EU countries must for the first time monitor levels of so-called forever chemicals in drinking water in accordance with rules that came into effect last week.

Levels of per- and polyfluoroalkyl substances (PFAS) must be reported to the European Commission (EC) to ensure compliance with limits set by the Drinking Water Directive, which member states were required to incorporate into national laws by 2023. Incidents such as spillages must also be reported.

Representing a large family of at least 10,000 synthetic organic compounds, PFAS are used widely in about 22 industrial sectors, from cosmetics to food packaging and medical devices.

The rules were motivated by the fact that PFAS persist for generations in the air, surface water, groundwater, and soil. The chemicals accumulate in humans, fish, shellfish, plants, and animals. The Forever Pollution project estimates that there are 23,000 PFAS-contaminated sites in Europe. Of these sites, 2300 are hot spots with high levels of pollution that may threaten human health.

Moreover, the health effects of PFAS are believed to be wide-reaching. They may range from kidney and testicular cancer to increased cholesterol and immunotoxicity and fertility issues in men and women. Indeed, recent research shows a strong association between levels of PFAS in the blood of pregnant women and low birthweight babies, gestational diabetes, and liver problems, Fionnuala McAuliffe, MD, chair and full academic professor of obstetrics and gynecology at University College Dublin, Dublin, Ireland, told Medscape News Europe. “With fetal growth restrictions, it is perhaps affecting how the placenta feeds the baby,” she said.

McAuliffe is also division director for maternal and newborn health at the International Federation of Gynecology and Obstetrics, a global alliance of national obstetrics and gynecologist societies, which has called for significant PFAS restrictions. “We would welcome any reduction in the exposure of toxic chemicals to women planning pregnancy, pregnant women, and newborns,” she added.

Calls for More Monitoring

The EC has published limit values for PFAS in drinking water. If such values are exceeded, member states are required to deal with them by, for example, closing contaminated wells, adding treatment steps to remove PFAS, or restricting the use of drinking water supplies for as long as the level exceeds the published limit values.

Italy, Denmark, and Sweden are monitoring more chemicals than those stipulated in the legislation, according to a report by Health and Environment Alliance (HEAL), a European nongovernmental organization. “At least some member states are of the opinion that additional PFAS should be monitored,” Sandra Jen, health and chemicals programme lead at HEAL, told Medscape News Europe.

PFAS levels permitted in drinking water have been set as much as two orders of magnitude higher than those for PFAS in food, said Hilma Samuelsson, toxicologist with ChemSec, a Swedish advocacy group working to restrict PFAS in the EU. The European Food Safety Authority (EFSA) set a series of limits after a rigorous health-based assessment in 2020, she explained. “The drinking water limits reflect what is currently technically and economically feasible to treat, not what would fully align exposure with health-based science,” she said. “It’s very costly to remove PFAS from water. You need a lot of energy and a lot of very expensive technology.”

Countries are permitted to choose to monitor one or two limit values specified by the Drinking Water Directive: the sum of 20 PFAS in water and the PFAS total. The latter is the concentration of every known PFAS in the water, which includes potentially thousands of compounds, whether they have been classified as hazardous. The Drinking Water Directive allows 100 ng/L for the sum of 20 PFAS and 500 ng/L for PFAS total. Yet using the EFSA’s own health assessment as a basis, equivalent levels in water should be in the low single-digit nanogram-per-liter range for the most harmful PFAS, said Samuelsson.

The EC did not respond to Medscape’s requests to explain how the levels were reached. In a statement, however, it suggested that guidelines are based on technical and socioeconomic assessments developed in close consultation with member states.

Targeting the Source

It is unsurprising, then, that some member states have pushed for wider-reaching restrictions on the manufacturing and sale of PFAS. “The drinking water rules are an important safety net, but they are not sufficient on their own,” explained Samuelsson. “They address PFAS after contamination has already occurred, at the point where people consume the water.”

To target contamination at its source, Germany, Netherlands, Denmark, Norway, and Sweden have proposed an EU-wide restriction of around 10,000 PFAS across a wide range of uses. “The proposal is the most extensive in the history of the EU, both in terms of number of chemicals and range of uses covered,” said a spokesperson for the EU’s European Chemicals Agency (ECHA), which is assessing the proposal.

HEAL, ChemSec, and 116 other organizations say they support the proposal because it takes a group-wide approach to avoid a phenomenon called regrettable substitution, where one hazardous chemical is monitored or banned, only to be replaced with another newly developed chemical that poses similar or greater risks to human health or the environment.

Importantly, however, the proposal does not call for a complete ban of PFAS, said Jen. “Instead, it calls for the EU Commission to adopt a broad restriction on the production and use of PFAS by 2030,” she explained. “We support time-limited derogations for uses where alternatives are still in development and for uses that are critical for the health, safety, and functioning of society.” ECHA will report on the next steps to be taken regarding the proposal in March.

Jen, McAuliffe, and Larsson reported having no relevant financial relationships.