The Minderoo-Monaco Commission on Plastics and Human Health.

Plastics are ubiquitous in modern societies. They have supported breakthroughs in fields as diverse as medicine, electronics, aerospace, construction, food packaging, and sports. It is now clear, however, that current patterns of plastic production, use, and disposal are not sustainable and are responsible for significant harms to human health, the environment, and the economy as well as for deep societal injustices. While there remain gaps in knowledge about plastics’ harms and uncertainties about their full magnitude, the evidence available today demonstrates unequivocally that these harms are already great and that they will increase in magnitude and severity in the absence of urgent and effective intervention [ 34 ]. Manufacture and use of essential plastics may continue. But reckless increases in plastic production, especially increases in the manufacture of an ever-increasing array of unnecessary single-use plastic products, that take no heed of health or environmental consequences must be curbed. Global intervention against the plastic crisis is needed now, because the costs of failure to act will be immense. The good news is that many of plastics’ harms can be avoided via better practices of production, design of alternative, less toxic materials, and decreased consumption. Plastics’ harms to human health, the environment, and the global economy can be mitigated by building on the same cost-effective strategies that international bodies and governments at every level have used for 50 years to prevent and control air, water, soil, and ocean pollution [ 21 1380 ]. Contrary to the oft-heard tropes that pollution is the unavoidable price of progress and that pollution control destroys economies, a review by the Lancet Commission on Pollution and Health clearly demonstrates that actions taken by governments to prevent and control pollution have, in fact, yielded large positive returns on investment [ 9 ]. Thus, every dollar invested in air pollution control in the USA since passage of the Clean Air Act in 1970 has yielded a return of $30 (USD) (range, $4–88) [ 1492 ]. These gains resulted from the substantially increased economic productivity of a healthier, longer-lived population and from reductions in the costs of health care associated with pollution-related disease. Likewise, the removal of lead from gasoline in the USA reduced children’s blood lead levels by 95% and has generated an estimated economic benefit of $200 billion (USD) in each year’s annual birth cohort since 1980—an aggregate benefit in the past 40 years of over $8 trillion USD [ 1493 ]. This large economic gain resulted from the population-wide increase in children’s cognitive function (IQ scores), creativity, and productivity that followed widescale reduction in lead exposure. This Commission has four major findings: Current practices for the production, use, and disposal of plastics cause great harms to human health and the global environment, and they are not sustainable. These harms arise at every stage across the plastic life cycle and are described in Sections 2 and 4 of this Commission. They include human health impacts such as developmental neurotoxicity, endocrine disruption, and carcinogenesis. In the ocean (Section 3), plastics’ harms extend far beyond the visible and well-recognized damages of beach litter, contaminated mid-ocean gyres, and physical injury to marine species and include extensive injury to marine ecosystems. Plastic production results in GHG emissions equivalent to nearly 1.96 Gt of CO 2 e annually that contribute to climate change. The main driver of plastics’ worsening harms is an almost exponential and still accelerating increase in global plastic production. More than half of all plastics ever produced have been manufactured since 2002. Plastics’ harms are further magnified by low rates of recovery and recycling—less than 10% globally—and by the long persistence of plastic waste in the environment. The result has been the accumulation since 1950 of nearly 6 Gt of plastic waste that now pollutes every corner of the planet [ 3 ]. The thousands of chemicals in plastics—monomers, additives, processing agents, and NIAS—are responsible for many of plastics’ known harms to human and planetary health (Section 2). These chemicals leach out of plastics, enter the environment, cause pollution, and result in human exposure (Section 4). In the environment and in the bodies of living organisms, many plastic-associated chemicals can undergo chemical transformation to form breakdown products and metabolites, some of which are highly toxic and contribute further to plastics’ harms. Plastic manufacturers disclose little information on the identity, chemical composition, or potential toxicity of plastic chemicals at the time of entry to market and in most countries are under no legal obligation to do so. Both the complexity and the lack of transparency regarding the chemical composition of plastics has led to the current situation in which publicly funded epidemiologic research must attempt to discover possible health impacts of plastic-associated chemicals, but only after these chemicals have been released to market and resulted in potentially widespread human exposure. The economic costs of plastics’ harms to human health and the global environment are very high (Section 5). We estimate that in 2015 the health-related costs of plastic production exceeded $250 billion (2015 Int$) globally, and that in the US alone the health costs of disease, disability, and premature death caused by just three plastic-associated chemicals (PBDE, BPA, and DEHP) exceeded $920 billion (2015 Int$). The cost of GHG emissions from plastic cause economic harms that we value at $341 billion (2015 Int$) annually. These costs, large as they are, underestimate the full costs of plastics’ impacts on human health and the environment. All of these costs are externalized by the petrochemical and plastic manufacturing industries, and they are borne by individual citizens, taxpayers, and their governments without compensation. The health, environmental, and economic harms caused by plastics disproportionately affect vulnerable and at-risk populations—the poor, people of color, and Indigenous populations as well as fossil fuel extraction workers; plastic production workers; informal waste and recovery workers; persons living in communities adjacent to fossil fuel extraction, plastic production, and plastic waste facilities; and children [ 1494 1495 1496 1497 1498 1499 1500 ] (Sections 4 and 6). These disparate harms are seen in countries at every level of income, including high-income countries [ 1494 1497 1499 ]. They are seen globally in the export of vast quantities of plastic waste, including plastic-laden e-waste from high-income to low-income countries, where this waste accumulates in open tips and landfills, pollutes air and water, degrades vital ecosystems, befouls beaches and estuaries, damages fisheries, and harms human health, especially children’s health [ 1495 1498 ]. SEJ principles require reversal of these inequitable burdens to ensure that no group bears a disproportionate share of plastics’ harms and that those who benefit economically from plastics bear their fair share of its currently externalized costs. This Commission’s strongest recommendation is that the Intergovernmental Negotiating Committee (INC) for the Global Plastics Treaty develop and implement a strong and comprehensive, legally binding Treaty that ensures urgent action and effective interventions at an international scale across the entire life cycle of plastics to end plastic pollution, pursuant to the mandate set forth in the March 2022 resolution of the UNEA [ 37 ]. Progress toward development of this Treaty is already underway, and the first meeting of the INC took place in Punta del Este, Uruguay, in late 2022 [ 1501 1502 ]. International measures to curb plastic production and pollution are critical because the harms to human health and the environment caused by plastics, plastic-associated chemicals, and plastic waste transcend national boundaries, are planetary in their scale, and have disproportionate impacts on the health and well-being of people in some of the world’s poorest nations. A powerful and effective Treaty, consistent with fundamental principles of precaution, would build on models already elaborated in existing multilateral environmental agreements [ 1503 1504 ]. Experience with accelerated timelines for such other agreements as the Ottawa Land Mine Convention [ 1505 1506 ] and the Nuclear Weapons Prohibition Treaty [ 1507 ] suggest that the timeline proposed in the UNEA resolution, for completion of Treaty development by the end of 2024, is realistic. The Commission notes that effective implementation of the Global Plastics Treaty will require coordinated action at the global, national, regional, and local levels. This Commission encourages national, regional, state and local policymakers to be involved in the negotiations on the Treaty, including to support evaluation of the efficacy and feasibility of measures proposed for inclusion in the Treaty as negotiations proceed. National and local policymakers are uniquely well-positioned to pilot test and assess the efficacy of harm reduction strategies, and their experience can provide valuable guidance and real-world grounding to the treaty deliberations. This Commission recommends that a global cap on plastic production be a central provision of the Global Plastics Treaty . Given the great and growing magnitude of the harms caused by plastics to human and planetary health [ 1508 1509 ] (Sections 2, 3, 4, and 6), the substantial and still undercounted economic costs resulting from those harms (Section 5), and the enormous increases in plastic production projected for coming decades (Section 2), this Commission is of the considered opinion that a cap on plastic production is well-justified, much needed, timely—and importantly—the most effective harm-reduction strategy. The great power of a global cap on plastic production is that it will reduce the volume of plastics and plastic waste at its root source. It will slow the current massive global buildout of plastic production infrastructure. It will help put the world on track to end plastic pollution by 2040, a target put forth by the High Ambition Coalition to End Plastic Pollution [ 1510 ]. Like the phase-out of ozone-depleting chlorofluorocarbons under the Montreal Protocol [ 1511 ] and the removal of lead from gasoline [ 1512 ], a global cap on plastic production will have far-reaching benefits for planetary and human health. As was the case with both of those interventions, a cap on plastic production can be expected to have salutary public policy impacts by encouraging industry to develop new technologies and substitutes for existing uses. Complementary, “downstream” control strategies such as enhanced plastic recovery, recycling, and reuse need also to be encouraged. Experience indicates, however, that these approaches are inherently less effective than “upstream” prevention and that without curbing continuing unsustainable production of plastics, they may be expected to continue to lag behind for the foreseeable future (Section 2) [ 57 577 ]. This Commission recognizes that for a global cap on plastic production to be effective, the Treaty will need to include a roadmap that stipulates targets and timetables, and the Treaty includes national contributions that are binding. Targets and timetables for LMICs will likely need to be less stringent than those for high-income countries, to facilitate a just transition. This Commission recommends that a provision banning or severely restricting manufacture and use of unnecessary, avoidable, and problematic plastic items, especially single-use items, be included in the Global Plastic Treaty . As is described in Section 2, manufacture of single-use plastic products accounts for 35–40% of current plastic production, and this fraction is growing rapidly. Inclusion in the Global Plastic Treaty of a provision restricting manufacture and use of unnecessary single-use plastics will help curb current unsustainable increases in plastic production and slow the accumulation of plastic waste. The Montreal Protocol and the Stockholm Convention both provide precedents on how such a ban or restriction could be structured under the Global Plastic Treaty. Many countries, states, and cities have already successfully imposed bans on some single-use plastic items [ 1513 1514 1515 1516 ]. Additional strategies for limiting use of single-use plastics at the national and local levels are suggested in the UNEP report, Single-Use Plastics: A Roadmap for Sustainability [ 1432 ]. This Commission suggests that manufactured MPs such as microbeads in cosmetics (see Box 7.1 ) be considered as a target for banning under the Global Plastics Treaty. Manufactured microplastic (MP) particles. Manufactured MP particles, often called “microbeads” are now intentionally added to many personal care products and cosmetics, including sunscreen, shampoo, makeup, and deodorants as well as in other commercial and consumer products [ 1233 ]. These products contribute directly to environmental contamination and human exposure yet their perceived benefit to society is trivial [ 1517 ]. To counter these materials’ potential hazards to human health and the environment, several countries including New Zealand, Canada, UK, and the Republic of Korea and have banned plastic microbeads in cosmetics and personal care products [ 1518 ]. In the US, the Microbead-Free Waters Act of 2015 prohibits the manufacture, packaging, and distribution of rinse-off cosmetics containing plastic microbeads [ 1519 ]. In 2019, the European Chemicals Agency proposed a sweeping restriction on the use of MPs in all types of EU market products. A year later, the agency’s Committee for Risk Assessment recommended an additional ban on all MPs utilized in infill for artificial turf fields [ 1520 ]. The final EU rule on intentionally added MPs in products is scheduled to be released soon [ 1518 ]. The Nordic Council of Ministers recommend minimizing MP releases at every stage of the plastic life cycle [ 1521 ]. This Commission strongly recommends that the scope of the Global Plastics Treaty extend beyond MPs and marine litter to include all of the many thousands of chemicals incorporated into plastics [ 8 43 1522 ] (Section 2) . Thousands of chemicals, including monomers, additives, and NIAS, are incorporated into plastics during manufacture and are integral components of plastic products, macroplastic waste, and MP particles. Many of these chemicals are responsible for a very great part of the harms to human health and the environment caused by plastic. Over 2,400 plastics chemicals have hazard ratings that are of high concern. Most of the rest have never been assessed for their potential impacts on human and ecosystem health. Plastics chemicals include neurotoxicants, human carcinogens and endocrine disruptors. As is documented in Section 4, plastics chemicals are especially dangerous for infants in the womb, young children, and pregnant women. This Commission recommends the establishment of health-protective standards for plastic-associated chemicals under the Global Plastics Treaty, including global rules to be implemented at national level, requiring testing of all polymers and plastics chemicals for toxicity before they enter markets . The incorporation of hazardous chemicals into plastic production is part of the larger problem of inadequate regulation of chemicals in consumer goods. Health-protective standards for plastic-associated chemicals and their associated reporting obligations should address five major areas: sustainable design; mutual acceptance of data; transparency on the chemical composition and toxicity of plastic-associated chemicals; and systems for human biomonitoring and post-market surveillance [ 1523 ]. Sustainable Design : If plastics are to continue to provide benefit to humanity while not harming human and planetary health, they need to be fundamentally redesigned to use sustainable, non-toxic, and more circular materials. Mandatory health-protective standards applied to all ingredients in plastic—both polymers and other plastics—are a mechanism for achieving this goal. These standards need to prohibit the incorporation into plastics of toxic chemicals and chemicals of known concern for either humans or the environment. The current practice of allowing new plastic-associated chemicals to enter markets without full disclosure and comprehensive toxicity testing is dangerous and unsustainable. It has time and again resulted in widespread disease and premature death [ 1524 ]. The INC’s remit in the UNEA Resolution specifically calls for it to promote sustainable design. International regulatory cooperation for chemicals is essential to harmonize chemical assessments with the aim of minimizing risks [ 1525 ]. Mutual Acceptance of Data : The Mutual Acceptance of Data system is a framework whereby OECD chemical safety guidelines developed in one adhering country must be accepted in all adhering countries and is helping to minimize regulatory divergencies, and the framework facilitates work-sharing with a recent case-study indicating significant cost-benefit estimated at ~3 million Euros [ 1525 ]. In addition to OECD member countries, seven non-OECD member countries (Argentina, Brazil, India, Malaysia, Singapore, South Africa, and Thailand) are participating [ 1525 ]. To avoid conflict of interest, it is important that all toxicity testing of plastic-associated chemicals be performed by independent laboratories and not by the chemical manufacturing industry or by laboratories financed by the industry. Such an independent testing program could be supported by user fees paid to national governments by chemical and plastic manufacturers, as is done today in registration of pharmaceutical and food chemicals [ 1526 ]. Transparency : Mandatory disclosure regimes are needed to require labeling of the full chemical composition of all plastics products, including resins, polymers, additives, monomers, and adjuvant chemicals as well as information on transformation products of these materials. The UNEA mandate addresses this question, calling upon the INC to consider the provision of policy-relevant scientific information and assessment related to plastic pollution in its drafting of the Global Plastics Treaty. Traceability : Mandatory disclosure on composition should be complemented by the systematic collection of data on the specific chemical signatures of specific plastic products, which can be made publicly available so that waste can be tracked, traced, and effectively managed. Human Biomonitoring : Even with adequate premarket toxicity testing, it is never possible to fully know all of the short- and long-term health risks that may be associated with plastic-associated chemicals until wide-scale human exposure has occurred. Health protective standards for plastics chemicals should therefore be complemented by mandatory systematic biomonitoring and post-market surveillance of plastic chemical exposures in human populations, as is already routinely done in the pharmaceutical and food industries [ 1526 ]. These biomonitoring programs should cover LMIC and vulnerable populations as well as populations in high-income countries. Effective biomonitoring will require surveillance for plastic-associated chemicals as well as for their degradation and biotransformation products. It will also require a sustainable funding mechanism, which could be funded by industry through chemical registration fees, as is routine practice in the pharmaceutical and food chemical industries. This Commission recommends inclusion in the Global Plastics Treaty of mechanisms for reducing the complexity of plastic products . Currently, many different chemicals are used to perform similar functions in plastic production. This, together with a lack of coordination among manufacturers, has resulted in an enormous proliferation of different types of plastic. This complexity poses great challenges to downstream control efforts, including recovery and recycling. These problems are compounded by the lack of any system to trace the identities and levels of the chemicals present in specificplastic products. To address this issue, the UNEA resolution specifically identifies the need to address the design of products and materials …so that they can be reused, remanufactured or recycled and therefore retained in the economy for as long as possible, along with the resources they are made of, and of minimizing the generation of waste, which can significantly contribute to sustainable production and consumption of plastics. This Commission notes that several suggestions on how to achieve product streamlining have recently been put forth [ 1510 ]. They include developing design standards for plastics to simplify their chemical composition and increase compatibility with end-of-life management [ 43 ], for example, through removing toxic chemicals from plastics and replacing them with more environmentally friendly materials, redesigning clothing to reduce fiber shedding and redesigning tires to reduce PM and microfiber release. This Commission recommends inclusion in the Global Plastics Treaty of requirements for Parties to enact and enforce legislation and policy frameworks on EPR . The Treaty could prescribe minimum global standards for EPR frameworks to be implemented at the national level by treaty parties. EPR legislation makes plastic producers and the manufacturers of plastic products legally and financially responsible for the safety and end-of-life management of all the materials they produce and sell. By making plastic producers responsible for costs that until now they have externalized and shifted onto governments, taxpayers, and the general public, the goal of EPR is to incentivize change within industry. By analogy, liability protocols have been adopted for releases of hazardous substances [ 1527 ], wastes [ 1528 ], and genetically modified organisms [ 1529 ] under other major multilateral conventions. At a minimum, EPR programs require producers of plastic products to either take back these products at the end of their useful life (with take back encouraged in some instances through deposit fees) or to cover costs of waste management and clean-up (see examples in Boxes 7.2 , 7.3 , 7.4 ) [ 1530 ]. For example, Canada has had a national EPR policy in place since 2009 that has been implemented in at least five provinces [ 1531 ]. Container deposit laws in multiple countries provide additional examples of successful EPR strategies ( Box 7.4 ). EPR and E-Waste. Electric-powered and electronic products contain large quantities of many types of plastic. Substantial opportunities exist to reduce both plastic production and the generation of e-waste by requiring that all electric-powered and electronic products be repairable, that their components be reusable, and that manufacturers take their products back at the end of their useful life for reuse, remanufacturing, recycling, or safe disposal. Such requirements will make manufacturers of electric-powered and electronic products responsible for the costs of e-waste handling that they currently externalize and shift on to state and local governments and vulnerable populations. It will also make them responsible for the large volumes of e-waste that they currently send to landfills in high-income countries and into e-waste dumpsites in LMICs. Product design standards that require easy disassembly of all electric and electronic products and the repair and reuse of components are key to achieving this goal. They should include standardization of the plastics used in electrical appliances and electronic goods. The European Commission has already proposed design requirements mandating most of these features [ 1532 ]. “Right to Repair” laws are a further strategy for reducing e-waste. These laws prohibit manufacturers from placing limitations on access to repair materials such as parts, tools, diagnostics, and programming such as firmware. In July 2017, the European Parliament approved a recommendation that Member States should pass laws giving consumers the right to repair their electronics. Likewise, the British government introduced a “Right to Repair” law that went into effect on July 1, 2021. EPR and ALDFG. Abandoned, lost, or discarded fishing gear constitutes a significant portion of ocean plastics [ 551 ]. Entanglement in ALDFG is well known to endanger marine mammals, turtles, seabirds, and some fishes and poses a threat to ecosystems [ 505 567 722 ]. ALDFG may also serve as an ongoing source of marine leakage of harmful chemicals and MPs [ 1533 1534 ]. Several EPR provisions pertaining to fishing gear are already in place in the EU, where Directive 2019/904 requires producers of fishing gear containing plastic to cover the costs of 1) the collection of waste gear and 2) awareness raising measures to prevent and reduce the abandonment of gear at sea. EU Member States are required to monitor and assess compliance [ 334 ]. The measure was built on earlier directives, such as that of 2008 obliging national minimum annual collection rates of gear containing plastic for recycling [ 1535 ] and of 2009 requiring that gear be tagged with an external identification number, and that the master of the vessel attempt to retrieve lost gear as soon as possible, reporting losses to authorities of the flag state within 24 hours [ 1536 ]. An international program of EPR can incorporate and expand on these provisions, for instance by implementing a universal system of equipment registration, and by marking registered gear with acoustic transponder tags, which can be used to ensure that lost gear is tracked and, when possible, retrieved. Such tags are relatively inexpensive and are already in use in fisheries in Southwest England [ 1537 ]. Commercial fishers who use fish aggregating devices employ similar devices, and these have been successfully utilized in demonstration projects by bodies such as the European Climate Infrastructure and Environment Executive Agency to locate and retrieve lost nets [ 1538 1539 ]. Technologies such as these, in combination with deposit schemes or regulations that impose financial penalties for discarded or lost equipment, can introduce stronger systems of accountability. Drawing on the EU’s minimum annual collection rates, international requirements can be instituted requiring manufacturers to offer take-back credits, and to ensure that new gear be made using a percentage of recycled materials. A certification or labelling scheme can be initiated to identify products made from recycled fishing gear, thus conferring a higher value [ 1537 ]. Container Deposit Laws. Deposit laws in multiple countries for bottles, cans and other containers provide an example of a highly successful EPR strategy implemented at national level. Under EC Directive 2019/904, EU Member States are encouraged to establish bottle bills that incentivize the collection and reuse of containers, including plastic bottles [ 334 ]. Such bills are already in place in many countries worldwide [ 1540 ]. In 2022, the 11 Canadian provinces with deposit laws had an average return rate of 74%, the 13 EU countries averaged 90%, and the 13 jurisdictions in Oceania averaged 69%. All of these rates are far higher than the global average plastic recycling rate of about 9%. Across the US, polyethylene terephthalate (PET) plastic beverage containers without a deposit were recycled at a rate of only 17%, in contrast to a nationwide average recycling rate of 57% for PET bottles with a deposit [ 1541 ]. In 2019, Oregon and Michigan—the two US states with 10¢ deposits—had overall redemption rates of 86% and 89% respectively. In contrast, states such as Massachusetts and Connecticut, which have 5¢ deposits, had redemption rates of 43% and 44%. In the European Union, the five best performing Member States with deposit schemes for PET bottles (Germany, Denmark, Finland, the Netherlands, and Estonia) reached an average collection rate for PET of 94% in 2014 [ 1532 ]. A striking example of the benefit that could have been delivered by EPR is seen in the case of plastic microbeads in cosmetics. The patent for the use of plastic microbeads in cosmetics was filed decades ago. If EPR been in place at that time it would have likely prevented the hundreds of thousands of tons of totally avoidable environmental contamination that have resulted from use of these materials. EPR programs can be coordinated with national and state strategies to reduce virgin plastic production. The ultimate goal of this suite of interventions is to make the plastic supply chain more circular and less linear, thus reducing need for virgin plastic production and slowing the accumulation of plastic waste. This Commission encourages inclusion in the Global Plastic Treaty of a provision calling for exploration of listing some plastic polymers as POPs under the Stockholm Convention [ 187 ]. Plastics meet many of the cardinal criteria for listing as POPs: All plastic polymers are synthetic chemicals (Section 2). Macroplastics as well as MNPs are resistant to natural degradation and can persist in the environment for many decades [ 1542 1543 ]. Persistent materials such as plastics will continue to accumulate in the environment for as long as they are released, reaching high levels. Toxic effects that would not otherwise be evident could emerge [ 1544 ]. Plastic can be transported over long distances, especially through the oceans (Section 3). Although the larger MP particles (>10 µm) that result from the environmental breakdown of plastic waste appear not to undergo biomagnification themselves, there is potential for bioaccumulation and biomagnification of the smaller MP and NP particles (<10 µm), which cannot yet be reliably measured. Based on the foregoing considerations, this Commission urges the Parties to the Stockholm Convention to consider listing of some plastic polymers as POPs and urges the INC expressly to call for exploration of this action. This Commission makes two further observations in regard to the Stockholm Convention: A great strength of the Stockholm Convention is that it reaches into domestic production and use. It consequently is a superior model for the Global Plastics Treaty than either the Basel or Rotterdam Conventions, which primarily address international trade. Under the Stockholm Convention, domestic production, use, importation, and exportation of listed POPs can be eliminated or restricted. The 2013 Minamata Convention on Mercury [ 1545 ] is another comprehensive instrument, which requires parties to implement policies and measures to control mercury throughout its life cycle, including reductions across various products, processes, and industries where mercury is used, released, or emitted. The Stockholm Convention also has limitations that should be overcome in the new Global Plastics Treaty. For example, the process of listing new substances is slow and cumbersome, bound by a consensus decision-making process, often influenced by least-common-denominator results. Thus, since entry into force in 2004, only 20 new substances or groups of substances have been listed, most recently in 2022. This Commission recommends that protection of human health and well-being, and especially protection of the health of vulnerable and at-risk populations, be a paramount consideration in developing globally binding controls addressing the harms caused by plastics under the Global Plastics Treaty . The UNEA resolution on the Global Plastics Treaty specifically identifies human health in its preamble. Building on this foundation, the operational provisions of the Global Plastics Treaty should be crafted to assure that protection of human health is a central goal of the instrument. The UNEA remit specifically instructs the INC to adopt a full life cycle approach to addressing the health impacts of the global plastics problem. The groups at greatest risk of harms to health caused by plastic across the life cycle are infants, children, pregnant women, workers, Indigenous populations, and persons living in “fenceline” communities adjacent to plastic industries (Sections 4 and 6). Protection of the health of these vulnerable and at-risk groups is ethically well justified, and measures crafted to protect their health will safeguard the health of entire populations. Consistent with the directive of the UNEA resolution, it is essential that affected communities, civil society organizations, Indigenous populations, environmental justice organizations, the scientific community, faith-based organizations, and LMIC representatives such as waste-pickers contribute to the treaty negotiations. People living near plastic production and waste facilities in both high-income countries and LMICs have a particularly important voice that needs to be heard and factored into decision-making. Their participation will help ensure that the Global Plastics Treaty includes measures specifically designed to address the disproportionate harms that plastics impose on these populations. Liberal standards for admission of accredited non-governmental observers to negotiations under UN auspices for major conventions on climate, biodiversity, international trade in wastes, POPs, stratospheric ozone protection, and others is now the global good practice standard. This Commission recommends a strong interface between the Global Plastics Treaty and the Basel and London Conventions to support ongoing management of hazardous plastic waste . The provisions of the Global Plastics Treaty will need to build upon and reinforce the work of the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal. Having entered into force in May 1992, the Basel Convention [ 1546 ] was designed to reduce the movement of hazardous waste between nations, and specifically to discourage wealthier countries from exporting unsafe waste to lower-income nations. In 2019, this Convention was updated by the Plastic Waste Amendment, which modified three annexes to include certain plastic wastes [ 1528 ]. This amendment requires prior written consent of the importing country for most categories of plastic waste, including e-waste. A companion amendment [ 1547 ] has the effect of banning the export of contaminated and highly mixed plastic waste from the OECD countries, the EU, and Lichtenstein to LMICs. Despite the strong and well-crafted provisions of the Basel Convention and its Plastic Waste Amendment, massive amounts of plastic waste continue to flow into the world’s least developed countries where it degrades environments, harms human health, and deepens social injustices. To address this continuing crisis, this Commission recommends that the Global Plastics Treaty include a provision calling for collaboration with the Basel Convention to strengthen enforcement of Basel Convention’s regulations and increase awareness among national leaders of their power to refuse unwanted shipments of plastic waste under the provisions of the Basel Convention. Additionally, recognizing that The Basel Convention is primarily limited in scope to international trade in wastes, this Commission notes that the Global Plastics Treaty needs to penetrate to the domestic level, establishing globally agreed-upon standards for production, use, and disposal of plastics within countries and not only on shipments that enter into international trade. The London Convention and Protocol [ 1549 ] can and should be mobilized further to address the problem of the dumping of plastics into the marine environment. The Rotterdam Convention [ 1548 ] creates a similar prior-informed-consent procedure for chemicals and pesticides in international trade, potentially including many plastics or their precursors and starting materials. The parties to the Rotterdam Convention should consider a plastics amendment analogous to that under the Basel Convention. Even without such an instrument, the Rotterdam Convention can be mobilized to address an important additional component of the global plastics problem. The governing UNEA resolution directs the INC to consider “the possibility of a mechanism to provide policy-relevant scientific and socioeconomic information and assessment related to plastics pollution.” Currently, in parallel with negotiations on the plastics treaty, the global community is working on establishing an intergovernmental, independent science-policy panel on chemicals, waste and pollution prevention, with the ambition to establish it by 2024. This body will need to interface closely with the Plastics Treaty and appropriate frameworks for that interface should be established. Negotiators may consider whether the science-policy functions for the Plastics Treaty could be realized through this new science-policy panel on chemicals, waste, and pollution prevention, or would be better served by a dedicated science-policy body established under the Treaty (or some combination of both). This Commission recommends establishment of a dedicated Permanent Science Policy Advisory Body for the Global Plastics Treaty, with core functions of providing scientifically rigorous, unbiased advice to the Treaty implementation through close engagement, on an ongoing basis, with the global academic community, national research institutes, and national and local policy makers . Such a body should be transdisciplinary in scope and include expertise in the natural, economic, and social sciences as well as regional expertise and Indigenous knowledge. It will be essential that this body is shielded from special interests. The overall priority of such a dedicated Permanent Science Policy Advisory Body could be to guide Treaty Parties in evaluating which solutions are most effective in reducing plastic production and consumption, curbing the generation of plastic waste, enhancing plastic waste recovery and recycling, and ensuring proper disposal of plastic waste. This Body could also assess trade-offs among proposed solutions, evaluate unintended consequences to interventions, and evaluate safer alternatives to current plastics (see Box 7.5 ). The Need for Independent Evaluation of Evidence on the Efficacy of Solutions. It will be essential that solutions proposed to the plastics crisis be subject to careful review and due diligence to avoid “regrettable substitutions.” Some examples of inadequately vetted solutions that have been found, on review, to aggravate global plastics crisis include: Carrier bags marketed as “biodegradable” that fail to explain the context required for meaningful degradation to occur, and that actually remain fully functional after several years at sea or buried in soil [ 1550 ]. Devices that claim to reduce the release of microfibers from laundering, but fail to deliver any significant reductions [ 1551 ]. Devices marketed for the removal of litter from ports and harbors, that fail to remove much plastic, but instead capture large quantities of seaweed and kill juvenile fish [ 1552 ]. It is critical that we learn from these mistakes and take a far more precautionary approach, e.g., based on EPR. This transition needs to start now; it needs to be evidence-based; and it needs to be enshrined in all approaches intended to address the issue of plastic production [ 60 ]. It is also critical to adopt an evidence-based approach to identify which aspects of the plastic crisis are best addressed by actions at an international versus the national level. A case study is seen in the release of MP fibers from textiles. Three main intervention points exist to reduce microfiber shedding: 1) increasing the availability and quality of wastewater treatment [ 1553 ], 2) fitting filters to washing machines [ 1551 ], and 3) reducing the shedding of fibers via design changes to fabric and yarn [ 1554 ]. Options 1 and 2 are more attractive in the Global North because they can be implemented at a national scale. For example, new legislation in France will mandate filters on washing machines. By contrast, Options 1 and 2 will not be very effective in the Global South, where many populations do not have the benefit of washing machines or advanced wastewater treatment. Option 3, improved fabric design, which could be mandated by international legislation under the Global Plastics Treaty, appears to be effective in reducing microfiber shedding in all countries at every level of income, because 50% of all microfiber emissions occur while garments are being worn rather than while they are being washed [ 1555 ]. Improved fabric design therefore has far greater potential to address the issue of microfiber shedding than any “downstream” solution [ 1555 ]. Specific functions of this Body could be to: Track global and national trends in plastic production, recycling, transnational export, environmental leakage, and plastic-associated GHG emissions; Coordinate, assist, and provide guidance in the crafting of national EPR legislation/policy frameworks; Provide ongoing guidance to Treaty parties for the refinement of health-protective standards for plastic-associated chemicals; Provide guidance on effective strategies for plastic waste recovery, recycling, and disposal; Summarize information on the heretofore externalized and undercounted health and environmental costs of plastic production and pollution, including impacts on the marine environment; Examine the health and environmental costs of products proposed as replacements for plastics to assure that they entail no net increases in production, use and disposal externalities; and Support robust aquatic, land, and air-based monitoring programs for primary and secondary MPs. This Commission is very clear in our view that the most effective strategies for slowing the accumulation of plastic waste and reducing the harms associated with plastics across its life cycle are “upstream” solutions that address the root causes of the plastic crisis. They include: Reducing plastic production through an agreed-upon production cap; Enacting and enforcing EPR legislation; Banning production and sale of non-essential single-use plastics; and Redesigning plastics to simplify their chemical composition and increase compatibility with end-of-life management [ 43 ]. These “upstream” solutions need to be supplemented by complementary, “downstream” strategies such as effective recovery, recycling, and reuse. The Commission makes the following comments regarding some existing and emerging, expensive, and unproven downstream waste management methods from the perspective of minimizing harm to human health and the environment: Open burning of plastic waste in landfills and municipal waste dumps is the most dangerous approach to plastic waste disposal and should be prohibited in all countries under the Global Plastic Treaty. Open burning of plastic releases metals and toxic chemicals, including lead, mercury, arsenic, PM 2.5 , carbon monoxide, NO x , arsenic, PCDD/Fs, PCBs, PBBs, PAHs, and pyroplastics (a complex mixture of plastic transformation products) to air, water, soil, and ultimately the ocean [ 679 1355 ]. The ash resulting from plastic burning is also toxic and contains many of these same pollutants, which can leach into the soil and contaminate groundwater [ 384 ]. The full scope of risks associated with chemical and thermal conversion (also known as “advanced recycling,” “pyrolysis,” “gasification,” “hydrothermal conversion,” and “waste-to-energy” processes) remain unknown. All of these technologies involve super-heating or burning plastic waste in furnaces or kilns, or they use chemical reactors to break chemical bonds and produce smaller molecules. At present, these are mostly small-scale enterprises of limited capacity and unproven reliability that are able to cope with only a small fraction of the millions of tons of virgin plastic produced each year [ 322 ]. “Upcycling” is a term used by some to describe depolymerization of plastic waste into smaller molecules that can be used to make the same or different higher value materials—higher value than those resulting from mechanical recycling. While these approaches seem promising, none of them are yet proven effective at any useful scale. This Commission notes the following risks associated with these technologies: Heating and burning of plastics that contain chlorine (e.g., PVC) and bromine (e.g., BFRs) can release highly toxic halogenated dioxins and furans and other hazardous pollutants such as benzene into the atmosphere through their stacks unless combustion temperatures and waste gas filtration devices are meticulously well maintained at all times [ 1556 ]. The residue that remains after combustion may also contain these toxic chemicals. Chemical and thermal conversion operations are disproportionately sited in low-income communities and communities of color, where they exacerbate environmental injustices [ 1557 ]. Because they require high heat, chemical, and thermal conversion processes are energy-intensive with high energy costs and potential to produce abundant GHG emissions [ 1558 1559 ]. This Commission advises countries to approach these emerging, expensive, and unproven technologies with great caution and to undertake thorough, independent assessments of their environmental impacts prior to any adoption. Any implementation of these technologies should proceed step-wise and be closely scrutinized. A final consideration in regard to chemical and thermal conversion is that investments into these costly yet unproven technologies will divert funding away from proven effective strategies. Investments made in chemical and thermal recycling thus have potential to derail efforts to address the root causes of the global plastics crisis. While much actionable information is already available on plastics’ hazards to human and planetary health, gaps in knowledge remain and additional research is needed to better safeguard health. Governments will likely support much of this research using public funds. An additional source of support could be a carbon tax levied against the industries that produce the coal, oil, and gas feedstocks used in plastic manufacture. Such a tax would complement EPR fees paid by the manufacturers of plastic products to prevent the accumulation of plastic waste. Like EPR, it would have the effect of making the producers of fossil carbon responsible for the harms to human health and the global environment caused by the materials they produce and sell. This Commission recommends urgent investment by national governments and major foundations in research into practical solutions to the global plastic crisis . This research will need to determine which solutions are most effective and cost-effective in the context of particular countries and assess the risks, benefits, and trade-offs of proposed solutions. It will need additionally to evaluate any potential unintended consequences of interventions. This Commission recommends that there be close coordination between research on these topics at the national and international level and the Permanent Science Policy Advisory Body that this Commission suggests be established under the treaty. This Commission recommends increased oceanographic and environmental research to : Better measure and understand the concentrations and health impacts of plastics <10µm on marine species; Monitor levels of plastic regardless of size (macro-, micro- and nano-) or origin (primary or secondary) and assess their fate throughout the global ocean (see Section 3); and Better measure and monitor the impacts of plastic-associated chemicals on marine species. This Commission recommends increased research on the human health effects of plastic-associated chemicals (see Section 4) to : Better assess human exposure to a wider range of plastic chemcials; Develop enhaced toxicologial techniques, including high-throughput and in silico techniques, to screen currently untested plastic-associated chemicals for toxicity; Undertake longitudinal biomonitoring studies to assess plastic chemical exposure in human populations within both developed countries and LMICs, and including high-risk populations such as plastic production workers, residents of “fenceline” communities, and waste-pickers; and Undertake longitudinal epidemiological studies in human populations within both developed countries and LMICs, including high-risk populations to assess the impacts of plastic chemical exposures on human health. This commission also recommends increased research on the potential human health effects of MNPs (see Section 4) to : Refine and validate existing measurement techniques and develop novel techniques for quantifying both MPs and NPs in biological and environmental media; Develop rigorous contamination control methodologies and equipment for use during sample collection, storage, processing and measurement; Undertake longitudinal biomonitoring studies in human populations, including high-risk populations, to assess MNP exposure; and Undertake longitudinal observational studies in human populations, including high-risk populations, to assess the impacts of MNPs exposure on human health. This Commission recommends that plastics researchers and policymakers engage educators as partners to inform the next generation of consumers and decision-makers about the health and environmental impacts of plastics . Because plastics’ manufacture, use, disposal, and pollution are globally pervasive and growing, it is imperative that today’s youth be educated about the plastic world that they will inherit and have to address as the consumers and leaders of tomorrow. Youth need to have as keen an appreciation of the dangers of chemical and plastic pollution as they do of climate change. Educators can instill in students the importance of a healthy body and a healthy environment and help students grow into well-informed consumers and members of society who have the power to make change with their individual voices, choices, and actions. This Commission recommends that plastics researchers and policymakers engage their local communities to provide accurate information about the plastics life cycle, the health and environmental impacts of plastics, and the alternatives to unnecessary plastic products . Although plastics are materials upon which modern society is heavily reliant, substantial outreach is required to inform the general populace about the dangers of pervasive use of unnecessary plastic products and the negative impacts these products have on human and environmental health from production through use, disposal, and pollution of the environment. It is critical that accurate and timely information be shared, and that concrete, actionable alternatives are co-created according to the specific needs and circumstances of each local community. This Commission recommends that the medical, public health, and scientific communities take an active role in reducing use of unnecessary single-use plastic and raising awareness about impacts of plastic-associated chemicals on human and environmental health . While the oceanographic and marine biology communities have been aware of plastic’s negative impacts on the environment since the 1970s [ 1 490 ], the medical and public health communities have until now not been widely aware of plastics’ impacts on human health [ 284 1560 ]. This is not surprising, given that the science in this area is still emerging and the majority of reports on plastics’ hazards have appeared in environmental and oceanographic journals and in government agency publications not widely read by physicians, nurses, and public health professionals. Moreover, plastic and chemical pollution have been worsening quietly, while the world’s attention has been focused on climate change. Today, however, as knowledge of plastics’ many harms to human and planetary health increases and becomes more widely available, physicians, nurses, and public health professionals have an opportunity to lead the global effort to reduce these hazards and to protect the health of their patients. Health professionals can educate themselves and their patients about plastics and their hazards. They can take a leadership role in reducing plastic use and plastic waste generation in hospitals and health care facilities. The health care sector generates substantial volumes of plastic waste, and depending on the medical facility, plastics comprise between 20–65% of all waste generated [ 284 ]. While some plastics are essential in health care, many are not, and careful review of inventories and supply chains has potential to greatly reduce plastic use. Examples include going back to cotton rather than plastic sheets and using sterilizable, reusable surgical instruments instead of single-use plastic devices. Public health agencies can increase support for toxicological and epidemiological research into the health hazards of plastics and plastic additives. They can launch and support large-scale, multi-year human biomonitoring programs and observational studies. They can increase their educational offerings on chemical and plastic pollution. Medical societies and public health organizations are uniquely well positioned to educate elected officials about plastics’ harms to human health and the environment and to advocate governments at every level to reduce plastic production, use, and disposal to protect the health of their patients. They can advocate for such goals as reductions in plastic production; moratoria on fracking and on the construction of cracker plants, pipelines, and compressor stations; restrictions on single use plastics; and passage of EPR legislation. By pointing out to elected officials the increasingly well-documented links between plastics and harms to human health, and by noting that actions to control plastic production will also help control climate change, prevent pollution, and save tax dollars, doctors, nurses, public health professionals, and scientists are in a powerful position to oppose the forces that call for endless, unchecked increases in plastic production. These trusted advocates are uniquely well positioned to catalyze enduring action to safeguard human health, protect the planet, and advance the common good. The Minderoo-Monaco Commission on Plastics and Human Health finds that plastics are both a boon to humanity and a stealth threat to human and planetary health. Plastics convey enormous benefits, but current linear patterns of plastic production, use, and disposal with little attention paid to sustainable design or safe materials and a near absence of recovery, reuse, and recycling are responsible for grave harms to health, widespread environmental damage, great economic costs, and deep societal injustices. These harms are rapidly worsening. While there remain gaps in knowledge about plastics’ harms and uncertainties about their full magnitude, the evidence available today demonstrates unequivocally that these impacts are great and that they will increase in severity in the absence of urgent and effective intervention at global scale. Manufacture and use of essential plastics may continue. But reckless increases in plastic production, and especially increases in the manufacture of an ever-increasing array of unnecessary single-use plastic products, need to be curbed. Global intervention against the plastic crisis is needed now, because the costs of failure to act will be immense.

The additional file for this article can be found as follows: Abbreviations and Glossary.