Lessons have not been learnt and the full public health implications are unknown
On 26 April 1986, a nuclear incident occurred in the then Soviet Union in a place called Chernobyl. Radiological data garnered after the United Kingdom’s Windscale (Sellafield) nuclear incident in 1957 had been used a decade earlier to set emergency reference levels to protect the UK public after such events. [1] These would be used to determine evacuation and food control policies in the immediate aftermath of an incident. In 1979, the Three Mile Island incident in the United States did not pose a threat to the UK, but it was clear in 1986 that Chernobyl might. Unfortunately, not all the UK authorities recognised this possibility, so when Cumbria and southern Scotland received fallout about a week after the incident the state of preparedness was less than optimal—the first radiological assessment appeared 20 days later, [2] but it contained errors that went uncorrected for three years. [3]
The situation was much worse closer to Chernobyl: the fallout was serious and extensive, but the Soviet authorities initially denied that an incident had occurred, then acknowledged a small one, and finally—by evacuating more than 100 000 people from their settlements—acknowledged the full seriousness of the situation. Throughout Europe chaos reigned for several weeks: bans on milk were enforced in some places but not others, suspicion of contamination was enough to prevent trade in commodities, and conflicting official advice about travel was rampant. The European Regional Office of the World Health Organization (WHO/EURO) quickly evaluated the available data to formulate rational risk based advice to member states. In the immediate aftermath a programme was developed recognising the need for harmonisation and rapidity of response. An early visit made to the worst affected areas by Professor Lennart Levi of the Karolinska Institute identified an epidemic of stress related disease attributable to public anxiety. This subsequently became known as the psychosocial effect, [4] and is arguably Chernobyl’s most serious health detriment to date, notwithstanding more than 6000 thyroid cancers in those exposed to iodine-131 as children and more to come. [5] A lack of trusted and timely information in the public domain exacerbates the public health effects of such incidents.
The events taking place at Fukushima in Japan over the past weeks are similar to the situation immediately after Chernobyl. Although information abounds, little of it is usable, [6, 7] especially in terms of determining the potential effect on public health, and its truthfulness is doubtful. In the first days the engagement of the international organisations (WHO and the International Atomic Energy Agency) to ensure harmony in response to the incident was notable by its absence, the dedicated Nuclear Emergency Project Office in Helsinki set up in 1998 as part of EURO’s post-Chernobyl response having been closed in 2000.
Institutional failure aside, attempts by the international research community to learn and implement the public health lessons of Chernobyl have been less than effective. Although useful information on the sensitivity of a child’s thyroid to iodine-131 has been collected (and stable iodine prophylaxis was used at Fukushima), more knowledge is still needed. [8] Recently, an in-depth review of health related research carried out by experts under the auspices of a European Commission project (Agenda for Research on Chernobyl Health (ARCH);
http://arch.iarc.fr) referred to the coverage at the international level as “uncoordinated . . . forming a patchwork rather than a comprehensive, structured attempt to delineate the overall health consequences of the accident.”
Looking forward, the ARCH group’s strategic research agenda recommends that a lifespan study—in part bringing together cohorts already under study in the most affected countries, Belarus, Russia, and Ukraine—is funded by the European Commission. [9] Latency periods for diseases caused by radiation generally extend from 10 to 60 years, so much could still be learnt and “no evidence of health damage” after comprehensive investigation would be a valuable result.
The health implications of Chernobyl have, since the incident occurred, been the “battle ground” for the lobbies for and against nuclear power, which seek to interpret the effects or absence of effects to their own advantage and are apparently unwilling to find the truth. Apart from exacerbating the psychosocial effects on those directly affected, this situation has prevented a comprehensive evaluation of the importance of the event to public health. A determined attempt to “close the Chernobyl book” was made in 2006, which sadly some UN agencies signed up to.[10]
Chernobyl can still help us understand the public health consequences of radioactive fallout and the consequent exposure to low doses of ionising radiation over prolonged periods. It represents the other side of the coin from the information gathered from the atomic bombings in Japan in terms of the consequences of exposure to high doses over extremely brief periods. The Japanese and American governments are supporting long term ongoing studies of a lifespan cohort of people who were exposed.
Many have been unconvinced by arguments that Chernobyl would be the final nuclear incident, and they have been proved correct. Now it is time to act, both to ensure that the protection of the population exposed to fallout from Fukushima benefits from the experience of Chernobyl, and that the long term health effects of Chernobyl are subject to appropriate and ongoing study.
Provenance and peer review: Commissioned; not externally peer reviewed.
Footnotes
Competing interests: The author has completed the Unified Competing Interest form at
http://www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declares: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
References
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↵ Fry FA, Clarke RH, O’Riordan MC. Early estimates of UK radiation doses from the Chernobyl reactor. Nature1986;321:193-5. [CrossRef][Web of Science]
↵ Baverstock KF. Cleaning up after Chernobyl. Nature1989;342:744. [Medline][Web of Science]
↵ Bromet EJ, Havenaar JM, Guey LT. A 25 year retrospective review of the psychological consequences of the Chernobyl accident. Clin Oncol 2011; online 16 February.
↵ United Nations Scientific Committee on the Effects of Atomic Radiation. Sources and effects of ionizing radiation: UNSCEAR 2008 report to the General Assembly with scientific annexes. Volume II: annex D. Health effects due to radiation from the Chernobyl accident. 2011.
↵ Butler D. Fukushima update: Data, data, everywhere [blog]. Nature2011.
http://blogs.nature.com/news/thegreatbe ... a_eve.html.
↵ Editorial. A little knowledge. Nature2011;472:135. [Medline]
↵ Baverstock K. Chernobyl and public health. BMJ1998;316:952-3. [FREE Full text]
↵ Agenda for Research on Chernobyl Health. Strategic research agenda: the health consequences of the Chernobyl accident. 2010.
http://arch.iarc.fr/documents/ARCH_SRA.pdf.
↵ Peplow M. Special report: counting the dead. Nature2006;440:982-3. [CrossRef][Medline][Web of Science]