The Committee has followed with interest the evolving research on PFAS, including research into its environmental and health impacts, as well as research into PFAS remediation techniques.
The Committee’s first progress report discussed evidence from the Australian National University (ANU) PFAS Health Study. The Committee's second progress report discussed this study, a study by the Queensland Alliance of Environmental Health Sciences Centre at the University of Queensland, and provided an overview of targeted grants issued by the National Health and Medical Research Council (NHMRC).
Between August 2020 and December 2021, the Committee heard from researchers associated with the following institutions:
Commonwealth Scientific and Industrial Research Organisation (CSIRO),
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE),
Macquarie University, and
University of Queensland.
Commonwealth Scientific and Industrial Research Organisation (CSIRO)
The CSIRO has been commissioned by the Department of Defence as part of a special research initiative. The Committee heard in Chapter 3 how this special research initiative has informed the Department of Defence’s approach to remediation.
CSIRO advised it has a ‘broad portfolio of research and technical expertise relevant to PFAS issues’. However, the CSIRO also acknowledged that ‘PFAS remains a global issue’ and that data about the behaviour of PFAS chemicals in the environment and their treatment ‘remains lacking’. The CSIRO advised that ‘resolving all PFAS issues is probably a decadal or multidecadal issue.’
Focus of PFAS research
The CSIRO stated the focus of their research is on ‘the environmental fate and behaviour of PFAS chemicals, as well as their remediation and treatment’ including pathways for exposure. The CSIRO’s work does not include the potential impact to human health.
Dr Paul Bertsch, Science Director, Land and Water, CSIRO, informed the Committee that the organisation is currently working to ‘ensure better measurement, prediction, risk definition and risk mitigation.’ This includes engaging with ‘a range of international agencies’ to ensure Australia remains at the forefront of PFAS research and understanding.
The CSIRO stated it has advanced research and development ‘on PFAS distribution in the environment and mobility to soils and groundwater as well as surface water.’ The Committee heard that CSIRO research also includes PFAS ‘remediation technologies and site management scenarios’.
The CSIRO advised that its research has resulted in important findings for Australian-specific challenges in terms of understanding how PFAS compounds move through the environment.
Work with the Department of Defence
The CSIRO described their work with the Department of Defence as focused on the ‘the design and relevance of various remediation strategies for Defence bases nationally.’
This work includes site sampling, measuring the mobility of the PFAS chemicals through various materials, and then ‘embedding that knowledge into this modelling platform to assess management scenarios for defence bases.’
The CSIRO explained its work with the Department of Defence includes testing the effectiveness of ‘reducing the leaching of PFAS through soils into the groundwater’ with a view to examining the ‘effect that might have on the extent of subsequent groundwater plumes or ongoing groundwater impacts.’
Other research with Defence involved reviewing the relative effectiveness of pumping and treating water at the boundaries of PFAS-contaminated sites, compared to pumping and treating the water ‘in the body of sites’.
Based on its research, the CSIRO emphasised the need for multiple technologies and approaches to combat PFAS contamination:
… you need multiple options for treatment for different circumstances. In some environments, the PFAS chemicals will be more readily mobile. In other environments, they'll be more retained in the soil and the groundwater environments, and so you may address them with different approaches. The immobilisation strategy is a very relevant and very useful tool. Complete removal is obviously very attractive, but much more difficult—for example, over long dilute groundwater plumes. You need a number of technologies and approaches, depending on site conditions…
PFAS National Environmental Management Plan (NEMP)
The second version of the Australian Government’s PFAS National Environmental Management Plan (NEMP) was published in May 2020. The PFAS NEMP is discussed in Chapters 4 and 8 of this report.
The CSIRO advised it has provided ‘advice and review to the PFAS assessment criteria for the Department of Agriculture, Water and the Environment’ and input to ‘the National Chemicals Working Group of the Heads of [Environment Protection Authorities] in Australia and New Zealand as they seek to update the PFAS National Environmental Management Plan.’
The CSIRO stated it is trying ‘to create a national program around PFAS that links in to state regulators’ and that its role as the national science agency is to link and partner with the ‘heads of the [Environment Protection Authorities] across the various state agencies and federally.’
Cooperative Research Centre for Contamination Assessment and Remediation of the Environment (CRC CARE)
The Cooperative Research Centre (CRC) for Contamination Assessment and Remediation of the Environment (CARE) is an initiative funded through the Australian Government’s Cooperative Research Centres Program.
Established in 2005, CRC CARE works collaboratively with 29 partner organisation and conducted research which:
… focuses entirely on contaminants, be they conventional contaminants or emerging contaminants, to assess risk and, where contaminants pose risk, to develop solutions for environmental contamination problems.
A PFAS immobilisation technology, matCARE, developed by CRC CARE is discussed in the Committee’s second progress report.
Work with the Department of Defence
Professor Ravi Naidu, the Managing Director and Chief Executive Officer, stated that CRC CARE’s relationship with the Department of Defence began in 2005. CRC CARE was engaged to ‘develop methods for assessing the presence of [PFAS] in the environment and to develop technology for the cleaning up of the environment, both in wastewater and soil.’
Professor Naidu described the Department of Defence as being:
The very first organisation globally that recognised PFAS, particularly the active ingredients PFOS and PFOA, as being of potential concern, particularly that it could pose risks to the environment and human health.
CRC CARE outlined its development of tools to monitor the presence of the active ingredients PFOS and PFOA, as well as soil and wastewater remediation technologies. CRC CARE’s PFAS immobilisation technology, matCARE, is discussed in the Committee’s second progress report.
CRC CARE has been engaged by the Department of Defence to remediate PFAS-contaminated wastewater at RAAF Base Edinburgh, RAAF Base Pearce, RAAF Base Townsville and RAAF Base Darwin. Trials of its immobilisation solutions have also been carried out at RAAF Base Richmond (contaminated groundwater) and RAAF Base Darwin (contaminated soil).
CRC CARE stated that its studies conducted from 2010-2017 demonstrated the long-term stability of its soil immobilisation technology and that PFAS was not released following the remediation work.
The Centre also outlined the role it has played in training ‘more than 4,000 environmental practitioners, including those environmental managers who work for Defence or who work in private companies here in Australia.’
In addition to its work with the Department of Defence, CRC CARE was engaged by Airservices Australia to remediate PFAS-contaminated wastewater at Adelaide Airport and Darwin Airport. The role of Airservices Australia is discussed in Chapter 5.
ANU PFAS Health Study
The Committee heard from the ANU PFAS Health Study at an early stage of its study on 25 November 2019. This evidence, including discussion of the ANU PFAS Health Study’s systematic literature review, examining the state of PFAS research in 2018, and the focus group study, gathering ‘social and health-related experiences and perceptions from current residents and workers exposed to PFAS in Katherine, Oakey and Williamtown’ was discussed in the Committee’s first progress report.
In December 2016, the Australian Government commissioned the National Centre for Epidemiology and Population Health at the Australian National University (ANU) to conduct an epidemiological study examining the potential health effects resulting from PFAS exposure in the investigation areas of Williamtown, NSW and Oakey, Queensland. Katherine in the Northern Territory was added to the study in May 2018.
The PFAS Health Study had five main components, which were conducted over two phases:
Phase I - Systematic Literature Review
Phase I - Study Protocols for Phase II
Phase II – Focus Groups Study
Phase II – Cross-sectional Survey and Blood Serum Study
Phase II – Data Linkage Study
The ANU PFAS Health Study reported its final results in December 2021. The Committee previously heard from the PFAS Health Study at an early stage of its study on 25 November 2019. This evidence, including discussion of the ANU PFAS Health Study’s systematic literature review, examining the state of PFAS research in 2018, and the focus group study, gathering ‘social and health-related experiences and perceptions from current residents and workers exposed to PFAS in Katherine, Oakey and Williamtown’ was discussed in the Committee’s first progress report.
Following the publication of its final results, the Committee heard again from the ANU PFAS Health Study on 15 December 2021. The findings discussed at this hearing included the results of Cross-sectional Survey, Blood Serum Study and the Data Linkage Study.
The Committee understands that letters with the results of biomarker testing were sent to participants in Katherine, Oakey and Williamtown. The Committee also understands that the PFAS Health Study team and the Department of Health held a webinar with participants on the results of the study on 9 December 2021.
Blood Serum Study
The Blood Serum Study tested blood specimens of people living or working in an area contaminated with PFAS and compared them to people not living in those areas. The study began in November 2016.
The study examined the blood PFAS levels, biochemical markers of health and exposure to PFAS in 2,587 people living or working in Katherine, Oakey and Williamtown. These were compared with 702 people living in Alice Springs in the Northern Territory, Dalby in Queensland, and Kiama and Shellharbour New South Wales.
The PFAS Health Study conducted a survey of participants to understand the blood test results, along with health effects and other concerns. Professor Martyn Kirk, Principal Investigator of the PFAS Health Study, advised the Committee the purpose of this survey was ‘to identify whether people had poorer self-reported health and also their level of psychological distress’.
The study detected PFOS, PFHxS and PFOA in the blood serum samples of more than 80 per cent of participants from exposed and comparison communities. Average blood serum concentrations of PFOS and PFHxS (the main types of PFAS in firefighting foam) were higher in residents and workers of PFAS Management Areas than in residents of comparison communities. The study did not observe a similar result for PFOA.
The study also found that certain groups within exposed communities were more likely to have elevated PFAS levels:
PFAS concentrations were higher in older participants and in males. In Oakey and Williamtown, serum PFOS and PFHxS concentrations were also higher in participants who lived in a section of the PFAS Management Area located closer to the military base…
The study identified several risk factors for a resident of an exposed community having an elevated PFOS or PFHxS concentration. These include:
consuming bore water or certain locally grown foods at least weekly
length of residence in an exposed community
occupational exposure to firefighting foams.
In terms of links between elevated PFAS levels and adverse health outcomes, the study identified elevated cholesterol concentrations as the ‘most commonly observed ‘abnormality’ among participants from the exposed communities’:
A higher concentration of PFAS in blood serum was associated with elevated blood cholesterol levels in participants from Williamtown and uric acid levels (a marker of kidney function) in participants from Williamtown and Katherine.
While emphasising the limitations of the study, given the self-selecting nature of the participants in PFAS-affected communities, and the ‘point-in-time’ nature of the samples collected, the study did not observe any other significant links to adverse health outcomes.
The Cross-sectional Survey investigated the exposure history, physical health, and mental health of 917 people living or working in Katherine, Oakey and Williamtown, and 801 people living in the three comparison communities of Alice Springs, Dalby, and Kiama and Shellharbour. The survey compared ‘the prevalence of self-reported physical and mental health outcomes between exposed and comparison communities’. It also examined associations between self-reported health outcomes and blood serum levels of PFAS.
The survey asked people in the exposed and comparison communities about:
their demographic details,
where they had lived and worked,
whether they had ever been diagnosed with any of 32 health conditions, and
the state of their mental health.
The survey also asked people in exposed communities about their health concerns and use of healthcare related to the PFAS contamination.
The main findings of the survey were:
People who lived or worked in PFAS Management Areas were more likely to self-report various health outcomes than participants from comparison communities. Participation in the survey was voluntary, however, so survey findings may not accurately reflect the experience of the whole community.
Participants from PFAS Management Areas reported higher levels of psychological distress than participants in comparison communities.
PFAS concentrations in blood serum were largely not associated with a higher prevalence of self-reported health outcomes, nor were associations consistently observed across the three exposed communities.
With regard to comparisons between the exposed communities and comparison communities, the results of the survey showed that:
People in Katherine were more likely to report cancer (especially breast cancer) and liver disease (especially fatty liver disease) than people in Alice Springs.
People in Williamtown were more likely to report rheumatoid arthritis, hypercholesterolaemia (high cholesterol), type II diabetes, and problems with fertility compared to people in Kiama and Shellharbour.
In Oakey and Dalby, the numbers of people surveyed were too small to make reliable comparisons.
The study also found that people living in PFAS-affected communities reported much higher levels of mental distress. Again, certain cohorts within exposed communities were more likely to experience mental distress as a result of PFAS exposure:
People who worked with firefighting foams containing PFAS and people who used bore water on their properties reported higher levels of worry and concern than people who did not.
The findings on the mental health of residents living in PFAS-affected communities echoes the concerns raised with the Committee throughout its inquiries:
One in three people reported being ‘very’ or ‘extremely’ concerned about their health and one in five people had serious concerns about their mental health. People surveyed in these communities also reported concerns about their finances, the stigma of living in exposed communities, and uncertainty about the future.
Professor Kirk noted that mental distress has been consistently observed in communities exposed to environmental contamination events:
When you look at communities that have had environmental contamination and have been put in a situation they are not in control of, you see overt psychological distress. It's definitely something we've seen before, and it's experienced by communities that have these environmental contamination events.
The PFAS Health Study researchers again stressed that participants in the Cross-sectional Survey were not randomly sampled, and that the results may therefore represent the experiences of people who were more concerned with PFAS exposure, and not the experiences of all residents of affected communities.
Noting this caveat, overall the study found ‘that people with higher PFAS levels were not more likely to report most diseases’. This finding appears broadly consistent with the results of the Blood Serum Study and the Data Linkage Study.
Data Linkage Study
The Data Linkage Study used historical health records collected since 1984 to examine whether rates of adverse health outcomes were higher among people who had lived Katherine, Oakey and Williamtown, than among people who had lived in the comparison areas.
Professor Kirk, Principal Investigator of the PFAS Health Study, advised that the Data Linkage Study comprised three separate studies. These studies examined a total of 48 health outcomes:
The first study investigated maternal and infant (perinatal) health outcomes (15 outcomes),
The second study examined childhood development (6 outcomes), and
The third study investigated cancer (23 outcomes) and death from specific causes (4 outcomes).
The childhood development study used repeated surveys to examine whether children in affected areas had higher rates of poor health outcomes.
Dr Nina Lazarevic, a Research Fellow at the National Centre of Epidemiology and Population Health at the ANU, described the Data Linkage Study, which used a large dataset of ’35 or so years of historical records’, as a ‘more reliable analysis’ of adverse health outcomes such as cancer than the Cross-sectional Survey.
Over the three separate studies, for most of the health outcomes that were examined, the researchers did not conclude that rates of adverse health outcomes were higher in the PFAS-affected towns than the comparison areas.
Several health outcomes did, however, show at higher rates in a particular PFAS-affected community, but this was not observed in the other two affected towns. In Katherine, the evidence showed higher rates of prostate cancer. In Oakey, the researchers observed higher rates of stillbirth, laryngeal cancer, as well as developmental vulnerabilities in physical health and wellbeing, and communication skills and general knowledge. In Williamtown, there were higher rates of postpartum haemorrhage, pregnancy-induced hypertension, kidney cancer and lung cancer.
In presenting these findings, the research team emphasised the study’s design limitations. These included an inability to fully account for risk factors such as smoking or family medical history, or for the impact of a person’s socioeconomic background.
Despite these limitations, the researchers ultimately concluded that they could not find a conclusive, causative link between PFAS and the examined adverse health outcomes. The study also found that, while there was evidence of higher rates of some adverse health outcomes in PFAS-affected communities, ‘the evidence suggesting that this was due to living in these areas was limited’.
Macquarie University was commissioned by the United Firefighters Union and Fire Rescue Victoria to study a possible medical intervention for reducing PFAS levels, as mentioned in Chapter 4. The Committee heard from Macquarie University on 31 August 2020, and on 3 September 2021.
The study is a health intervention that:
hypothesises that the reduction of serum PFAS levels via blood and plasma donation may be a mechanism to lower the body burden of these persistent compounds, which may reduce potential future health impacts, and
aims to determine if regular blood donation (either whole blood or plasma donation) will be effective in reducing circulating serum PFAS levels.
In the study, 285 firefighters were randomized into three separate groups. One group received no intervention, one group was asked to donate plasma every six weeks, and one group was asked to donate blood every 12 weeks.
The Committee heard that the focus of the study was:
… on two particular PFAS chemicals: PFOS and PFHxS, although we did look at a large panel of 28 PFAS chemicals in total. But we chose those as the primary endpoint because previous research had shown that they are the chemicals which tend to have the higher levels. We also looked at other PFAS chemicals and at other health markers: blood count, biochemistry, biofunction and lipids.
Results of the study
Dr Gasiorowski of Macquarie University stated that the study showed regular blood and plasma donation is ‘effective at reducing blood PFAS levels’. PFOS levels in participants who did not donate blood or plasma over the course of the trial showed ‘minimal change in PFOS levels’ and ‘actually saw a slight increase in [PFHxS] levels over time’.
This was compared to the blood donation group, which experienced a reduction in PFOS levels of approximately 10 per cent, and stable PFHxS levels. The plasma donation group saw ‘a much greater drop in the PFOS levels of about 30 per cent’ and a similar 30 per cent reduction of PFHxS levels.
While cautioning that the ultimate impact of these findings to people’s health remains unknown, the Macquarie University researchers emphasised that this study shows that ‘we can actually do something for people with elevated blood PFAS concentrations.’
Importantly, the Committee heard that the study demonstrated ‘the biggest changes were in those with the highest [PFAS] levels’, noting that ‘these are the people for whom there might be the greatest urgency to intervene.’
Mr Tisbury of Fire Rescue Victoria advised that many firefighters were ineligible to participate in the study. This was due to a range of factors, including blood donation within three months of the commencement of the study, whether firefighters were taking certain medications, or if they had contracted certain diseases. As a result, many of the ‘most highly exposed firefighters’ and ‘older firefighters’ were not able to participate.
The Committee heard that following the presentation of the results of the study, there are firefighters ‘who want to go and have their blood or plasma removed right now’ but that there are not necessarily interventions options, such as blood donation, available to them. As a response to this, Dr Gasiorowski called for a mechanism for people with high PFAS levels to receive the identified interventions.
Professor Mueller of the University of Queensland agreed with the need to offer these interventions of people with high PFAS levels, stating:
I think the frustration in the communities and for these people is because they lose control, and loss of control is really bad for you. In a strange way, if you allow people to give blood and have a way to reduce their own level it means they can actually do something to gain the control back. That is mentally important. It's not just about what it does to the PFAS level; it also helps people to deal with the problem they are in. So I'm really supportive of the idea. I've brought it up for many years that bloodletting should be at least considered as an option for helping people dealing with it. We think it's low risk to donate blood, so why not allow people to do that? It doesn't sound expensive, considering how big the PFAS problem is.
In terms of future research, Dr Gasiorowski noted the importance of examining the health outcomes for those who regularly donate blood or plasma, and advised that ‘funding to do more longitudinal studies on this group or other groups to see how these interventions perhaps help with their overall health would be extremely useful.’
Professor Mark Taylor echoed these comments, stating that he also sees value in a longitudinal study or further research on the firefighter cohort, in part to better understand if there are any longitudinal adverse health effects of PFAS. Professor Taylor added a further reason for such a study:
Most states and territories have adopted the presumptive legislation for firefighters, and the diseases associated with PFAS are not included, largely, on that list. So there is some benefit in better understanding what those risks may be so that those illnesses or diseases associated with PFAS could then be added to the presumptive legislation disease list.
University of Queensland
The Queensland Alliance of Environmental Health Sciences (QAEHS) Centre at the University of Queensland has undertaken a series of PFAS blood serum studies. The first two studies were commissioned by Airservices Australia, as mentioned in Chapter 5. The third study is the result of a grant by the NHMRC.
The Committee heard from the University of Queensland on 3 September 2021.
Airservices Australia study
The University of Queensland also undertook a study in 2018 to evaluate per- and polyfluoroalkyl substances in the blood serum of Airservices Australia’s current and former staff. This was the second PFAS Exposure Study of Aviation Rescue and Fire Fighting Services staff, following the first study in 2014.
The study of 799 Airservices Australia current and ex-staff aimed:
to measure the participants’ PFAS blood concentration levels and understand how these levels were linked to ‘work history’;
to determine how PFAS blood levels change over time and compare these levels and changes to those in the general population;
to determine whether the PFAS blood levels were associated with any changes in other biochemical measures of health such as cholesterol, liver and kidney tests; [and]
to provide advice to Airservices Australia on how best to assess and minimise exposure to PFASs.
Professor Mueller of the University of Queensland told the Committee that the study made every effort to recruit firefighters who had taken part in the 2014 study.
Similar to the results of the earlier study, the second Airservices Australia study showed that ‘only firefighters who really worked before 2005 had elevated levels [of PFAS compounds]’ and that firefighters who began work after 2005 had ‘very normal’ levels of ‘PFOS, perfluorohexane sulfonate and PFOA.’
The Committee heard the study also showed decreased levels of PFAS in the blood of firefighters who had previously returned high results, suggesting:
… that the intervention or essentially the move from 3M Light Water to other [aqueous film-forming foams] has really discontinued exposure above general population levels.
Exposure control study
The aim of the QAEHS study is to ‘investigate the changes over time in PFAS concentrations in the blood serum of individuals who are known to have elevated exposures to PFAS.’
The study commenced in 2020 and individuals from exposed communities in Williamtown, Oakey and Katherine were invited to participate, as were members of exposed occupational groups, such as firefighters.
Professor Mueller informed the Committee that while PFAS levels in the general population are decreasing, no studies at the time had shown if exposure in PFAS-affected communities was also decreasing.
The Committee heard the study has recruited 450 people, including 300 from affected communities, who had returned elevated levels of PFAS in the ANU PFAS Health Study or other previous studies.
On 21 December 2021, participants were sent the PFAS results for their first blood sample. No results have been published to date.
The Committee is pleased to see the range of research being undertaken in relation to PFAS, both in terms of its environmental impact and its effect on human health.
While much about PFAS remains unknown, the Committee has heard evidence of the real progress that has been made, especially in the last decade, to clarify our understanding about many aspects of PFAS.
The Committee acknowledges the important research that has been done in Australia, by the CSIRO, by bodies such as CRC CARE, by Australian universities, and by industry partners. This research has been undertaken in a spirit of cooperation, with a view to furthering our collective understanding and capability.
The Committee notes that the studies conducted by universities were undertaken with a commitment to community engagement. This approach has provided a level of comfort and assurance to communities.
The Committee also acknowledges evidence it heard from researchers and industry partners about the positive approach of the Department of Defence to trialling PFAS remediation technologies and solutions.
The Committee welcomes the results of the ANU PFAS Health Study. While the study observed evidence of higher levels of mental distress among residents of PFAS-affected communities, it did not otherwise show evidence of significant adverse health outcomes for those people with elevated PFAS levels.
The Committee has had a longstanding concern for the mental health of those affected by PFAS, and acknowledges that, despite the findings of the ANU PFAS Health Study, people will continue to experience mental distress as a result of PFAS contamination. The Committee also understands that people may continue to be concerned about any future effects of PFAS on their health.
The Committee also welcomes results of the Macquarie University study showing that regular blood and plasma donation is effective at reducing blood PFAS levels, and echoes the calls of researchers at Macquarie University and the University of Queensland for a mechanism for people with high PFAS levels to be able to donate or let blood.
The Committee considers it is important that longitudinal studies of firefighters and members of PFAS-affected communities continue to monitor for adverse health effects.
The Committee recommends that the Australian Government consider the research, with a view to examining suitable options for a mechanism for people with high levels of PFAS, who are otherwise unable to donate blood or plasma, to make therapeutic donations as an intervention to reduce their levels of PFAS.
The Committee recommends that the Australian Government provide funding for further longitudinal studies on potential adverse health effects for firefighters and members of PFAS-affected communities.
Senator the Hon David Fawcett
Joint Standing Committee on Foreign Affairs, Defence and Trade
15 March 2022
Senator Dr Sam McMahon
15 March 2022