forward-thinking exercise anses 2020 · jean-claude desenclos bernard toma . 3 . 4 contents
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Forward-thinking exercise ANSES 2020
REPORT OF THE PROCEEDINGS OF THE FORWARD-THINKING SYMPOSIUM
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List of participants
Scientific Board 16 Frédéric Auvray 1 Robert Barouki 2 Alfred Bernard 3 Olivier Borraz 15 Cédric Chauvierre 4 Jean-Pierre Cravedi 5 Elisabeth Erlacher-Vindel 6 Paul Frimat 7 Jeanne Garric 8 Michel Gérin 9 Pierre Kerkhofs 17 Martial Ledoux 10 Michèle Legeas 11 Anne Maitre 18 Cécile Michel 12 Isabelle Momas 13 Pierre Ricci 14 Noël Tordo ANSES 36 Solenne Chardigny 38 Philippe Colas 30 Salma Elreedy 24 Frank Fourès 37 Dominique Gombert 34 Sophie Guitton 28 André Jestin 35 Laurent Laloux 27 Gérard Lasfargues 33 Louis Laurent 26 Marc Mortureux 39 François Moutou 40 Jean-Pierre Orand, 31 Jean-Nicolas Ormsby 32 Pascale Parisot 29 Olivier Pierson 41 Pascale Robineau 21 Pascal Sanders 19 Marc Savey 25 Benoît Vergriette 23 Jean-Luc Volatier
Guest participants Jean-Claude Desenclos Bernard Toma
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Contents
I. Introduction ................................................................................................................................. 5 II. The factors determining change to risk ....................................................................................... 6
a) Increasing environmental pressure .......................................................................................... 6 b) From densification to globalisation: the intensification of trade and travel ........................ 7 c) Society and the economic crisis .............................................................................................. 7 d) New technologies ................................................................................................................ 8
III. A work plan for 2020 .................................................................................................................. 9 a) Chemical agents ...................................................................................................................... 9 b) Biological agents ............................................................................................................... 10 c) Physical agents ...................................................................................................................... 11 d) Occupational health ........................................................................................................... 11 e) Agricultural practices ............................................................................................................ 12 f) Food ....................................................................................................................................... 12
IV. The future agenda ...................................................................................................................... 13 a) Subjects that will still be topical ............................................................................................ 13 b) Loss of faith in science ...................................................................................................... 15
V. Discussions of working methods ............................................................................................... 16 a) The complexity of the modes of action of chemical or biological agents ............................. 16 b) The use of integrative concepts ......................................................................................... 16 c) And society in all this? .......................................................................................................... 17 d) A new wave of input from information technologies ........................................................ 17 e) The nature and status of expert appraisal .............................................................................. 17
VI. Discussing prioritisation ............................................................................................................ 19 a) Prioritisation based on multiple criteria ................................................................................ 19 b) The time horizon for the risk ............................................................................................. 19 c) The nature of the risk ............................................................................................................. 20
VII. Conclusion ................................................................................................................................. 21 Annex .................................................................................................................................................... 22
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I. Introduction The Agency organised a symposium dedicated to forward thinking on 18 September 2012. It brought together the members of the ANSES Scientific Board, certain ANSES employees and two guest participants. Its purpose was to think in advance about what the main priorities for the Agency’s work programme might be by 2020. It covered the field of health, meaning human health in the general population and at the workplace, based on a “products/environment” approach, and animal and plant health. More specifically, the symposium attempted to address the following four questions:
• What are the factors determining change to the risks affecting humans, animals and plants: technologies, societal change?
• What “risk families” could make up the work plan for 2020? • What issues might emerge in future political agendas? Who would be the stakeholders? • Is it possible to work differently compared to a situation where risk assessment is
addressed cause by cause?
To prepare for the discussions, a “Forward Thinking” preparatory document, drafted by ANSES personnel and members of the Scientific Board, was sent to symposium attendees at the beginning of September. The symposium opened on the evening of 17 September with a review of the objectives and an initial exercise in which participants were asked which issues they thought would be on the political agenda in 2020, for each major sector (the environment, human health, occupational health, diet, animal health, and plant health). The results are given in the Annex On the morning of 18 September, three spin-off groups worked on the four questions listed above, and the afternoon was given over to reporting back on the work of these groups and to a general discussion.
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II. The factors determining change to risk
The goal was to identify the key trends that will affect the Agency in 2020. The subjects raised during the symposium can be divided into four families: 1) Increasing environmental pressure; 2) From “densification”1 to globalisation: the intensification of trade and movement of people throughout the world; 3) Society and the economic and financial crisis; 4) New technologies. Within the next 10 years, some of these trends appear inescapable (environment, demography), while others are less inevitable but remain likely (globalisation, economic crises, social change), although they may be affected by unexpected events. Some of these trends are already visible in 2012 while others, though already identified, still have only a limited impact but are likely to increase in importance. These four determining factors are interlinked and must be considered as parts of a complex system. For example:
• There is a clear correlation between the economic downturn on the one hand and the search for increased agricultural and industrial production and globalisation on the other;
• Some factors are incompatible with each other. For example, the pursuit or even the intensification of unsustainable (and in fact increasingly polluting) industrial or agricultural processes coincides with the predicted increasing scarcity of resources and the need for sustainable practices;
• Others reinforce one another, such as the effect of environmental pressure and social or health inequalities.
a) Increasing environmental pressure Climate change and the predicted end of the intensive use of non-renewable resources will lead to a profound transition in our way of life and the means of production. The first factor, climate change, includes global warming and changes to the water cycle, ecosystems and the repercussions they will have. It will have numerous consequences:
• Direct effects, such as the increase in atmospheric temperature and extreme climate events (heat waves and “cold waves”). This is likely to cause geographical movement of risk, such as the vectors of transmissible diseases (rodents, insects, etc.) or toxin-producing species (cyanotoxins, mycotoxins or phycotoxins) and changes to air pollution patterns;
• Indirect effects, resulting from the way humans react to these changes. These will include: modified technologies in the energy sector (scarcity, reduced emission of greenhouse gases), in crop-growing, stock-raising and trading practices (changes to the environment, water resources and the availability of energy, of which agriculture is a major consumer through the production of fertilisers and transport), changes to habitable regions (shrinking space), town planning and transport, population movements. These changes started to occur in the early years of the 21st Century but have by no means finished.
Equally inevitable is the increasing scarcity of all kinds of resources either as a result of climate change (water and energy) or through the exhaustion of fossil fuels, for which the only solution is the transition to closed-circuit economies involving massive recycling and the development of renewable resources.
1 A generic term incorporating the following ideas: urban development, reduced cultivable land, pursuit of higher yields, more intensive agricultural methods.
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b) From densification to globalisation: the intensification of trade and travel
There is a natural trend towards densification which began several decades ago, involving populations (demographic concentration around urban centres), the centralisation of production and the intensification of agriculture.
• This trend renders the population more vulnerable to pollutants, pathogens and hazardous products by facilitating transmission or aggravating the impact of contamination.
• Intensive agricultural processes (the search for profitability combined with the reduction in cultivable area) leads to a concentration of agricultural properties. One result is the increasing industrialisation of pig and poultry farms. At the same time, cattle farms hold larger numbers of animals. This in turn leads to new sources of exposure and greater risk of zoonoses.
• In the workplace, these increasingly intensive practices go hand-in-hand with the pursuit of higher production and flexibility (particularly via new types of organisation of work and the use of subcontractors). These changes are recognised causes of increased psychosocial risk.
These trends are all a part of the increasing globalisation of trade, and clearly conflict with the need for better husbandry of energy and resources and for lower pollution that environmental constraints seem to impose. Lastly, globalisation goes hand-in-hand with the increasing “financialisation” of commercial activities, a practice that can also have an impact on health. Some participants drew attention to speculation on agricultural produce, which can influence the choice of crops that are grown, irrespective of local needs, and also drive the pursuit of yield without consideration for environmental constraints.
c) Society and the economic crisis French society is changing in different ways:
• as a result of demographic change, i.e. an ageing population, migration and the fertility rate, bearing in mind that France, with comparatively high fertility, is a special case in Europe. This has an influence on the age pyramid and the proportions of the sexes in society and in business. Demographic change has an overall effect both on which parts of society are most vulnerable, and on lifestyles;
• as a result of the greater range of cultures and religions, which can have an effect, for example, on consumer behaviour;
• in changes in the behaviour of consumers and users, for example in terms of diet or choices of transport. Participants referred to the increasing use of e-commerce, which facilitates the circulation of goods that escape proper inspection. Certain fads, which are not always predictable, can have an effect on risk (e.g. the fashion for slimness or pursuit of performance);
• by adopting practices related to sustainable development: thermal insulation, the development of organic produce, rising energy prices.
Many participants in the symposium drew attention to a phenomenon that seems certain to intensify in the coming years which they referred to as the economic crisis. This affects society in several different ways:
• social inequalities, whether in the workplace or in the increasing number of people suffering from insecurity. This notion of inequality must be taken in the broadest sense as it can cover employment contracts, housing, health, access to care and social services, access to medication at a reasonable cost, etc.
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• a reduction in the State’s ability to intervene in a certain number of fields, and ageing infrastructures. This could affect risk management (impact assessments, risk assessment, product monitoring, and the surveillance of workers’ health).
A final factor that could affect the operations of health agencies is a redistribution of responsibilities between the State, local and regional authorities, and Europe. An increase in the number of administrative authorities to which groups or individuals can turn to gain recognition of supposedly unacceptable health status could have the effect of multiplying the number of health issues brought to the top of the public agenda. This in turn could exacerbate competition between local authorities and between different levels of the administration.
d) New technologies These have both positive and negative aspects. Since the symposium was about risk, it was the latter kind that were mostly discussed. As a general rule, the deployment of new technologies in the workplace leads to changes in behaviour (especially in the case of information technologies) and exposure (novel substances). In the future, users will be faced with more complex, multifunctional products, e.g. consumer items containing embedded chips, or ready-cooked dishes produced with a variety of foodstuffs and technologies, of diverse geographical origin. This can mean combinations of risk factors and sometimes loss of traceability. Sometimes these technologies do not create risk as such but affect social vulnerability (e-commerce) or society’s ability to manage risk2 (information technologies and the spread of rumours). Another subject of concern, the increasing scarcity of non-renewable natural resources, will lead to the development of methods to exploit hard-to-get-at resources that generate even more pollution3. The increase in the production of waste and the need to recycle it will probably lead to a greater number of polluted sites and the emergence of new contaminants, at higher concentrations, in certain products and foodstuffs. The symposium reviewed these technologies as generating a generic risk. However, some sources of potential hazards were mentioned explicitly: radiofrequency radiation, nanotechnologies, green chemistry and genetic engineering.
2 This last point will be dealt with more specifically in the section “Discussions of working methods”. 3 A topical example is hydraulic fracturing for the extraction of shale gas.
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III. A work plan for 2020
This involves extrapolating from the current work plan, mainly by following the trends identified in the previous section. The first class of concerns involves chemical, biological and physical agents likely to affect health. They can affect both the general and the working populations, even though conditions of exposure may differ.
a) Chemical agents ANSES is already heavily involved in the study of chemical agents. Pesticides and endocrine disruptors are examples that will certainly remain topical issues. The symposium concluded that two main trends could be seen: A more comprehensive approach to exposure: one subject of growing concern amongst stakeholders, but that advances in technology have made easier to investigate, is population exposure to multiple chemicals, possibly at low doses via different exposure routes. This exposure is often associated with an increase in the incidence of non-infectious chronic diseases (cancer, metabolic diseases, diabetes and obesity, reproductive disorders, cardiovascular diseases). For the coming years, we can therefore expect to see an increased use of a more global approach, taking into account multiple exposures to substances found in low doses; such approaches are likely to have become fairly widespread by 2020. Corresponding keywords are: low doses, windows of exposure (effects can vary depending on time of life), exposure of women, individual susceptibility, synergies between substances, and epigenetics (the study of the way environmental changes can modify gene expression). These broader approaches could be completed by other, more crosscutting approaches, which would take into account oral, dietary, respiratory, and dermal routes of exposure, and approaches related to diseases, especially metabolic diseases such as obesity and diabetes, cardiovascular diseases and neurodegenerative diseases. Fundamental changes, resulting from the trends identified in the previous section.
• Globalisation. The flow of products, some of them highly complex, round the planet increases the risk of population exposure to harmful substances, known or unknown, possibly acquired individually over the Internet, with the resulting difficulty in tracing the ingredients or in detecting fraud. Moreover it can be extremely difficult to implement control procedures to cover these risks. This issue is already recognised in 2012 and will still be topical in 2020. It will be necessary to develop warning procedures and to implement systems to detect prohibited substances.
• The development of recycling practices is absolutely indispensable, and this trend is bound to become more widespread in the coming 10 or 20 years. While these practices help address the increasing scarcity of resources and also certain environmental issues, they also involve risk. For example, the risk of toxic substances finding their way into products formed from recycled materials, either via official recycling channels or fraudulent ones, or risk of pollution from recycling facilities. Recent examples have shown that these dangers are real4. We can expect that, in the future, the increase in the production of waste and the need to recycle it will oblige
4 Such as the "dioxin in chickens" scare, or meat and bone meal
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ANSES to be on the lookout for the emergence of new contaminants, in greater concentrations, capable of affecting certain products or foodstuffs.
• The intensification of production, especially agricultural (both stock-raising and crop-growing), in conjunction with unfavourable climate change, is likely to cause an increase in the quantity of inputs employed. Apart from the risks associated with these inputs, it can be predicted that ANSES will have to pay greater attention than at present to the consequences of increasing resistance of all types (to pesticides, herbicides and antimicrobials). In the same way, the increasing scarcity of non-renewable natural resources is likely to lead to the development of more pollution-generating methods to exploit resources that had previously been almost inaccessible.
b) Biological agents Risk factors were clearly identified, the most important of which are the effects of globalisation, and the intensification of international trade and travel, aggravated by the trends to densification and intensification mentioned in Section 1. Climate change is a further risk factor, but is considered to be of less importance than globalisation. In the field of animal or plant health, there are fears about imported diseases related to the movements of animal and plant populations and pathogens, the spread and delocalisation of risks, and the emergence of new pathogens. These would have an economic impact (lower yields, or diseases affecting production livestock) but also a health impact if the diseases in question proved transmissible to humans. The food sector can also be affected by the complexity of trade flows which can lead to the transfer of pathogens via contaminated foods. In this field, it is more difficult to make predictions. The challenge here is not to predict but to be sure that ANSES has a work programme for developing a full set of key skills so as to be able to provide a quick response, while also developing tools for rapid detection in animal and plant health. These can take a variety of forms:
• the search for weak signals on the Internet (media, repositories of scientific literature); • detection by random gene-sequencing in all areas, in combination with consultation of
databases; • searching for the onset of syndromes in human or animal populations, independently of the
search for a cause, which is the following stage; • organising the players on the ground into networks.
One cause of concern is the possible reduction in resources attributed by the public authorities in this field, especially at local level.
This risk was also discussed with regard to the development of technologies. Possible causes of concern included:
• a lack of data on the products embodying new technologies. This is the case regarding chemicals resulting from green chemistry or biotechnology or nanoparticles;
• vaccines and the interesting notions of cost/efficacy or efficacy/risks, which are largely dependent on individual and collective beliefs and behaviour;
• regarding biological agents: the genetic manipulation of microorganisms, with synthetic biology as an extreme case. More generally, genetic selection also causes concern. This vast field raises questions concerning risk (the creation or modification of pathogens, threat to biodiversity, vulnerability as a result of excessive genetic uniformity), ethics (the
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consequences of being able to determine individual susceptibilities) and society as a whole (if scientists create life, where will it lead and how will it be perceived by the community?).
c) Physical agents Concerning innovations and technologies, the group looked particularly at radio frequency radiation, which it regarded as one of the most important issues of the next 10 years. Work in conditions of artificial lighting is likely to be another subject of study, especially with technologies such as LEDs, with which we so far have little experience. Developing technologies: Nanotechnology can be classed in this topic, even though, strictly speaking, this does not really involve physical agents. There is an increasing amount of work on the characterisation of exposure to nanoparticles and the associated dangers. As this research progresses, more complex subjects such as the question of low doses are likely to emerge, which seems logical considering the ubiquitous nature of these technologies.
A second approach, summarised below, was more closely related to practices in the workplace, farming and food.
d) Occupational health This field also takes account of chemical, biological and physical agents as mentioned above, but with specific relevance to the workplace. Among the expected changes discussed were:
• risks related to new occupations: Green technologies, waste recycling, the continued existence of numerous occupations exposed to chemical risk;
• new types of organisation at work, implying considerable changes to the factors of psychosocial risk in the workplace;
• the ageing of the working population, which will give rise to new risks and the need for taking better account of considerations on adapting workstations, retention in employment as well as on ways of managing the end of the professional lives of older workers;
• working from home and different forms of individual work; • the blurring of boundaries between private and professional lives; • occupations entailing increased exposure due to mobility (such as nomadic or itinerant
working practices); • less job security generally.
A large proportion of the participants in the symposium were concerned about social change (the economic crisis, globalisation, lack of job security, etc.) and its impact on the world of work (see the Annex). Working conditions were mentioned, partly because poor working conditions are risks in themselves but also because they can exacerbate the risks discussed above. There are also risks that interact between the world of work and society at large, such as addictions, which can also be found in the workplace. One member of the Scientific Board emphasised an alternative approach developed as part of the ISO 26000 standard published in 2010 (corporate social responsibility), which consists in promoting health rather than concentrating on risk.
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e) Agricultural practices Two topics were discussed in particular:
• Alternative production methods: Practices will be forced to change as a result of environmental constraints (pressure to eliminate biocides) and changing consumer habits (organic produce, novel types of foods) together with the need to maintain high yields. It seems likely that alternative practices will spring up in the gap between organic farming and more conventional methods. ANSES will face a growing demand for assessments of these new practices, particularly from the benefit/risk angle. There is already considerable interest in this approach as regards GM organisms and organic products and this is bound to intensify.
• Resistance to antimicrobials and biocides. It seems inevitable that such resistance will increase. This leads to the development of alternative methods, but they too will be subject to risk. Here as well, it will be necessary to monitor the risks related to the development of these methods.
f) Food This subject is considered to be of great importance for the future. ANSES will be confronted with three phenomena:
• Non-infectious chronic diseases: food is expected to acquire greater importance in the years to come because of its association with metabolic disorders (diabetes, obesity). The economic crisis and social inequality are particular aggravating factors;
• Fads: consumer behaviour can be affected by fashion (products supposedly “good for you”, the pursuit of fitness, novel and “ethnic” foods, food supplements, short supply chains, etc.). The enthusiasm of consumers for such products or practices, combined with the ease of buying them over the Internet, could provide much grist to the mill for the ANSES 2020 work programme.
• Changing practices: some of these have already been mentioned in the Agriculture section. Another source of concern is the increasing difficulty of tracing foodstuffs from the farm to the fork because of the complexity of the distribution system.
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IV. The future agenda
a) Subjects that will still be topical It is difficult to forecast what will be on the political agenda almost 10 years in advance, not least because it will also be shaped by health and environmental crises, advances in knowledge and the concerns of stakeholders. On the other hand, many of the subjects dealt with by ANSES are long-term issues, several of which can be expected to remain topical. As a result, the participants in the symposium saw the following items as being relevant in 2020:
• Chemical contaminants: considering the on-going assessment of substances in circulation as a result of the European REACh Regulation, and also the increasing incidence and prevalence of various non-infectious chronic disorders (diabetes and obesity, cancer, allergies), it seems probable that this issue will be of increasing concern, as may water quality. Various new concepts may be expected to come to the fore, such as the issue of low doses of multiple contaminants, and that of endocrine disruptors, which are currently being recognised as a specific threat;
• Electromagnetic waves: modern society could almost be described as mobile phone-
dependent or, yet more generally, wireless-dependent, a dependency that is likely to increase with the growth of home automation or the notion of an Internet of on-line objects (i.e. wireless-connected household appliances). There is unlikely to be any reverse of this trend, unless a clear correlation can be found between exposure to radio frequencies and severe pathologies. Despite the high degree of interest in these technologies, there are some clear concerns about risk. By 2020, several studies will have been undertaken (investigating mechanisms, epidemiology, exposure of the general population and workers, with greater hindsight concerning the use of mobile phones), which should gradually create a shared knowledge base for consultation by the stakeholders. However, it is likely that controversy will remain (see below) and that new issues will emerge with new technologies.
• Nanotechnologies: concerns about the risk of manufactured products with nanometric status
emerged at the start of the 2000s and, in 2012, we still have little experience. Over the next 10 years, the results of several toxicology studies already undertaken and also, for example, the experience acquired from national databases of products incorporating nanometric particles5, will give us greater hindsight. It nonetheless remains probable that the matter will not be closed in 2020. Questions will remain, including regulatory issues and the effects of nanoparticles, and other, more sophisticated, products will appear on the market, raising new questions. “Nano” solutions will also probably be suggested as substitutes for compounds deemed undesirable. After a wave of questions concerning the effects on humans, one can also expect questions to be raised about the effects on the environment. Factors governing the likelihood of such a subject remaining on the agenda will include: feedback resulting from regulation of such substances, advances in knowledge on their safety or otherwise, and any calamitous event;
• Infectious diseases and non-transmissible chronic diseases: the incidence of non-infectious
chronic diseases (diabetes and obesity, cancer, allergies, neurodegenerative disorders) is
5 In France, a database was set up in 2013, under the second law inspired by the Grenelle Environment Round Table.
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constantly increasing and they now constitute the primary cause of mortality. For this reason they are at the forefront of concerns and will certainly be on the agenda whether through consideration of health inequalities, chemical agents or diet. ANSES is primarily involved in the issues of infectious diseases through its focus on animal health. Infectious diseases will remain on the political agenda. Unlike chronic diseases, infectious diseases (such as BSE, H1N1 or E coli O157:H7) often give rise to crises sometimes on a considerable scale (sometimes objective, but sometimes exaggerated by the media), as reminders of how vulnerable society is to microbiological risk. This vulnerability has by no means diminished and if anything is exacerbated by our current lifestyles. In addition, the massive use of antimicrobials is making various pathogens increasingly resistant. Participants in the symposium concluded that such topics will remain on the agenda and that history shows that if there is one thing that is sure to turn up, it is the unexpected. In ANSES’s field of competence (animal and plant diseases) the only reliable rule is to maintain the ability to sound the alarm and to respond rapidly.
It should not be ruled out that one of these subjects may emerge as the result of media hype following the publication of a scientific article or issues raised by stakeholders (as with concern about aluminium and neurodegenerative diseases).
Other subjects with broader applications will no doubt also make headlines.
• The workplace: Questions related to the agents mentioned above will remain on the agenda. We can however expect a greater number of questions related to working conditions as a result of the economic crisis, globalisation and the ageing of the working population. Participants concluded that all of the related subjects, such as psychosocial disorders, organisation of work and lack of job security were likely to become more topical than ever;
• The agri-food sector: The first half of the 21st Century will be devoted to a transition towards more environment-friendly practices. We can expect endless debates on the cost/benefit ratio of alternative methods of production. In the same way, the issue of animal welfare could gain a higher profile in the future. These discussions regarding agri-foods could also be combined with issues concerning some of the agents mentioned above; chemical contaminants, added nanoparticles, and pathogens. Furthermore, as already occurs periodically, new nutritional behaviour patterns may emerge in smaller communities, facilitated by the Internet, whether inspired by the Anglo-Saxon model, obsession over body image, or fear of non-infectious chronic diseases. It will then be necessary to consider the corresponding risks. The issue of pesticides deserves special attention, considering the tonnages involved. Some of the participants in the symposium believe that the issue could make headlines in 2020, bearing in mind the accumulation of proof of their effect on health (e.g. neurodegenerative diseases for certain compounds). It will affect those working in agriculture, the general population, and animals, plants and soil. Another problem likely to become more acute is the issue of the development of resistance to pesticides, antiparasitics and antimicrobials, combined with the need to work with lower
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doses. The Agency will be obliged to become involved in this subject, particularly in topics such as multiple or combined exposure, low doses and chronic effects.
b) Loss of faith in science Participants in the symposium thought deeply about the central role of science in risk assessment, and also of its fragile nature:
• Science is not always able to provide a clear-cut opinion on the presence or absence of hazard or risk, as the public would like it to. There are so many uncertainties surrounding both traditional subjects, such as chemicals, and more recent issues, such as those related to new technologies, that it can be impossible to come to a definitive conclusion. As a result, any clear position is likely to be questioned immediately on the grounds that certain aspects have not been thoroughly investigated, while a more cautious response may be interpreted as an admission that there is a risk;
• It can be difficult for the general public to grasp the notion of scientific proof, especially when this involves mathematical abstraction or modelling. Furthermore, knowledge progresses through periods of controversy that divide scientists themselves. This is particularly true in the field of risk assessment in which different approaches are used by different disciplines, and even within given disciplines, thus opening the door to controversy;
• Moreover, the circulation of vast amounts of information and misinformation on the web and on social networks, and the dangers of exaggeration, make it practically impossible for the uninitiated to sort fact from fiction6. Subjects are considered in very different ways, as a result of the coexistence of information of varying status, especially when individuals tend to select information that supports their own suspicions or convictions, irrespective of its origin.
To conclude this part of the report, we recommend looking at the Annex which contains the results of a survey of symposium participants.
6 Such phenomena can already be seen in cases of medically unexplained syndromes, in a loss of confidence in the State (e.g. vaccination campaigns, which could have serious consequences in the event of a real epidemic), and in other controversial subjects (GMOs, electromagnetic radiation)
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V. Discussions of working methods
The participants in the symposium also discussed changes to the Agency’s working methods. They foresaw a trend that could be summed up with the expression “integration and cross-cutting disciplines”.
a) The complexity of the modes of action of chemical or biological agents In the field of chronic non-infectious diseases that can be associated with exposure to chemicals in low doses or over long periods: exposure of the general population is the result of complex exposure, to which must be added the complexity of the modes of action of the agents themselves. Some population groups have higher sensitivity thresholds than others7 and vulnerability can also vary at specific periods. The traditional exposure-danger-risk approach for each substance will remain valid, at least for risk assessments concerning individual products, but it will be completed by a more global vision of the exposure of the population by taking more complex concepts into account, such as synergies between contaminants, windows of exposure, individual susceptibility and vulnerable population groups. This type of approach is closely related to fundamental research projects, meaning that ANSES will need to form partnerships with research institutions. In the field of transmissible diseases, the complexity of the factors that determine whether or not a disease will emerge is well known. Considering the multiplicity, and indeed the unpredictability, of the possible scenarios, the Agency cannot deal with every eventuality. It needs to develop detection and reaction capabilities to enable it to confront any scenario. To develop the necessary capacity would require rapid methods of analysis and massive recourse to databases to detect weak signals and track down pathogens rapidly.
b) The use of integrative concepts ANSES’s work in 2020 may require the adoption of integrative concepts providing a multidisciplinary explanation of exposure taking several routes of exposure into account (dietary, respiratory and dermal). Several possibilities were suggested including:
• an approach that focuses on individual diseases, involving the observation and interpretation of changes in the incidence and prevalence of a given disease and its determining factors;
• the notions of resistance (to antimicrobials, pesticides, etc.) or barriers (epithelial, species, etc.) which encompasses defence mechanisms against harmful agents, via research into such topics as cellular mechanisms of action, either with animal models or in vitro;
• exposomics, which takes into account all the ways in which an individual is exposed to various aggressive agents from before birth and throughout his or her lifetime;
• syndromic surveillance: rather than looking out for specific hazards, the aim is to try and detect the appearance of syndromes in the population;
7 To give an example, one might imagine a future in which many individuals have had their genome analysed or have information on biological markers, which could reveal new forms of vulnerability.
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• health promotion activities as ways of identifying the factors influencing individual and collective health, so that action can be taken to reduce the effect of these factors either on the entire population or, depending on specific characteristics, on subgroups of the population (vulnerabilities, behaviour, etc.).
It was suggested that health agencies could work more closely together and that cross-disciplinary discussions should be encouraged between Expert Committees.
c) And society in all this? Many of the risks mentioned above are directly influenced by socio-economic, sociological and even cultural factors. It is only possible to understand these risks when considered alongside the consequences of any measures taken to mitigate them. Such approaches might be called:
• risk-benefit approaches (e.g., for a technology used as a substitute for another with known associated hazards),
• assessment of practices (the example given above of production practices for a more sustainable agriculture),
• evaluating the cost of inaction, weighing prevention against therapy, • socio-economic factors, • taking vulnerability and social inequalities into account.
d) A new wave of input from information technologies The increasingly widespread use of micro-technologies means that we can expect qualitative leaps due to the widespread use of embedded sensors and the geolocation of data. It will be possible to treat the notion of exposure in greater detail by taking into account the behaviour patterns of each individual. Another field which has seen impressive advances is that of data processing, and the search for sense in vast accumulations of heterogeneous data. Tools for collecting, processing and analysing information from the Internet, databases, or other media offer many new possibilities. These might include keeping abreast of the latest scientific research and debates or picking up weak signals (e.g. by analysing blogs or social networks) that may indicate the emergence of a new health issue.
e) The nature and status of expert appraisal As discussed above, the status of scientific proof will probably have to change because of the influence of such factors as controversial health issues, especially those concerning different ways of producing scientific knowledge, or the success of the Web and various networks as vehicles of a wide range of opinions, not all of which can claim to be supported by scientific procedures. The symposium did not look into the consequences of these expected changes but it seems likely that they will have an impact on risk assessment and the way its results are published. ANSES may need to rethink its relationship with society at large, how to involve the general population in the production of knowledge, the organisation of its internal expert appraisal procedures, its working methods, and lastly its lines of communication.
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Another topic raised during the symposium was, the restriction, and possibly the ban, on animal testing for ethical reasons. Since animal models cannot always be extrapolated to the human case, such tests cannot provide proof for identifying hazards, but they are nonetheless considered to be very useful for assessing these same hazards. If, in the comparatively near future, risk assessment could be done on the basis of tests on cell strains and digital simulations to represent an organism, this would revolutionise substance assessment.
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VI. Discussing prioritisation
a) Prioritisation based on multiple criteria Participants were asked to prioritise risks. During the preparatory work for this event, an analysis grid was drawn up.
Nature of the factor and the corresponding risk
Time horizon for the risk: • Risk already current in 2012 and which will still be current in 2020 • Emerging in 2012 and will be a reality in 2020 • Risk that will start to become apparent in 2020 but is likely to become a long-term issue
Severity of the risk • Consequence in terms of severity8 • Population affected and/or gradients of exposure or effects within different segments of the population • Uncertainty about the risk • Possibility of large-scale events, either locally or on a global scale (alerts, crises) • Sensitivity of the issue, existence of controversy • Associated economic costs
Preventive measures required to address the risk • Development of skills within working groups, • Internal research and development activity on analytical methods, R&D contracts • Inclusion in the French National Research Programme for Environmental and Occupational Health
(PNREST) • Organisation of national and international partnerships, networks for science watch and surveillance • Formal requests?
Impact of the work of ANSES on public policy
There was insufficient time during the symposium to prioritise these responses. However, in the course of discussions, different families of risks became clear, based on two criteria.
b) The time horizon for the risk Risks can thus be divided into three categories:
• First, risks already known in 2012 and which will still be current in 2020, related to chemical, physical or biological agents;
8 This expression needs to be defined in terms of the field in which it is used: health, social, economic, etc. severity, as is also the case for the indicators used to define it.
20
• Those emerging in 2012 that will be current in 2020. This category can include changing practices in the agri-food sector (reduced inputs, alternative methods), nanotechnologies (an issue that is likely to have attained a certain degree of “maturity”), endocrine disruptors (bearing in mind the knowledge that should have been accumulated by then), green technologies or factors more generally related to climate change and the scarcity of resources. Increased risk in occupational health as a result of globalisation and the economic crisis;
• In the longer term, other technologies (such as synthetic biology), novel foods, and the effect of climate change.
c) The nature of the risk ANSES deals with two main types of situation that can take the form of risk.
• Those that tend to break out suddenly and intensely. This primarily concerns relatively high risks such as those related to transmissible diseases in animals or plants; participants in the symposium emphasised the unpredictable and potentially severe nature of these outbreaks. Other situations are possible, such as a sudden change in dietary behaviour which, following a health scare, might appear as risky, or massive environmental chemical pollution.
• Those that are suspected or feared of being associated in the medium or long-term with
degradation in the quality of life or comparatively severe effects on health. In this category we might place risks judged to be low but concerning large numbers of people and related to nutritional, respiratory and dermal factors, chemical contaminants in food, certain chemical substances such as nanoparticles, and related socio-economic factors. The risks here concern non-infectious diseases whose incidence and prevalence is on the increase (metabolic disorders, diabetes and obesity, certain cancers, cardiovascular diseases, allergies, and neurodegenerative diseases).
Some of these situations are still the object of considerable scientific controversy as there is no consensus as to whether the risk is proven, possible or indeed probable. They are likely to include controversies already in the news in the early 2010s and will remain on the agenda but that, we may hope, will benefit from some degree of hindsight after eight years of research. One comment that was made during the symposium was that with increasing progress in analytical methods, slighter and slighter traces of chemical and biological contaminants will be identified. Such progress may well profoundly modify the notion of low doses. The difference between the risk threshold and the detection threshold is growing all the time. It will therefore be necessary to consider the significance of these traces in the context of risks to public health and the perception of these exposure limits.
21
VII. Conclusion
The symposium provided a forum for initial discussions about the medium-term future of ANSES’s activities. Participants were given an overview of the factors driving change in risk assessment and the risks to which the population is likely to be exposed in the medium term. It was agreed that environmental and socio-economic factors as well as intensive production in a globalised context and social change, are all bound to affect the way we determine risk. Looking ahead to 2020, it would appear that subjects already in the news in 2012 will continue to be so, but that we can expect some of these themes to arise associated with the forces driving change mentioned above. And we should never forget the possibility of unexpected crises (especially those associated with pathogens). The symposium also produced a certain number of avenues for discussion on future ways for the Agency to function:
• For risks associated with crises: stronger surveillance systems, with greater use of information technologies, combined with a continued effort concerning the ability to analyse and respond to animal health events in particular;
• For sets of “diffuse” risks (e.g. those related to chemical agents such as endocrine disruptors, pesticides, etc.), investigation should not be restricted to a single approach per product but should take a more overall view, including exposure (exposomics), society (economic aspects, socio-economic inequality, etc.), and integrative concepts (resistance, barriers, diseases, etc.). Such approaches, which diverge from traditional methods of expert appraisal, may require closer cooperation between ANSES and higher education institutions.
• The question of science-based risk assessment was debated at some length. This subject needs to take account of both the nature of science (including the different approaches used in different disciplines and various controversies) and the social dimension (communication, the relationship between assessment and stakeholders). Some of the participants felt that change was inevitable, especially since the explosion in means of communication (the Web, social networks and search engines).
22
ANNEX Introduction On the evening of 17 September, the 25 participants each received a questionnaire during the opening session, i.e. prior to the workshops that took place the following morning. They were asked to indicate what they thought would be on the agenda for 2020 of the ministers responsible for:
- occupational health - the environment - health - consumer affairs - agriculture (regarding animal health) - agriculture (regarding plant health) - and food.
Respondents were also asked to indicate their degree of competence (from 1 to 5) in each subject. After analysis it was found to be difficult to distinguish between responses from “experts” and “non-experts”. The responses were then analysed (the questions were open-ended) and compiled into blocks for each major subject. No weighting was used: if two responses fell in the same block they were counted as one. Furthermore, if a single response fell between two blocks (e.g. chemical risk and biological risk) it was divided into two with a coefficient of one. The scores were then listed in order of the competence declared by respondents. Scores by themes were then expressed as a percentage of the total of all responses within the blocks of major subjects. A column was added on the right to explain the response or to mention themes that did not fall within the blocks of responses treated quantitatively. Principal results
• In the field of occupational health, the highest score was obtained by fears associated with globalisation and new types of organisation of work generally (35%). This was followed by the issues of insecurity and unemployment (19%). The risks with the highest scores were chemical risk (17%), risks due to new technologies (15%), and the issues surrounding nanometric particles and asbestos (9%).
• In the environmental field, the main concern involved the risks related to technologies (26%), followed by those related to environmental constraints: energy (20%) and water resources (20%), recycling practices (11%), climate and biodiversity (11%).
• Concerning consumer affairs, globalisation and the lack of regulation accounted for 43% of responses, ahead of new technologies (37%) and foods (20%).
• Regarding health, most disorders are represented: diabetes and obesity (21%), infectious diseases and antimicrobial resistance (21%), old age and neurodegenerative diseases (19%), reproductive disorders and the effects on offspring (10%), cancer (7%), and allergies (7%). It should be noticed that the multi-topic theme “impoverishment-inequalities-vulnerability” scored highly with 16%.
23
• In the field of animal health, it was predicted that highest on the agenda would be infectious diseases (37%), changing production systems (24%), resistance to antimicrobials and antiparasitics (20%), animal welfare (10%), and loss of biodiversity (8%).
• In plant health, a majority of responses concerned the return of pests, often linked to the reduction in the use of pesticides, new technologies and agricultural practices (20%), reduced soil fertility or the shrinking of cultivable areas (20%), the climate (12%) and globalisation (10%).
• For foods, “junk food” scored highest (19%), closely followed by additives and the effects of fads plus purchases over the Internet (17%), then “authentic” produce (organic, short supply chains) and biological contamination (15%), issues related to the economy (13%), while chemical residues and nanomaterials on the one hand and high prices on the other each scored 11%.
24
3 1 1 1 1
8 1 1 1
10 1 1 1
11 1
12 1 1 1 1
13 1 1 1 1
14 1 1 1
15 1 1 1 1
17 1 1
18 1 1 1 1
20 1 1 1 1
21 1 1
22 1 1
5 2 1 1 Predicting harmful effects
7 2 1
9 2 1 1
24 2 1 1
1 3 1 1 Ageing population
2 3 1 1 Genetic/bio. screening
6 3 1 1 1
23 3 1 1
4 4 1 1 1
16 4 1 1 Medication - Lifestyle
19 5 1 1 1
25 5 1 1 1 Neurodegen. diseases
Occupational health Id
entif
icat
ion
num
ber o
f res
pond
ents
Com
pete
nce
(5 =
exc
elle
nt)
New
tech
nolo
gies
– G
reen
jobs
R
F –
Nan
o –
ICTs
– B
iolo
gy
Nan
o an
d as
best
os
Che
mic
als –
CM
R-p
estic
ides
Stre
ss –
loss
of r
outin
e –
psyc
hoso
cial
di
sord
ers –
glo
balis
atio
n –
dere
gula
tion
Mus
culo
skel
etal
dis
orde
rs
Une
mpl
oym
ent –
job
inse
curit
y Jo
b/ris
k ba
lanc
e
Oth
ers
Total 54 occurrences
8 5 9 19 3 10
15% 9% 17% 35% 6% 19%
25
Environment Id
entif
icat
ion
num
ber o
f res
pond
ents
Com
pete
nce
(5 =
exc
elle
nt)
Was
te –
recy
clin
g
Ener
gy sh
orta
ges –
risk
s and
ene
rgy
tech
nolo
gies
–
nucl
ear p
ower
– b
uild
ing
ther
mal
insu
latio
n
Che
mic
als –
pes
ticid
es –
nan
o is
sues
– te
chno
logi
es
in g
ener
al
Wat
er re
sour
ces –
pol
lutio
n –
recy
clin
g
Indo
or a
nd o
utdo
or a
ir
Con
tam
inat
ed so
ils a
nd si
tes
Clim
ate
– bi
odiv
ersi
ty
Oth
ers
Total 46 occurrences
5 9 12 9 7 4 8 11% 20% 26% 20% 15% 9% 11%
3 1 1 1
10 1 1 1
11 1
12 1 1 1
17 1 1 1 1
20 1 1 1
8 2 1 1 1
9 2 1
13 2 1 1
18 2 1 1
21 2 1 1 1
24 2 1 1
1 3 1 1 1 Index to measure degradation
2 3 1 1 1 Sharing data over networks
5 3 1 Migrations Combinations of risk
6 3 1 1 1
14 3 1 1 1
15 3 1 1 1
22 3 Indicator of environmental health Remuneration of ecological services Risk of environ. management
23 3 1 1 1
7 4 1 1 Loss of agricultural soil
16 4 1
19 4 1 1 1
25 4 1 1 Multiple exposure
4 5 1 1 1
26
Consumer affairs Id
entif
icat
ion
num
ber o
f res
pond
ents
Com
pete
nce
(5 =
exc
elle
nt)
New
tech
nolo
gies
– n
ano
issu
es –
smar
t ite
ms –
nov
eltie
s – re
cycl
ing
prac
tices
Food
– fo
od a
dditi
ves –
obe
sity
Lack
of c
ontro
ls –
frau
d (g
loba
lisat
ion,
In
tern
et, l
ocal
pro
duct
ion)
Oth
ers –
key
wor
ds
Total 30 occurrences
11 6 13 37% 20% 43%
5 1 1 Controls – unfair competition
8 1 1 Imported products – controls
10 1 1 Water resources
11 1
3 1 1 1 Nanotechnology – Internet sales
14 1 1 Contamin. fishery produce – packaging – GMOs
17 1 1 Urban development – recycling
18 1 1 Poverty and unemployment – malnutrition
20 1 1 1 Uncontrolled sales – addictions
21 1 Transport/access to data/foods
22 1
24 1 1 Local production
3 2 1 1 “Natural” products – claims
7 2 1 1 Imported products – risks of new technologies
9 2 1 Internet sales
15 2 1 Aerosols – air purifiers
19 2 1 Smart products – RF – allergies
25 2 1 Children – Chronic risk
1 3 1 1 1 Nutraceuticals
2 3 1 1 Imports – fraud
4 3 1 Foods/young people – obesity
6 3 1 Contaminated imported products
12 3 1 1 New products – fraud
16 3 1 Products for children – vulnerable populations
23 3 1 Dietary behaviour
27
Health Id
entif
icat
ion
num
ber o
f re
spon
dent
s
Com
pete
nce
(5 =
exc
elle
nt)
Can
cer
Dia
bete
s – O
besi
ty –
sede
ntar
y lif
esty
les
Vec
tor-
born
e tra
nsm
issi
ble
dise
ases
– a
ntim
icro
bial
resi
stan
ce
– va
ccin
atio
n
Alle
rgie
s – a
utoi
mm
une
diso
rder
s –
asth
ma
Rep
rodu
ctiv
e di
sord
ers –
eff
ects
on
off
sprin
g
Old
age
– d
epen
denc
e –
neur
odeg
ener
ativ
e di
seas
es
Impo
veris
hmen
t – in
equa
lity
– vu
lner
abili
ty –
mal
nutri
tion
Oth
ers –
key
wor
ds
Total 58 occurrences
4 12 12 4 6 11 9 7% 21% 21% 7% 10% 19% 16%
20 ? 1 Link toxicity/chronic
diseases – Food supplements – drugs
11 1 1 1 1
14 1 1 1 Waste water
17 1 1 1 1
22 1
3 2 1 1 1
8 2 1 1 Chronic diseases in general
9 2 1 1
10 2 1 1 Organisation of care
18 2 1 1 1
25 2 1 1 1 1
1 3 1 1 1
2 3 1 1 Mental disorders Addiction to technology
12 3 1 1
15 3 1 1 Addictions
16 3 1 Environment – Air Climate change
19 3 1 1 1 Chronic diseases
23 3 1 1 1
24 3 1 1 1
4 4 1 1 1
6 4 1 1 1
13 4 1 New drugs
21 4 1 1 1
5 5 1 1 Managing uncertainty
7 5 1 1 Chronic diseases in general
28
Animal health Id
entif
icat
ion
num
ber o
f res
pond
ents
Com
pete
nce
(5 =
exc
elle
nt)
Zoon
osis
A
nim
al e
pide
mic
s R
esis
tanc
e to
ant
imic
robi
als o
r ant
i-par
asiti
cs
Bio
dive
rsity
– e
cosy
stem
s
Ani
mal
wel
fare
Cha
ngin
g pr
oduc
tion
syst
ems –
Tec
hnol
ogie
s
Total 49 occurrences
18 10 4 5 12 37% 20% 8% 10% 24%
14 1
15 1
2 1 1 1 Climate and birds surveillance network
3 1 1 1 1 Zoonoses – Organic farming
5 1 1 1
Inspections of intensive livestock units – Reducing the use of drugs
8 1 1 1
16 1 1 1 Traditional farming – GMOs
18 1 1 Cloning
19 1 1 1 Diseases and travel Genetic engineering
4 2 1 1 1 Zoonoses
9 2 1 1 Cloning
22 2 1 1 Zoonoses – Health and stockbreeding systems
23 2 1 1 1 Animal epidemics – Food chain
25 2 1 Globalisation – Climate
1 3 1 1 Cloning – Zoonoses
7 3 1 1 1 Animal epidemics – Conservation of species
20 3 1 1 1
10 4 1 1 Arboviruses – drug monitoring
17 4 1 1 1 Industrialisation
24 4 1 1 1 Arboviruses
6 5 1 1 Animal epidemic – Vector-borne zoonoses
11 5 1 Bovine tuberculosis – Vector-borne disease Disease reservoirs
12 5 1 1
13 5 1 1 Nano and biofuel by-products in foods
21 5 1 1 Recombinant viruses
29
11 1
2 1 1 1
15 1
3 1 1 1 1
4 1 1 1 GM crops – Fertilizers
5 1 1 1 Quality/quantity
6 1 1 Prices
8 1 1 Reduced biodiversity
10 1 1 1 Controls on the flow of plants Forest loss
14 1 1 1 Climate and new diseases
16 1 1 Urban farming
17 1 1 1 Mycotoxins
18 1 1 1 GMOs – Bioterrorism
19 1 1 1 Pollination
20 1 1
21 1 1 1 GMOs
24 1 1 Pesticides and pests
25 1 1 1 GMOs, Herbicides, Microorganisms
7 2 1 1
9 2 1
12 2 1 1 Inputs – GMOs – pests
13 3 1 1 1 Tree die-back Synthetic biology
1 3 1 1 GMOs and mutagenesis Good practice
23 4 1 1 New diseases
22 5 1 Plant protection methods Mycotoxins
Plant health Id
entif
icat
ion
num
ber o
f res
pond
ents
Com
pete
nce
(5 =
exc
elle
nt)
Stre
ssor
s an
d re
duce
d pl
ant
treat
men
t –
pest
s –
resi
stan
ce
Impo
veris
hed
soil
and
redu
ced
land
are
a fo
r fa
rmin
g –
Wat
er –
Thr
eat t
o bi
odiv
ersi
ty
Clim
ate
and
adap
tatio
n
Glo
balis
atio
n
Tech
nolo
gies
B
iolo
gica
l pra
ctic
es
Key
wor
ds
Total 41 occurrences
14 8 5 4 10 34% 20% 12% 10% 24%
30
Food Id
entif
icat
ion
num
ber o
f res
pond
ents
Com
pete
nce
(5 =
exc
elle
nt)
Bio
logi
cal c
onta
min
atio
n or
toxi
ns
Che
mic
al re
sidu
es N
anom
ater
ials
Add
itive
s – F
ads –
Nov
el fo
ods –
In
tern
et –
Tec
hnol
ogie
s
Junk
food
– O
besi
ty
Org
anic
pro
duce
– S
hort
supp
ly c
hain
s –
Aut
hent
icity
Impo
rtatio
n –
Com
plex
supp
ly c
hain
s –
Mon
opol
ies
Scar
city
– P
rices
Total 47 occurrences
7 5 8 9 7 6 5 15% 11% 17% 19% 15% 13% 11%
22
2 1 1 1 1 Green products
15 1 1 1
18 1 1
24 1 1 1 1 Risk/benefit
5 2 1 1 1
6 2 1
8 2 1 1 Systemic risk Pesticides
9 2 1 1
10 2 1 1 Health Protection
11 2 1 1
14 2 1 1 GMOs
16 2 1 Ageing population
17 2 1 1 1
19 2 1 1 Regional labels
21 2 1 1 1 1 Fraud Adulterated products.
1 3 1 1 Cocktail effect
3 3 1 Imports – Protecting health
4 3 1 Short sup. chains Local production
7 3 1 1 Loss of dietary diversity
23 3 1 1
25 3 1 Clones Additives Novel foods
12 4 1 1 Health Protection Antimicrobial resistance
20 4 1 Cocktail effects Nano packaging
13 5 1 1