agent orange final 1

Agent OrangeTHE HISTORY AND LEGACY OF A WARTIME HERBICIDE

Muoi NguyenUniversity of San Francisco

Fall 2013

Outline Learning Objectives Problem Statement What is Agent Orange? Effects from Exposure• Vietnam War Veterans• Vietnamese Civilians

Current Efforts Implications for Public Health References

Learning Objectives:(1) Provide background on Agent Orange and chronicle

its deployment during the Vietnam War.

(2) Discuss some of the associated illnesses and diseases and extent of exposure on:

I. Vietnam War Veterans

II. Vietnamese Civilians

(3) Update on current policies and discuss implications for future public health efforts.

Use of chemicals such as Agent Orange during the Vietnam War have lead to a multitude of negative health impacts. There is a need for further exploration into the toxic effects of chemicals employed during wartime to prevent future exposures.

Problem Statement

Historical Background: Vietnam War•The United States Armed Force employed an herbicide strategy plan.

•Produced a variety of “Rainbow Herbicides”, such as Agent Blue and Agent Orange.

The Aspen Institute, 2013

What is Agent Orange? A tactical defoliant to limit the coverage and reduce the food supplies of war opponents.

U.S. Department of Veterans Affair, 2012

Agent Orange was a phenoxy-herbicide.

Agent Orange = 2,4-dichlorophenoxyacetic acid (2,4-D) + 2,4,5-trichlorophenoxyacetic acid (2,4,5-T)

U.S. Department of Veterans Affair, 2012

What is Agent Orange?

Main ingredients 2,4-D and 2,4,5-T, degraded within a weeks’ time.

By-product, TCDD, in the mixture continued to be a persistent contaminant in the environment for many years and can lead to damages to human health, even in small exposures.

Schecter et al., 1995

TCDD is also known as “dioxin”.

1961 - President John F. Kennedy sent a group of advisors to South Vietnam and began testing Agent Orange.

1962 - The first aerial spraying of the herbicides started southern region of Vietnam in an operation known as “Operation Ranch Hand”.

1962- 1971 - The operation continued for roughly ten years.

Stellman et al., 2003

Timeline: Agent Orange

Only stopped after a study in 1970 found that the compound, 2,4,5- T in the mixture caused birth defects in lab animals.

Projected that the levels of dioxin sprayed during the war were at a significantly higher level than for the purpose of domestic agricultural defoliation.


An estimated 19.5 million gallons of herbicides were sprayed, covering one-tenth of the land in South Vietnam, spilling roughly 500 pounds of TCDD into the 5.6 million acre region


The military use of Agent Orange during the Vietnam War was historic for being the largest contamination of dioxins documented.


Exposure: Vietnam War Soldiers~ 1.5 million soldiers served during the period in which the spraying occurred (American Cancer Society, 2013).

Agent Orange was sprayed by helicopters, boats, trucks, and backpacks.

Mode of exposure:•involvement in spray itself (with no protective gears)•displacement in the air (aerial spraying)•in the water (in the rivers and lakes)•in the land (during combat)•In the food supplies (contaminated foods and water supplies)

Health Impact on Vietnam VeteransMany Vietnam Veterans returned home with reports of a variety of health problems.

High levels of TCDD linked to various health complications and illnesses

Diabetes

• Veterans with high levels of TCDD in the blood higher prevalence of diabetes

• Shorter onset of diabetes

• Increased risk of developing insulin resistance

Cranmer et al., 2000

Prostate Cancer

• Higher incidence of prostate cancer• Twice as many as unexposed men

• Earlier development and more aggressive variation of the cancer

Chamie et al., 2008

Effects of Dioxins on Human Health

According to the World Health Organization (WHO):

Short term exposure: skin lesions, altered liver functions

Long term exposure: impairment of immune system, nervous system, endocrine system, and reproductive functions

Research on chronic exposure in animals• Cancer • TCDD classified as “known human carcinogen”

Veterans’ Fight for Compensation

Hunger Strike

Agent Orange Settlement Fund Chemical manufacturers such as Dow Chemical and Monsanto Corporation produced the herbicide for its military use during the Vietnam War.

◦ Although scientists were aware of the high amounts of TCDD contaminants in the mixtures and its toxic effects have on humans, the product was still released for military use.


In 1979, U.S. veterans filed a class action lawsuit against the producers of Agent Orange and were compensated with $180 million through the Agent Orange Settlement Fund.

American Cancer Society, 2013

Agent Orange Act of 1991• Passed by Congress in 1991

◦ Aimed at promoting more medical and scientific research done by the National Academy of Science on the health effects of the exposure during the Vietnam War

◦ Recent findings are published by IOM in Veterans and Agent Orange.

(The Aspen Institute, 2012)

Agent Orange Act of 1991• Required the United States Department of Veterans Affair to recognize a list of “presumptive diseases” that can be compensated for and are associated with exposure to Agent Orange such as:

AL amyloidosis, Chronic B-Cell leukemia, Chloracne, Diabetes mellitus

type 2. Hodgkin’s disease. Ischemic heart disease, Multiple myeloma, Prostate cancer, Respiratory cancers, Soft tissue sarcoma…

(U.S. Department of Veterans Affair, 2012).

Compensation As of 2010, the U.S. Department of Veterans Affairs have compensated over $16.2 billion dollars to the 1,095,473 Vietnam Veterans.


Note: Compensations from the VA are solely their “services” during the war and not the effects of Agent Orange itself.

Exposure: Vietnamese Civilians An analysis of the Hamlet Evaluation System (HES), a comprehensive survey of rural census accounting for the numbers of hamlets and size of the Vietnamese population sprayed found:

◦ 3,181 hamlets/villages

◦ Between 2.1 and 4.8 million people were present during the spraying

*Not accounting an additional 1,430 known hamlets with unknown populations


Health Impacts on Vietnamese Civilians

◦ High levels of TCDD in Blood:Recommended monthly limits of TCDD in blood (WHO): .07 ppt

◦ 1970- Tests of Vietnamese mothers following spraying showed levels of TCDD as high as 413 ppt!

Schecter et al., 2006◦ Persistent in human tissue, blood, and milk:

◦ Levels of TCDD in blood, milk, and tissue of Vietnamese living in South Vietnam found at elevated levels of TCDD after pooling blood tested in 1991 and 1992, almost 20 years after spraying stopped.

◦ Regional effects: ◦ Compared to levels of TCDD in the blood for Vietnamese from south vs. north Vietnam was 33 ppt and

below 2.9 ppt, respectively. The difference supports the effects of Agent Orange spraying and its impact on the inhabitant of the region.

Schector et al., 2002

Health Impact: Birth DefectsIn animal studies done in the labs, large doses of Agent Orange caused tumors and birth defects.

American Cancer Society, 2013

Estimated about 150,000 births with congenital deformities such as neural tube defects as well as developmental disabilities associated with exposure.

Vietnamese Red Cross

Legacy of Agent Orange in Vietnam TCDD continue to leach into the soil or travel by runoff to the rivers where fish may be caught, sold, and consumed by uninformed citizens (Scheter et al., 2006).

In 2004, similarly to the U.S. Veterans, the Vietnamese citizens filed a law suit again the chemical companies. ◦ Case was dismissed the following year (The Aspen

Institute, 2011).

Without intervention, generation after generation will continue to be plague by the deadly and persistent toxin, dioxin, in the environment and in their bodies.

Update on Efforts Fortunately, some changes have occurred in the recent years to help combat the issue.

2003 - The U.S. Environmental Protection Agency (EPA) collaborated with Vietnamese officials in a joint project to deal with the hot spot in Vietnam (The Aspen Institute, 2013).

Hatfield Consultant and Vietnamese officials have identified 28 hot spots.

Hot SpotsLocation where the herbicides were stored during the Vietnam War or areas where dioxins are of high concentration from leaching soils and erosions such as Da Nang Airport, Phu Cat Airport, and Bien Hoa Airport.

Hot Spot: Da Nang Airport

Hot Spot CleanupsApril, 2011 - U.S. Congress approved an appropriation of $18.5 million towards investigating and assessing the contamination at the sites and developing an intervention plan.

Former Secretary of State, Hillary Clinton, announced the U.S. government support for a project to clean up the Da Nang hot spot at $43 million a year (The Aspen Institute, 2013).

The ultimate purpose of revisiting these issues is to ensure that future uses of military chemicals are thoroughly evaluated to protect soldiers and innocent civilians.

Implication for Public Health• More comprehensive testings on military chemicals prior to the manufacturing or production for human use.

• Closer look at soldiers’ exposure to toxic chemicals at war.

Monstantos Corporation

Iraq War and Burning Pits: Second Agent Orange?

Military burn pits emit toxins such as sulfur dioxide, arsenic, dioxins and hydrochloric acids which are linked to serious health ailments.

American Cancer Society. (2013, March). Agent Orange and cancer. Retrieved from

http://www.cancer.org/cancer/cancercauses/othercarcinogens/intheworkplace/agent-orange-and-cancer

Chamie, K., deVere White, R. W., Lee, D., Ok, J. and Ellison, L. M. (2008), Agent Orange exposure, Vietnam War veterans,

and the risk of prostate cancer. Cancer, 113: 2464–2470. doi: 10.1002/cncr.23695

Cranmer, M., Louie, S., Kennedy, R. H., Kern, P. A., & Fonseca, V. A. (2000). Exposure to 2,3,7,8-Tetrachlorodibenzo-p-dioxin

(TCDD) is associated with hyperinsulinemia and insulin resistance. Toxicological Sciences, 56(2), 431-436.

Schecter, A., Quynh, H., Päpke, O., Tung, K. C., & Constable, J. D. (2006). Agent Orange, dioxins, and other chemicals of

concern in Vietnam: Update 2006. Journal of Occupational & Environmental Medicine, 48(4), 408-413.

doi:10.1097/01.jom.0000194153.77646.7d

References

Schecter, A., Dai, L. C., Thuy, L. T., Quynh, H. T., Minh, D. Q., Cau, H. D., ... & Baughman, R. (1995). Agent Orange and

the Vietnamese: the persistence of elevated dioxin levels in human tissues. American Journal of Public Health,

85(4), 516-522.

Stellman, J. M., Stellman, S. D., Christian, R., Weber, T., & Tomasallo, C. (2003). The extent and patterns of usage

of Agent Orange and other herbicides in Vietnam. Nature, 422(6933), 681-687.

Stellman, J. M., Stellman, S. D., Weber, T., Tomasallo, C., Stellman, A. B., & Christian Jr, R. (2003). A geographic

information system for characterizing exposure to Agent Orange and other herbicides in Vietnam. Environmental

Health Perspectives, 111(3), 321.

The Aspen Institute. (2013). Agent Orange in Vietnam program. Retrieved from

http://www.aspeninstitute.org/policy-work/agent-orange/history.

The Aspen Institute (2013). Chronology. Retrieved from http://www.aspeninstitute.org/policy-work/agent-orange/program-

home/chronology

U.S. Department of Veterans Affair. (2012, February). Facts about herbicides. Retrieved from

http://www.publichealth.va.gov/exposures/agentorange/basics.asp.

U.S. Department of Veterans Affair. (2012, February). Exposure to Agent Orange in Vietnam. Retrieved from

http://www.publichealth.va.gov/exposures/agentorange/vietnam.asp.

U.S. Environmental Protection Agency. (2007, July). Exposure and human health reassessment of 2,3,7,8 -

Tetrachlorodibenzop-Dioxin (TCDD) and related compounds national aademy sciences (NAS) Review Draft. Retrieved

from http://www.epa.gov/ncea/pdfs/dioxin/nas-review/#part2

agent orange final 1

Education

vietnam veterans

vietnam war soldiers

agent blue

military use of agent

south vietnam

public health references

human health

future public health