Assessment of Chernobyl Health Consequences meets with resistance

Factors Influencing the Assessment of Chernobyl Health Consequences and the Contribution of International Non-governmental Organisations to Research and Treatment of Thyroid Pathologies in Belarus

By E. Lengfelder^(1,4,5), H. Rabes⁽²⁾, H. Scherb⁽³⁾, Ch. Frenzel^(1,4,5)

The Secretary-General of the United Nations, Kofi Annan, has repeatedly placed particular emphasis on the fact that millions of people continue to be directly affected by the consequences of the Chernobyl accident, that the acute suffering including health disorders continues, and that this disaster is a matter of global concern. Among the NIS countries, Belarus is mostly affected by the extent of radionuclide deposition, thyroid cancer incidence and many other effects.

Internationally, there is an intense and controversial discussion about which health effects in the population and to what extent they are truly caused by radiation exposure and those which are attributed to radiation, but are scientifically unsound. There are serious aspects how to look at and answer these questions, and scientists and the quality of their work become a very important factor, also in achieving political goals.

For the huge number of patients suffering e.g. from hypothyroidism or thyroid cancer, it is insignificant whether their disease can be scientifically attributed to radiation. Furthermore, it is also insignificant for the health system of the country, from which they expect to receive appropriate treatment. The Chernobyl accident was the largest and most severe disaster in the history of civil nuclear technology, which can and will happen again in one of the more than 400 nuclear power stations world wide, most of them being located in areas with a population density several fold greater than in the case of Chernobyl. The questions and answers concerning the particular health consequences of the accident and the possibility and effectiveness of countermeasures, are of extreme political and economical importance. There are essential interests of governments and industries internationally, e.g. to know about costs, how to inform the public, how to make preparations for catastrophe management; they need to get appropriate answers and results from scientists.

Learning from the past

If we do not know the past, we will not be able to understand the present and to make proper decisions for the future. This definitely applies also to the many announcements and reports on the health consequences after the Chernobyl accident that were released in particular by western governments, international bodies and the nuclear industry during the past 17 years.

During the first weeks after the accident, the authorities in Moscow released several orders to keep information on the issue Chernobyl secret. Later, in July 1987 the order was given that acute and chronic diseases of liquidators (emergency workers), who were exposed to less than 50 rem, must not be attributed to the effects of ionising radiation.

In 1990, the International Atomic Energy Agency (IAEA) organised the International Chernobyl Project, with the participation of the European Commission, the United Nations Scientific Committee on the Effects of Atomic Radiation (UNSCEAR), many countries in the West and others, to investigate and assess the radiological situation in the three affected Soviet Republics. 200 scientists from the West and 500 from USSR were sent by their governments to participate. Concerning the health impact, the IAEA team with the US Professor F. Mettler being one of the leaders concluded in 1991 that there were no health disorders, that could be attributed directly to radiation exposure. IAEA favoured psychological stress and anxiety to be the cause of health disorders observed. This information was disseminated world wide as the result of the work of so many scientists. However, in reality at this time the number of thyroid cancer cases in children in Belarus was already 30 times higher than the average in the 10 years before Chernobyl, although the absolute number of cases was low. But IAEA and other international organisations did not want to take into account the findings and reports of Belorusian and Ukrainian scientists on the marked increase in thyroid cancers.

The BBC investigated and broadcast several years ago in a TV documentary that as far back as 1990, F. Mettler in the course of the International Chernobyl Project and as the scientific representative of the USA, had analysed the pathological slides of thyroid cancers of 20 ukrainian children, confirming malignancy in all cases, which in this age group could not be due to background incidence. Mettler and his colleagues suppressed this fact and stated in their reports that there was none. As a result, international organisations and the UN did not start proper assistance programmes for the people affected and valuable time was lost. Because independent scientist from NIS and from the West continued to report on the increase in thyroid cancer, while scientist working for IAEA, UNSCEAR and governments in US and Europe denied it, WHO sent the British thyroid pathologist D. Williams, the radiation biologist K. Baverstock and some other experts to the Chernobyl region. They confirmed the findings on increased thyroid cancers and the probable link to radioiodine exposure from Chernobyl. The BBC also found that resistance to the idea was strongest in America. The US government has special reason to be wary. In the fifties the Department of Energy deliberately released a cloud of iodine131 to test how well they could track a plume. This added to other contamination from weapons tests. There were large releases of radioiodine from the Hanford nuclear facility over many years. Williams confirmed the evidence that large areas of the USA had a low level exposure to radioactive iodine. Naturally, the US government is very concerned and does not wish to be put into the position of admitting that they may have caused thyroid cancers and may have to pay compensation. According to Williams and other experts in this field there is a strong wish and hope that radioiodine would not be shown to be the cause of thyroid cancer. Vested interests in the West have distorted the issue of thyroid cancer. Fear of crippling compensation claims, entrenched views of scientists and the worries of industry about bad PR had all obscured investigation, by Williams. According USA laws, the compensation claims of American citizens, who developed thyroid cancer after these releases, could add up to many billions of dollars, which the government wishes to avoid paying.

International research projects on thyroid in Belarus

Two international research programmes on the health effects of Chernobyl are of special interest. In the Project 'International Cooperation for post Chernobyl NIS Thyroid Tissue, Nucleic Acid and Data Banks' the USA, the European Commission on behalf of the European Atomic Energy Community, Japan and WHO invited Belarus, Russia and Ukraine to form a collaborative research resource. In the description of the programme goals of the study are outlined, e. g. that competition among scientific groups should be avoided, that the study of the pathology and molecular biology of thyroid cancer should include the role of isotopes of iodine and of other factors influencing cancer incidence including exposure to other carcinogens, genetic factors usw.. All data are collected in Great Britain. The decisions e. g. which research group will receive cancer material and is accepted to participate in the project, will be made by a managing committee, where the Western participating countries and Organisations have a majority.

Also of great interest is the 'BelAm Project' in Belarus and 'UkrAm Project' in Ukraine. When the first compensation claims appeared in USA, the project started in 1996 in Belarus. A cohort of about 12 000 persons is supposed to be monitored for 30 years in order to see how many thyroid disorders including cancer cases would appear. Recent articles in the international press criticise the project as it would be only restricted to investigation of Belarusians while after the detection of cancer cases the treatment and aftercare would be left to the patients and to the health system in Belarus, which is not able to give all patients the appropriate treatment. The articles also highlight the fact that in the USA and Europe scientific investigations on the state of people's health are only allowed if proper medical treatment is also guaranteed, so why this should not apply to the people e. g. of Belarus? In Gomel Oblast alone, about 400 000 people who were children or adolescents at the time of the accident, have a high risk of developing thyroid cancer and deserve regular checks, and not only a group of the size necessary for the statistical significance of the interests of the USA.

A new report in 2000 by the UNSCEAR committee contained an evaluation of the consequences of the 1986 Chernobyl accident which concludes that 'there is no evidence of a major public health impact attributable to radiation exposure fourteen years after the accident', apart from a high level of (treatable, non-fatal) thyroid cancers in children. With this exception, the report states 'there is no scientific evidence of increases in over all cancer incidence or mortality or in non-malignant disorders that could be related to radiation exposure.' The statement of UNSCEAR again ignores a large number of scientific publications on a several fold increase in thyroid cancers in adults, the large increase in non-malignant thyroid disorders and in other diseases. It should be noted that this UN committee does not consist of independently chosen or elected scientists, but only of those being sent as representatives of the governments of the 21 nations, who have a strong interest in the use of nuclear technology. And F. Mettler is still member of UNSCEAR and is still representing the interests of the US government.

Activities of non-governmental organisations in Belarus

In 1991, the Otto Hug Strahleninstitut - MHM, a German non-governmental medical-scientific non-profit organisation, started several long term treatment and research projects on cancer and other diseases of the thyroid in Belarus. Within the Institute, numerous experts in radiation medicine, biology and physics, statistics usw. from several universities and research centres are integrated. The cooperation with Belarus is based on long term contracts with the Health Ministry and includes several university institutions in the West. The laboratories and medical institutions in Belarus received equipment and are now continuously supplied from the German Institute to facilitate medical treatment and research.

Since 1993, the project 'Thyroid Centre Gomel' (Head: L. Birjukowa) had more than 90 000 patients from this Oblast for diagnosis and treatment of thyroid diseases including cancer, processing over 220 000 blood analyses of thyroid parameters. The laboratory regularly participates in international quality assurance programmes. The 'Histopathological Laboratory' of the National Thyroid Centre of Belarus (Head: Prof. Demidtschik), started in 1995, was built up in cooperation with the German Institute, which besides the equipment, regularly supplies the consumables. Meanwhile, more than 7800 thyroid malignancies have been diagnosed, involving the preparation of over 40 000 pathological slides according to internationally accepted standards. Since 1993, a fruitful international scientific cooperation on pathology and the molecular genetics of thyroid cancer resulted in considerable progress in the understanding of the molecular biology of this disease and in the establishment of a tumour tissue bank. The extension of this cooperation to provide a molecular biology laboratory by the Institute is in progress. In 1997, the 'Radioiodine Therapy' project (Heads: T. Prigoschaja, L. Gamolina) started in Gomel, giving more than 2100 diagnostic and therapeutic radioiodine treatment courses to cancer patients since that time through the donation of equipment and regular delivery of radioiodine. Since 1991, the value of medical, social and scientific support of Belarus by the projects of the Otto Hug Strahleninstitut was equivalent to over 13 Million Euro.

The German Association of Chernobyl Help (DVTH) is an umbrella organisation, which integrates over 80 non-governmental organisations working in the fields of social rehabilitation, medical care and many other areas in order to mitigate the situation in regions affected by Chernobyl. All these organisations and their sponsors wish to have knowledge about the real consequences of Chernobyl, and not information distorted by intentions of playing down or dramatising. Up to now, the value of support and measures, given by the member organisations of DVTH to the population in the countries affected by Chernobyl (mainly in Belarus), is equivalent to about 75 Million Euro. A considerable part of the sponsoring of the thyroid projects of the Otto Hug Strahleninstitut, independent of political and economical interests, comes and will come from this side.

Look at the collective thyroid dose

The reported numbers of thyroid cancer cases after Chernobyl in Belarus range from 1200 up to about 10 000. The figures are influenced by the risk assessment models used, the assignment of patients to different categories of reconstructed organ doses, the believe of some scientists that a lower radioiodine dose is ineffective in inducing cancer etc. Recently, the authors of this paper completed a study on the annual age-specific and gender-specific incidence of thyroid cancers in the Czech Republic for the years from 1976 through 1999. The study is probably the largest on this topic, because it accounts for 247 Million person-years. From 1978 through 1999 there is an age-dependant annual increase in the thyroid cancer incidence proportion of 2,1%/annum. From 1988 on, the study revealed an additional significant increase in the thyroid cancer incidence of 2,3% per year. Although the contamination levels of the Czech Republic due to the Chernobyl releases, including radioiodine, were low compared to the situation in Belarus, Russia and Ukraine, resulting in low individual thyroid organ doses, it lead to a relevant collective thyroid dose of the Czech population. As in the Czech Republic improved medical surveillance and reporting after the accident in Chernobyl is unlikely to account for this increase in thyroid cancer incidence, the radioiodine from Chernobyl appears to be the real causation of this disease. This would mean that for the assessment of radioiodine associated thyroid cancers in the Chernobyl regions, one should look carefully at collective dose effects and at the group low in individual organ dose but very high in number, instead of taking parts of this group as an unexposed reference.

Regarding the statement of Kofi Annan that the Chernobyl disaster is a matter of global concern, research projects by international organisations on the health consequences for the citizens and patients of NIS countries after the Chernobyl catastrophe should be made dependant on the obligation that these organisations guarantee at the same time therapy and aftercare to a substantial part of the population at risk.

This approach will achieve the following objects:

• The benefit for the organisations and countries in the West of getting the results of the research projects is compensated by the benefit of treatment of the people affected in the NIS.
• The level of the health and treatment system in the affected areas is increased.
• The extent and the costs for health protection after a catastrophe in an atomic power plant can be felt in the West and the efforts to play down the consequences are reduced.
  

1. Institute of Radiation Biology, University of Munich, Germany
2. Institute of Pathology, University of Munich, Germany
3. GSF-Federal Research Centre for Environment and Health, Munich
4. Otto Hug Strahleninstitut   MHM, Munich
5. German Association for Chernobyl Help (DVTH), Munich-Ottobrunn