Due to environmental and health concerns, mercury is the first hazardous element targeted for a global treaty, aiming to protect human health by reducing anthropogenic releases of mercury to the environment.

An International Negotiating Committee (INC) is responsible for preparing the text of the mercury instrument. The 4th INC meeting happened (June-July 2012) in Punta del Este, Uruguay, to further develop the draft text (1).

One relevant aspect of the negotiations is the discussion about the provision of timely and sufficient technical and financial cooperation f for capacity building and convention compliance. The INC is discussing financial arrangements to be included in the convention to support Parties to implement the convention.

Options to phase out mercury mining and trade are being discussed. Storage of remaining mercury is planned to be addressed. Control on mercury trade has being considered.

There are decisions still to be made by the INC regarding the options for mercury added products. Allowable-use exemptions with expiration date for exemptions, or simply allowable-use exemptions, or the options of prohibition, phase-out and essential use. Also the precise products to be included in each of these options and categories are still to be defined.

The fact that artisanal and small-scale gold mining activities accounts for almost half of the global mercury use is recognized. This recognition is not in isolation from the fact that these economic activities play a significant role on poverty alleviation. National action plans and time frames are being considered with technical cooperation for gold mining with mercury use alternatives development and implementation, including environmental education and health promotion. Implementing best practices with knowledge sharing are consistent with on-going work implemented by several international agencies – UNIDO, ILO, UNEP, WHO to mention a few. In particular, the INC has prepared text that would require countries with more than insignificant use of mercury in artisanal and small-scale gold mining to develop a public health strategy relating to such mining.

Mercury emissions and releases to atmosphere, water and land could be addressed under available technology and best practices guidelines combined with monitoring. Inventories of mercury use, emissions and releases are being discussed. Sharing information on strategies and methods to work on these different inventories will be key for a collective learning.

Discussions address actions needed to reduce atmospheric emissions from different sources – coal-fired power plants, industrial boilers, waste incinerators, cement, artisanal gold mining and others. This will include alternative technologies. Similarly requirements for mercury release into water and land environment are being discussed. Some interesting experiences have been shared (2). Guidelines in multiple languages will be helpful to harmonize and disseminate methods and outputs regarding mercury storage, wastes and contaminated sites.

Different sectors – health, environment, industry and education to mention a few, should interact for public information, awareness and education.

Financial resources and technical and implementation assistance will require coordination among different institutions from developed, developing and development transition countries. Financial arrangements are being discussed to assist developing country parties and parties with economies in transition implement the convention. . The INC is discussing proposal for facilitating information dissemination and exchange for the implementation of risk reduction strategies, with attention from different sectors and stakeholders. Coordination among different committees and involved ministers will be required.

Another aspect being discussed relates to the need for awareness-raising, research and monitoring, and communication. The draft text includes provisions relating to the need of providing public information on health and environmental effects of mercury; products and processes that involves mercury and potential alternatives, and research to increase health protection from mercury exposures. For such, communication material in different language and personnel training will be required.

There are a number of possible roles for the health sector, depending on the final text of the convention. These may include: facilitating implementation of any obligations relating to mercury use in health care, such as thermometers, sphygmomanometers and dental amalgam; public health strategies relating to artisanal and small-scale gold mining; and communication for health workers and the general public about health implications of different mercury forms and compounds exposures. Finally, it will be interesting to evaluate health impacts of policies in place for the mercury convention. It is under discussion whether a dedicated article regarding health aspects will be included in the convention.

The WHO has been proactive on addressing different aspects of mercury use in health care. Major attention has been devoted to replacement of mercury thermometers and sphygmomanometers in health care, on the basis that validated and affordable non-mercury alternatives are available. In order to assist decisions relating to materials for dental restoration, WHO convened a technical meeting and published a report detailing the features of dental amalgam and other materials. Significant efforts will be required to implement mercury replacement and storage of mercury added products used in health care (3, 4).

Thiomersal use in vaccines is one contentious issue. Thiomersal containing vaccines are globally used to protect more than 80 million infants. Thiomersal free vaccines would compromise current global immunization efforts due to increased logistics and financial costs, likely unaffordable where vaccines are mostly needed. Also, a new licensing application for new products would require extensive validation studies, with no guarantee that better vaccine preservatives could be produced.

The WHO and UNEP documents listed under references regarding toxicology of different forms and compounds of mercury and methodologies for mercury health impact and other related documents will be instrumental on several aspects of the future mercury convention. WHO regional offices will be active in cooperating with communication and adjustment of this wealthy of knowledge for each specific context. Useful documents to trigger actions can be observed at references 5 and 6. Translation of these documents will facilitate their use.

Institutional arrangements for the convention will involve a conference of parties, a secretariat, and subsidiary technical bodies can be established. The draft text also addresses settlement of disputes, further development of the convention and final provisions – such as signature, ratification, withdrawal, etc.

In brief, further implementation of the future mercury convention implies mobilization of different resources – in kind, technical and financial for training and implementation of actions. The health sector will surely need to play a relevant role in several of these activities. We recommend that professionals from health and other sectors be trained as trainers to act upon these mercury related activities.

References

1. Intergovernmental negotiating committee to prepare a global legally binding instrument on mercury (INC). International Institute of Sustainable Development (summary of INC4 meeting in Uruguay – June 27th-July 2nd 2012).
2. UNEP story of the month on mercury replacement and storage technologies.
3. WHO - Departamento de Salud Publica y Medio Ambiente Agua, Saneamiento y Salud - El Mercurio en el Sector de la Salud.
4. WHO – Health Care without harm – Mercury-free health care.
5.United Nations Environment Program – Chemicals Branch and WHO Department of Food Safety, Zoonoses and Foodborne Diseases (2008). Guidance for identifying populations at risk from mercury exposures.
6. Poulin J, Gibb H. (2008) Mercury: Assessing the environmental burden of disease at national and local levels. Editor, Prüss-Üstün A. WHO, Geneva, 2008. (WHO Environmental Burden of Disease Series No. 16).