would take five years. It is still not clear when the bill will be presented to ministers.
Vithaya Kulsomboon, a member of the National Legislative Assembly who has been a staunch campaigner against the use of asbestos, said that work to tackle the issue is taking too long, and manufacturers have already had plenty of time to adapt.
“And I don’t think it’s right for power to lie in the hands of only one ministry,” he told Spectrum.
Meanwhile, tension between the two opposing sides shows no sign of abating.
At a seminar last week organised by 11 anti-asbestos groups, the managing director of Oranvanich Co, one of Thailand’s biggest roof tile makers, was asked to leave the conference because he “was not invited”.
One of the organisers expressed concern after Spectrum and another Bangkok Post reporter interviewed him outside the conference room.
The permanent secretary for industry was a notable absence from the seminar, although the Disease Control Department sent representatives along.
On the other side, the Chrysotile Information Centre, which receives funding from the International Chrysotile Association, made legal threats against Mr Vithaya for leading a campaign for a ban on the use of chrysotile asbestos in 2012.
The move caused an uproar in the international science community, which called on the Yingluck Shinawatra government to condemn efforts by the asbestos industry to intimidate Mr Vithaya, who is also director and an associate professor at Chulalongkorn University’s Social Research Institute.
Disease controller: Nopporn Cheanklin says international data proves asbestos is harmful.
WHERE THAILAND STANDS
The number of patients with asbestos-related diseases in Thailand varies from source to source, with the Disease Control Department saying there are only five proven cases.
Asbestos-related diseases cover a spectrum of afflictions, most notably mesothelioma, asbestosis and lung cancer.
Anti-asbestos groups claim Thailand has around 1,000 cases of mesothelioma per year. Pitchaya Paktongsuk, an associate professor of medicine at Prince of Songkla University, says the figure is 1,295 annually.
Mesothelioma is a rare form of cancer most commonly caused by exposure to asbestos.
But Somchai Bovornkitti, an emeritus professor at the Royal Institute’s Academy of Science, claimed Thailand has no asbestos-related diseases.
“In the old days, people were stupid and didn’t know about the dangers of asbestos, but now everyone knows that exposure to asbestos causes lung cancer, and we learn to prevent exposure so there is no danger,” he said.
He claimed there is no evidence that the number of known cases of mesothelioma patients in Thailand, which he put at 81, are caused by asbestos.
His view is echoed by Manoon Leechawengwongs, a lung specialist at Vichaiyut Hospital, who said there is no scientific evidence to support banning chrysotile asbestos.
He pointed out that the projections made by anti-asbestos NGOs are based on data from industrialised countries that used amphibole in the past.
Amphibole asbestos is a very potent carcinogen and has been banned by all countries.
“Chrysotile is a very weak carcinogen, and it can cause cancer only if inhaled in large doses,” Dr Manoon said.
He said asbestos-related lung diseases are very rare here, and he has not seen a single case since he returned to Thailand 24 years ago. However, he saw at least 10 cases while practising in New York City, most likely due to amphibole that was used in the US during the 1970s and ’80s.
While the World Health Organisation has estimated 107,000 global deaths per year from work-related asbestos diseases, Dr Manoon said the government’s decision must be based on the actual number of deaths from asbestos-related lung diseases occurring in Thailand.
If the actual number is 50-100 times lower than the estimate given by the anti-asbestos activists, then banning asbestos is not medically justified, he said.
“Thailand will spend hundreds of billions of baht to save less than 10 patients per year, as not all mesothelioma is associated with chrysotile,” Dr Manoon said.
“We should save money to deal with other diseases.”
Through the roof: Manufacturers say their costs will soar if they are prevented from using asbestos to make cheap roof tiles.
LACK OF EVIDENCE
The main argument from proponents of asbestos use is that there are no reports of asbestos-related diseases in Thailand.
Data from the West, they say, cannot be compared to present conditions anywhere in the world since amphibole is no longer in use.
But the WHO has maintained that an absence of reported cases of mesothelioma in a country does not indicate that there is no significant burden of disease resulting from asbestos.
Lesley Onyon, the WHO’s regional adviser on occupational health and chemical safety, said data and surveillance and registration systems for occupational diseases are non-existent or weakly developed in many countries. The ability of physicians and healthcare systems in the identification, diagnosis and management of asbestos-related diseases is also generally inadequate.
Diagnosis includes a physical examination, history of exposure, spirometry and chest X-ray.
“History of exposure is a key factor in the diagnosis of asbestos-related disease, but in many cases this history is in itself weak,” Ms Onyon said.
The latent period between exposure to asbestos and the development of mesothelioma can be 40 years or more.
Exposure does not always have to be associated with working in an asbestos factory, and often people may not have been aware that exposure has taken place, Ms Onyon said.
“Mesothelioma is so rare that most doctors would simply not have the experience of even seeing such a case,” she said. “Because all asbestos-related lung diseases can present as general breathing problems, detection may be delayed until it is too late.”
Dangerous home truths: About 90% of asbestos fibres in Thailand are found in roofing tiles and cement pipes, although experts are divided about whether the cost of removing it is worthwhile.
‘DOCTORS ARE AFRAID’
Officially in Thailand, lung cancer caused by asbestos is the least common recorded form of cancer, and many Thais do not have access to treatment, said Dr Nopporn of the Disease Control Department.
Apart from the difficulty in diagnosis and information collecting, the long latent period and lack of good registration and follow-up systems, Dr Nopporn said some doctors do not want to be involved in the matter because they are afraid of being sued by factories.
“Our doctors are very afraid of being sued and questioned in court,” he told Spectrum, adding that factory workers whose lives are dependent on their jobs also feel indebted to their employers, and refuse to cooperate in providing information.
Somboon Srikamdokcare, a member of the Council of Work and Environment Related Patient’s Network of Thailand, said only workers who have social security will seek medical treatment. Clinics in general have few lung experts, as they are mostly concentrated in Bangkok.
“Workers are not empowered. Their daily lives consist of going to work and then going back home, and they don’t worry about calling for their rights,” she said.
Dr Nopporn said another issue lies in Thailand’s Workmen’s Compensation Fund, a form of social security that provides insurance for occupational dangers.
The fund consists of a yearly premium depending on the salaries provided to employees and the risk of the business. If a company reports a high number of workplace-related illness or injury, it will have to increase its contribution to the fund, and that is why companies are reluctant to report cases, Dr Nopporn said.
Although he conceded Thailand has little evidence of patients with asbestos-related diseases, Dr Nopporn said known data from other countries that have used the substance is sufficient enough.
He cited figures from Europe, where it is predicted more than 50,000 people will develop symptoms of asbestos-related diseases in the next five years. If the same situation were to be applied to Thailand, there would be around 5,000 patients here, he said. “We don’t have to wait to build our own nuclear plant to realise radiation is dangerous for Thai people. The lesson has been learned from other countries, and that is enough for us,” he said.
WHAT THE WHO SAYS
In 2006, the WHO called for global campaigns to eliminate asbestos-related diseases. But the argument has been on asbestos in general, providing a loophole for the industrial sector to argue that chrysotile asbestos is safe and amphibole is the main culprit.
Maythee Uthayopas, public relations director at the Chrysotile Information Centre, said the risks associated with the use of chrysotile are 500 times less than amphibole asbestos, and called for “safe use” instead of a total ban.
In its newly released document on health risks attached to chrysotile asbestos exposure, the WHO concluded that the scientific evidence is clear that “chrysotile causes cancer of the lung, larynx and ovary, mesothelioma and asbestosis, whether or not it is less potent than amphibole types of asbestos in doing so”.
The questions of whether or not historical epidemiological studies may have been dealing with chrysotile contaminated with amphibole types of asbestos do not alter this finding, the report said.
The 40-page publication titled “Chrysotile Asbestos”, printed this year, signals the WHO’s firm stance on the issue that all types of asbestos cause cancer in humans, and that the most effective way to eliminate asbestos-related diseases is to stop using any form of it.
“It’s when the industries argue that white asbestos [chrysotile] is safe that we had to look into it again in making ourselves clear,” said Yonas Tegegn, the WHO’s representative to Thailand. “Asbestos in any form — even in the environment — is a threat for the general public.”
According to WHO estimates, at least 107,000 people die each year from asbestos-related lung cancer, mesothelioma and asbestosis resulting from occupational exposure. Approximately half of all deaths from occupational cancer are estimated to be caused by asbestos.
As of the end of last year, more than 50 WHO member states had already legislated to prohibit the use of asbestos.
The WHO, through its joint recommendations with the International Labour Organisation, recommends all countries to develop national programmes for the elimination of asbestos-related diseases.
These programmes should include the establishment of a central registry of all workers exposure to asbestos with record-keeping for at least 40 years.
Countries are also called upon to improve early diagnosis, treatment, social and medical rehabilitation of people with past or current exposure.
In an attempt to lower the risks associated with asbestos, Dr Nopporn of the Disease Control Department said officials will visit factories to perform tests and discuss ways to improve the working environment and reduce asbestos concentration in their workplace.
Around 200 factories in Thailand use asbestos material, with around 20-30 using the substance in large quantities.
Dr Nopporn said it is critical for Thai doctors, especially those in regional hospitals, to have knowledge of diagnosing asbestos-related conditions and monitoring people’s health.
“If we can do it right, it means in the next three years we can collect enough information on people affected by work-related asbestos,” he said.
Under the Industry Ministry’s draft plan to ban asbestos by 2020, it will not be mandatory for households and businesses with asbestos sheeting already installed to remove the material.
But those who oppose the use of asbestos have long been calling for measures to aid its safe removal.
Pasu Loharjun, director-general of the Industrial Works Department, which formulated the plan, said the ministry will work with related agencies to provide the public with information on the safe removal of construction material containing asbestos.
“There are no dangers when in use, but the problem is during installation or removal. That is when the asbestos fibres spread into the air,” he said.
But Mr Vithaya admits the cost of removal is a stumbling block. “Because removal costs a lot of money, the main focus is to limit new chrysotile asbestos in the country,” he said.
In the US, although asbestos has not been completely banned, the amount of money spent on asbestos removal from buildings has been massive, spurring debate on whether or not it is worth it from both an economic and public health standpoint.
According to a 2013 study by King Mongkut’s Institute of Technology Ladkrabang, the economic burden for business operators, consumers, households, pig farms, schools and hospitals would total 464.8 billion baht if a complete removal order was enforced.
The study cited National Housing Authority figures from 2012, which showed that Thailand had 21.68 million houses. Out of the total, 17.35 million households were using asbestos roof tiles, totalling 1.73 billion square metres of roof space.
The cost of removing these and installing new roofs would be around 450.98 billion baht.
The study said artificial cement roof tiles are two to three times less durable than asbestos roof tiles, resulting in maintenance costs of 30,000-50,000 baht every 10-15 years.
Uran Kleosakul has been on the forefront of the campaign to continue the use of asbestos.
The managing director of Oranvanich Co, one of Thailand’s biggest roof tile makers under the Globe Brand, frequently brings along samples of his products to conferences, so that participants can test them out.
Volunteers are asked to attempt to break two types of roof tiles, one made from non-asbestos materials which would always break in half.
Mr Uran’s point is that there are currently no substitute goods that match the durability of chrysotile, and that the safety or risks of these substitutes has not been studied in detail.
In the roof tile market, Siam Cement Group (SCG) and Mahaphant Group have stopped using asbestos.
Oranvanich and Diamond Building Products still use the substance, but have already partly invested in new machinery and prepared risk management plans for once the government outlaws the use of asbestos products.
Saravut Sumransub, the managing director for marketing in the housing business at SCG Cement-Building Materials, said the group’s decision to stop using asbestos in 2007 stemmed from its social responsibility to consumers.
“We have to believe [the WHO] and not wait for someone to die first for proof of its dangers,” he said.
But according to an invoice obtained by Spectrum, SCG still uses asbestos in its joint venture in Indonesia, shipping 660 million tonnes of chrysotile asbestos from Russia in March worth US$277,200 (nine million baht).
SCG’s 2013 annual report showed the company still has a 50% share in PT Siam-Indo Concrete Products.
SCG declined to comment, saying it needed to consult first with its joint venture partner in Indonesia.
Mr Vithaya of Chulalongkorn University attributed the slow progress of the delay in the asbestos ban to the vested interests of manufacturers, as well as politicians who invest in the roof tile business.
Thailand imports chrysotile asbestos mostly from Russia, and investors are concerned that a ban will jeopardise 281 million baht worth of annual bilateral trade in the product.
Ulan Marketing, a company owned by Mr Uran and his family, jointly invested $14 million in Canada’s Jeffrey Mine in an attempt to revive the mine in 2012.
The venture was also partly funded by the Quebec government.
“The strange thing is companies like Oranvanich have other means of doing things, but what they are afraid of is a domino effect,” Mr Vithaya said.
“If Thailand stops [using asbestos], it will be a huge moving force for other countries to do the same.” n