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Committee on the medical effects of air pollutantsMinutes of the meeting held on Friday 24th June 2005 in Room 125A, Department of Health, Skipton House, 80 London Road, London SE1 6LH.
ITEM 1. OPENING REMARKS, APOLOGIES FOR ABSENCE AND ANNOUNCEMENTS 1. Apologies for absence were received from Mr Ben Armstrong, Prof. Dafydd Walters, Prof. Stephen Holgate, Mr Ronnie Alexander (Welsh Assembly), Mr Nigel McMahon (Northern Ireland), Prof. Anthony Seaton (CV sub-group), Prof. Peter Whincup (CV Sub-group), Prof. Dick Heller (CV sub-group), Dr John Townend (CV Sub-group) 2. The Chairman welcomed Dr Pat Saunders from the Chemical Hazards and Poisons division of the Health Protection Agency and Dr Amin Anjum who is the Policy Advisor on Incineration at the Environment Agency, both of whom were present to discuss paper COMEAP/2005/2 - The use of substitute fuels in cement kilns. 3. The Chairman welcomed Ms Inga Mills who will officially join the Department of Health on the 1st July and Paul Tuite who is assisting the Secretariat on a temporary basis until 1st July. 4. The Chairman reminded Members to declare any interests they may have. 5. The Chairman reminded Members to submit their expenses claims forms. ITEM 2. MINUTES OF THE MEETING HELD ON 18th February 2005 6. The Chairman took Members through the Minutes of the last meeting page by page. The following changes were requested: 7. Paragraph 39 line 282: change word 'thrombosis' to 'thrombus'. Line 334 required the input of the word 'changes' prior to the words 'in HRV'. Action: Secretariat 8. Members agreed that once the above-mentioned changes had been made, the minutes were agreed as an accurate record of the meeting. ITEM 3. MATTERS ARISING Annual Air Pollution Meeting - Leicester 9. Members were informed that the meeting had been successful and that the two-day format would not be changed as this appeared to work well. The Committee were informed that the abstracts from this meeting could be found on the IEH website. Dr Paul Harrison 10. The Chairman noted that this was the last meeting of COMEAP Dr Paul Harrison, Director of the MRC's IEH would attend. He was thanked for his contribution to COMEAP. Meeting Dates 2006 11. Meeting dates for 2006 were confirmed as follows: 24th February 2006 ITEM 4: USE OF SUBSTITUTE FUELS IN CEMENT KILNS COMEAP/2005/2 12. One member declared an interest in this topic. A representative from the Health Protection Agency introduced the topic and noted that COMEAP had previously looked at data from a representative cement kiln in Clitheroe which operated a wet process. On that occasion, the Committee had agreed that they could not see any difference in health risks associated with burning substitute fuels compared with traditional fossil fuels. The Committee were asked if they could extend that advice to the data on the kilns at Westbury and Ketton and whether a generic statement could be provided referring to all kilns burning similar fuels. If this was not possible, it was asked what further data would be required to facilitate the production of a statement. 13. The main alternative fuels burned at the Westbury and Ketton plants are Substitute Liquid Fuel or Secondary Liquid Fuel (SLF) and used tyres. SLF is produced by blending organic wastes. 14. Members were broadly reassured by the emissions data presented for burning of SLF and tyres. No measured ambient levels showed exceedance of Air Quality Strategy objectives. There was a feeling among a number of members that there were also environmental benefits involved in burning substitute fuels over traditional fossil fuels as this is a more efficient way of treating waste and resulted in reduced CO2 emissions. 15. It was expressed that it would be beneficial to know more about what happened when operations malfunctioned and the level of exposure during such periods. Some of these concerns were answered on hearing that waste can only be fed when the plant is operating at certain capacities (90 tonnes cement/hour) and in the event of malfunction, waste feeding ceases. If the electrostatic precipitator (ESP) fails, waste burning must also stop and in the event of malfunction, the facility to return to coal burning still exists. The plant must not operate for more than one hour in shutdown mode. The Committee were informed that data for SO2, NOx and particulates exist for malfunctioning periods as plants are now operating with continuous monitoring of emissions. 16. There were however, concerns over the fact that there were less data available for certain fuels, in particular sewage sludge, for which there were no data available on their fate in cement systems. 17. One member commented on the HPA initial position statement on cement kilns. The sentence 'This process environment means that substitute fuel is no more polluting to the environment than conventional fuels and for some key pollutants is actually less so' was considered misleading. The sentence was correct for NOx emissions, however, SO2 emissions showed increases in certain circumstances. It was also noted that the comparison with traffic was misplaced as cement kiln emissions were mainly coarse particles and therefore not comparable with the predominantly fine particle emissions from traffic. 18. The Chairman summarised that in general the feeling from the Committee was that members were reassured by the data presented. There was some concern over episodes when malfunctions occur but as safety measures were in place, this was not likely to be too much of a problem. On the whole, members were agreeable to a generic statement on the use of substitute fuels presented on this occasion (SLF and tyres), however the statement would not extend to the use of new fuels such as sewage waste. 19. There was discussion over whether COMEAP would need to provide separate advice each time a novel fuel was introduced. It was agreed that the Secretariat would draft a statement on the use of substitute fuels in cement kilns based on the information currently available to the Committee. The Statement would include some alternative paragraphs which would provide options for when COMEAP would be required to consider data on new fuels (for example, should COMEAP consider minor changes in fuels, or only fuels of more obvious concern, such as those with a high heavy metal content?). It was noted that the Committee was expecting to see a report commissioned by the Environment Agency on incineration in the near future and that a further statement may be prepared at that time. Action: Secretariat ITEM 5: CARDIOVASCULAR DISEASE AND AIR POLLUTION REPORT - COMMENTS FROM MEMBERS 20. Members had been provided with a draft for comment. It was acknowledged that all referencing required checking. A new version of Table 1.1 was tabled. It was pointed out that the figures in the table for Ozone were given as the 8 hour averaging time, as used in Chapter 2 of the report. 21. Other than specific suggestions for amendments, there were some more extended discussion points as follows: 22. There was discussion of possible reasons for heterogeneity as mentioned in paragraph xviii on page 12. The Committee was informed that there was a COST 63 project looking at heterogeneity in terms of both epidemiology and toxicity. 23. There was discussion of whether air pollution both caused and worsened cardiovascular disease. The Committee was not convinced that there was evidence for air pollution initiating the early stages of cardiovascular disease but could not rule it out. In addition, the interpretation of 'causing' would vary from person to person - for example, a member of the public might quite reasonably consider that causing a heart attack was not substantially different from causing heart disease. It was, therefore, decided to leave references to causing heart disease in the report. General actions requested 24. The following changes were suggested (actions for Secretariat unless otherwise stated): P7 iv (b) remove precautionary principle and change to precautionary approach P7 iv (b) Provide details of views regarding individual pollutants rather than referring to Chapter 4. P7 iv (b) 'very much more likely to be causal than otherwise' check consistency with other parts of the report (e.g.p308 'plays a part in causing' p300 'more likely than not to be causal' p291 (re long term) 'a guarded conclusion', 'the evidence suggests an association', 'the evidence is limited'. (See also later actions on some of these pages)). Add text on occupational exposure to Executive Summary P11 (xv) Amend to state that the above hypotheses were developed in relation to particles and less work has been done on possible mechanisms of effect for gaseous pollutants. P12 xviii Change last sentence to 'Though this is at present not well understood' P20 paragraph 1.4 remove 'initiation' and add 'triggers' P20 paragraph 1.5 - remove bracket containing the term initiating and all in it. P24 Table 1.1 - Defra to re-draft the table, combining the urban and suburban levels. Levels to be checked (rural PM looked a bit high). Action: Defra P32, para 1.22 Remove sentence 'The first three are the most important.' P32, para 1.22 List of risk factors to be re-ordered - 1st cigarette, 2nd obesity/lack of exercise, 3rd diet - the rest to be ordered as is. P63 Figure 2.4 and later figures. Change, if possible, caption on figures to read per 10µg/m3. P122-140 Occupational exposure section
P183 check the footnote to Table 2.30 - should read 113% not 213% increase. Check similar error not made elsewhere. P221 Figure 3.3 'C' missed off protein C on left hand side. P230 paragraph 3.39 Amend second sentence to reflect the fact that Ghio et al 2000 is a volunteer study not an episode study. P232 Amend 'it seems logical' to 'it has been suggested' in penultimate sentence. P239 para 3.52 check references. Professor Ken Donaldson to send correct references. Action: Prof. Donaldson P245 Figure 3.4 Heading of diagram to read '2 current hypotheses that link….' P245 Figure 3.4 Add arrow from Pulmonary Inflammation to Autonomic Nervous System. Shade / colour arrows. P249 Add comment about interstitialisation of particles and possible interaction with the autonomic nervous system. P291 Paragraph 4.12 4th sentence Amend comment that occupational exposure studies not supportive (it was not considered that the occupational exposure studies detracted from the ACS study). P291 Paragraph 4.12 4th sentence Amend comment that Seventh Day Adventist cohort study not supportive (it was considered a weak study providing an absence of evidence rather than firm evidence against). P291 Paragraph 4.12 Remove word 'guarded' from 5th sentence. P302 (ii) Make clear vehicle-generated particles refer to primary particles. P304 (v) Mention Hong Kong study in discussion of sulphur dioxide P309/311 a) Epidemiology studies. Mention possible use of MINAP database. P311 (viii) Mention possible use of Biobank project. P312/313 b) Laboratory studies. Consider wording on animal models. Consider recommending use of alternative models. Send report to BHF, BCS and RCP for comment. Action 25. Secretariat to make changes and re-draft sections as requested. Secretariat Comments 26. Members were asked to send all further comments on the report to the Secretariat within 2 weeks of the meeting. Action Members ITEM 5. QUARK II - VERBAL UPDATE 27. Mr Hurley, the chairman of the QUARK II sub-group informed the Committee that the first meeting of this sub-group had taken place on the 23rd June and that the first task of this group would focus on mortality from the effects of long-term exposure and secondly, morbidity. The sub-group had been split to form working groups which would work on specific aspects of the report, culminating in the first instance, in an interim report on long-term exposure for the Committee to discuss in June 06. A full report, which would include work on short-term exposure, would be brought to the June 07 meeting of COMEAP. The value of having such a strong multidisciplinary group was highly commended. ITEM 6. OZONE REPORT - VERBAL UPDATE 28. Dr Walton informed the Committee that a sub-group meeting would be taking place that afternoon. The revised conclusions to Chapter 9 had been circulated to the Committee. A first draft of Chapter 8 on the long-term effects of exposure to ozone would be discussed at the meeting that afternoon. It was expected that the Executive Summary and a revised version of Chapter 8 would be circulated to COMEAP in due course. ITEM 7. AOB London Underground and Tunnel Dust 29. The chairman informed the Committee that IOM's report on London Underground Tunnel dust had been published. The full report could be found on IOM's website and a paper in June's edition of Occupational and Environmental Medicine. Nanotechnology 30. Dr Maynard informed the Committee that the Nanotechnology Research Co-ordinating Group was holding a meeting on the 18th July concerning the preparation of a literature survey on research in nanotechnology in the UK. AQEG 31. Mr Meadows informed the Committee that the AQEG report on Particulate Matter in the UK had been published. It was agreed that all Members would receive an Executive Summary and full reports would be sent out by the COMEAP Secretariat to those who requested a copy. The Secretariat reiterated to Members that this was excellent piece of work. Members were encouraged to request a full copy. Action Secretariat Secretariat
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