CPSP Annual Report 2020-2021
I. Intro
In 2020, the Centre for Pesticide Suicide Prevention (CPSP) finished its first funding cycle, with funding received as an Incubation Grant from Open Philanthropy Foundation/GiveWell. The grant, received in 2017, funded activities aimed at reducing pesticide suicides in low- and middle- income countries (LMICs). We would like to thank GiveWell and the Open Philanthropy Foundation for the three fruitful and interesting years that laid the foundation for saving lives from pesticide poisoning and suicide in LMIC.
While CPSP was waiting for the decision on further support from GiveWell in 2020, a bridging six-month grant from the Center for Effective Altruism allowed us to carry on our work. We thank the Centre for Effective Altruism for their support.
In January 2021, CPSP received further support from GiveWell in the form of a donation from Good Ventures Foundation for a further three years. We thank GiveWell for their continued support and encouragement.
CPSP will continue to work to reduce lives lost to acutely toxic highly hazardous pesticides (HHPs). It will collaborate with partners to eliminate pesticide suicides and replace HHPs with safe alternatives. In some countries, suicide is illegal or too sensitive to be discussed openly or considered in policy decisions. The same pesticides that feature commonly in suicide cases are also responsible for occupational exposure that results in acute or chronic illness, and for environmental contamination, biodiversity losses and other negative impacts following their authorized uses. The objective of phasing out HHPs therefore also contributes to improved health among pesticide users and their communities, cleaner environments through reduced pesticide contamination, enhanced biodiversity in agricultural production zones and safer food for consumers because residues of the most harmful pesticides are avoided.
CPSP’s second funding cycle will include increased attention to international and regional work. With a view of reaching more countries, CPSP will work with UN organizations, regional pesticide regulatory bodies, research and advisory groups, and civil society organizations. CPSP will support capacity development in the health sector to improve data collection and interpretation on suicides and pesticide poisoning and help to connect that data to pesticide regulators so that it can be used in regulatory decisions.
The geographical focus areas for CPSP’s work will be southern and eastern Asia, southern, eastern and western Africa and the Caribbean/northern South America. Within these regions CPSP will work with individual countries that have highlighted the issue of pesticide suicides for attention, and with regional groupings of national pesticide regulators in order to disseminate experiences and knowledge gained among more countries. Approaches from countries outside those regions can be made directly to CPSP or though the Food and Agriculture Organisation (FAO) or the World Health Organization (WHO) with whom CPSP collaborates closely.
Photographs are by Heshani Sothiraj Eddleston and CPSP staff
Photographs are by Heshani Sothiraj Eddleston and CPSP staff
II. International and regional work
International action
CPSP works closely with the UN agencies that guide their member countries on the management of hazardous chemicals including HHPs. FAO is leading the development of a Global Action Plan on HHPs into which CPSP has provided input and hopes to support its implementation after its proposed launch at the UN Environment Assembly in 2022. CPSP also collaborates with FAO-led projects that support countries in addressing pesticide risk reduction, improved pesticide management and transition to sustainable crop production and protection strategies in LMIC.
The United Nations Environment Programme (UNEP) coordinated Strategic Approach to International Chemicals Management (SAICM) and continues to prioritize HHPs as an issue that requires attention and action nationally and internationally. It is SAICM that called on the UN agencies to develop a Global Strategy and a Global Action Plan on HHPs. CPSP is engaging with UNEP and SAICM to support progress and delivery of action on HHPs with a specific focus on saving lives by prioritizing the removal of pesticides used in suicide around the world.
The WHO also addresses HHPs from two perspectives, that of chemical safety and suicide prevention. CPSP works closely with WHO to develop guidance for countries in regulating HHPs and preventing pesticide suicides. It worked with the WHO to assess the cost-effectiveness of banning HHPs for suicide prevention (https://pubmed.ncbi.nlm.nih.gov/33341152/ and supported the production of WHO’s implementation guide for suicide prevention (Live Life https://www.who.int/publications/i/item/9789240026629). Suicide is rarely considered in the evaluation of pesticide risks by regulators, yet the work of CPSP clearly demonstrates that the risk is present and its recognition in pesticide registration can save many lives(https://www.who.int/publications/i/item/9789241516389). CPSP supported a resolution on cost effective mental health interventions that was approved by the 2020 World Health Assembly (Menu of Cost-Effective Interventions for Mental Health )
Regional collaboration
CPSP is working to establish links and collaboration arrangements with five regional pesticide regulatory bodies in Asia, southern, eastern and western Africa and the Caribbean. Each of the regulatory bodies is developing a strategy on HHPs which CPSP will support to develop and implement. The regulatory bodies have been established to allow countries with limited resources to share the work, technical knowledge, resources and experiences in the evaluation, monitoring and decision-making processes on pesticides.
The key focus of CPSP interventions is to prevent suicides by identifying where pesticide suicides are occurring and which pesticides are responsible and working with regulators to remove these pesticides from agricultural use and replace them with safe alternatives. The Secretariats and member countries of the Asia Pacific Plant Protection Commission (APPPC), Southern African Pesticide Regulators Forum (SAPReF), East Africa Commission (EAC), Comite Ouest Africain pour l’ Homologation des Pesticides (COAHP) and Coordinating Group of Pesticide Control Boards of the Caribbean (CGPC) have welcomed the interest and inputs from CPSP in support of their work on HHPs.
While each regional body is unique, there are also commonalities that CPSP is able to draw on to cross fertilize and accelerate work in other regions. Thus, examples from the Caribbean have guided strategies in southern Africa while Asian knowledge is proving helpful for rice production in western Africa and the Caribbean.
III. Country work
Sri Lanka
World Future Council Award to best policies on protection from hazardous chemicals 
In 2020, CPSP nominated Sri Lanka’s pesticide legislation and suicide prevention policies for a global policy award given by the World Future Council (https://www.worldfuturecouncil.org). This award, also known as the “Oscars on best policies” is given annually to best policies on topics identified in advance ( https://www.worldfuturecouncil.org/future-policy-award/). In 2021, the focus was on Protection from Hazardous Chemicals. Sri Lanka’s policy entrenched in the Control of Pesticides Act No. 33 (1980, amended in 1994, 2011, 2020) and the National Policy and Action Plan on Prevention of Suicide (1997) won the Special Prize (https://www.bmu.de/media/future-policy-award-2021-sri-lanka/), contributing to increasing awareness of the importance of pesticide policy for prevention of pesticide suicides. https://www.worldfuturecouncil.org/p/2021-protection-from-hazardous-chemicals/
The award highlighted the pesticide suicide prevention policies in Sri Lanka, which have led to one of the greatest reductions in suicide rates ever achieved and lowered Sri Lanka’s total suicide rate by more than 70 percent. The bans saved about 93,000 lives over 20 years at a direct government cost of less than USD 50 per life. The award also highlighted extensive research that our director Professor Michael Eddleston and colleagues at CPSP carried out in Sri Lanka over two decades. This work has helped Sri Lankan policy makers identify the most dangerous pesticides to be banned, while monitoring the impact of the bans on suicide rates and agriculture outputs. We hope that the global recognition of these policies will help other countries who face similar problems design their interventions.
The full WFC awards ceremony can be found here: https://www.youtube.com/watch?v=OzReSRU5YxY
Nepal
CPSP’s study Highly Hazardous Pesticide Poisoning- Gathering Requisite Information from Selected Sites in Nepal for Decision-Making (HOPE GRID) ended in 2020. It showed that commonly available pesticides (organophosphates such as dichlorvos, aluminum phosphide and pyrethroids) and rodenticides (zinc phosphides) cause the majority of fatal poisonings in Nepal. The results of the project have been presented in two published papers (https://www.tandfonline.com/doi/full/10.1080/15563650.2021.1935993 and https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-11155-3).
The HOPE GRID study revealed challenges in addressing acute pesticide poisoning and pesticide suicides in Nepal. Nepal’s health system does not have a comprehensive system of pesticide poisoning reporting. Coordination to foster effective response to pesticide poisoning and deaths among the key players such as the Ministry of Health (MoH) and the Ministry of Agriculture and Land Development (MoALD) is lacking. Effective implementation of the existing pesticide regulation is needed to prevent black market pesticides coming from across the border.
In 2019, after the results of the study were presented to the authorities, Nepal banned eight pesticides, including dichlorvos and the tablet form of aluminum phosphide. Monitoring of pesticide poisoning and deaths in the country is necessary to understand the effect on pesticide bans on health and agriculture. In 2021, CPSP started a study monitoring the impact of the 2019 pesticide ban on agricultural productivity and suicide rates. In September 2021, CPSP partners Dr. Dilli Ram Sharma and Dr Rakesh Ghimire received ethics approval from the Nepal Health Research Council for the monitoring project.
India
Maharashtra
CPSP has a formal partnership with the Medical Education & Drugs Department, Government of Maharashtra. In the past year, we expanded our partnership to include the Directorate of Forensic Science Laboratories (DFSL). In collaboration with eight regional laboratories of Maharashtra, toxicology data regarding specific pesticide poisoning cases have been sourced. CPSP plans to analyze these data to develop a joint paper with the DFSL to guide policy decisions regarding HHPs usage in the state.
After CPSP engaged in dialogue regarding streamlining data systems, the DFSL has initiated a proposal for data digitization. CPSP will be involved in presenting recommendations to guide improvement of data quality at the directorate.
CPSP has engaged in the discussion with All India Institute of Medical Sciences (AIIMS), (Nagpur) which is working to set up a state-wide ‘Poison Information Centre’ (PIC) to tackle the issue of pesticide poisoning in Maharashtra. After the PIC is established by the end of this year, CPSP will explore research opportunities with AIIMS. CPSP plans to collaborate with agricultural institutes in the state and ongoing central IPM initiatives to corroborate the poisoning data obtained from DFSL.
Andhra Pradesh
CPSP collaborated with Dr Lindsay Jaacks from Harvard University on a research project in Kurnool district of Andhra Pradesh. The study aimed to evaluate how Andhra Pradesh Community-managed Natural Farming (APCNF) has impacted pesticide use by farmers and pesticide access at retailers. Phone interview surveys of 872 farmers and in-person surveys of 38 retailers in Kurnool District were conducted by trained enumerators from August to November 2020. We found that APCNF farmers were significantly less likely to use synthetic pesticides compared to conventional farmers. Nonetheless, pesticide use was still high among APCNF farmers at 49% (although compared to 99% among conventional farmers). APCNF farmers who cultivated rice and had a greater percent of their land under APCNF, and who met with government appointed regional managers or NGOs 1 or more times per week, were significantly less likely to use synthetic pesticides. All surveyed retailers sold insecticides, and very few reported a decrease in sales of pesticides in the past 4 years (18.4%). The odds of reporting a decrease in pesticide sales in the past 4 years were not significantly lower among retailers who reported the presence of APCNF training in their area. These results from early stage APCNF implementation indicate that the program has substantially reduced the use of pesticides, but demand has not changed enough yet to see an impact on access to pesticides at retailers. Moreover, while significantly lower than conventional farmers, use of pesticides is still common among APCNF farmers, and so training and support for alternative pest management strategies should be strengthened. This research paper is under journal review.
Chhattisgarh
CPSP has supported Emmanuel Hospital Association (EHA) – a network of 22 hospitals and community health and development programmes in North, Central and North-east India – to run a small pilot project on community responses to pesticide suicide.
EHA hospitals in the states of Bihar, Chhattisgarh, Madhya Pradesh, Jharkhand and Uttar Pradesh report large numbers of pesticide self-poisoning cases; this project is a response to community requests for a response. The main objective of this pilot initiative conducted in Champa district of Chhattisgarh state is to understand how rural communities respond to pesticide use and pesticide suicides. This project focuses on the general community, including young people, and important key stakeholders such as government institutions, civil society organizations, suicide survivors, and their family members; it includes awareness raising, education, skill building, sensitization and advocacy activities.
The main objective of the project is empowerment of the community to address the issue of pesticide poisoning and to take action for their wellbeing and safety. The project started in October 2020 and is expected to end in 2022. Despite the COVID-19 lockdowns in India, the project has conducted most of its planned workshop and training activities and has the support of local communities.
South Africa
CPSP’s project in South Africa is coming to an end. The project collected data from Demographic Surveillance System (DSS) sites in South Africa and other countries. Unfortunately, it demonstrated that DSS sites are not major sources of pesticide mortality data. CPSP will examine other ways of obtaining data on poisoning in Africa, perhaps using mortuary data. The project will result in two papers (a scoping review and case study of the DSS project). The scoping review will present a broad picture of how pesticide suicide deaths in Africa are recorded by identifying and assessing the various surveillance systems in place, as well as highlighting key limitations and data collection barriers.
Malaysia
In 2020, CPSP supported the Malaysia researcher Dr Lai Fong Chan to monitor the impact of Malaysia’s 2020 paraquat ban through noting patients presenting to hospital with pesticide poisoning. The preliminary results of the study, that is still ongoing, showed that the majority of the pesticide self-poisoning cases were intentional (73.47%); most were precipitated by an acute stressor (66.8%). Where the substance that caused poisoning was identified, paraquat was the most common type of pesticide ingested (31.63%).
Pakistan
CPSP is working with Prof Murad Khan of Pakistan’s Aga Khan University on a review of pesticide poisonings in Pakistan. We reviewed the literature to identify the most problematic pesticides in relation to national pesticide regulations. We found that organophosphorus insecticides and aluminium phosphide 3 g tablets are the most commonly used agents in poisoning cases in Pakistan, both being highly hazardous pesticides.
IV. Special issues
Alternatives to HHPs
Regulatory decisions to remove HHPs from use often face some resistance from farmers, traders and others who believe that no alternatives are available to deal with the pests that the HHPs currently control. CPSP is helping to share knowledge and experience from countries that have successfully taken HHPs out of use without any agricultural losses being incurred. Our researchers gather data on agricultural yields before and after pesticide bans to monitor differences. CPSP is now partnering with Pesticide Action Network UK to collect and publish national experiences of replacing HHPs with less toxic crop protection. Using connections with agricultural advisory bodies, the biopesticides and pesticides industries, and academic research, CPSP provides reassurance to pesticide regulators that agriculture will not suffer if the acutely toxic HHPs are removed from use.
Paraquat poisoning
CPSP continues to work to understand the extent of paraquat poisoning globally. Paraquat fatality data was sought for all countries to assess the impact of paraquat poisoning since its introduction into agriculture in 1960s. Data were collected from digital archives of google scholar, and the University of Edinburgh library beginning from the year 1960 until 2021. The analysis is underway to estimate the total number of deaths from this HHP.
Human rights
In 2020, CPSP published a paper on human rights and pesticide poisoning (https://www.tandfonline.com/doi/full/10.1080/14754835.2020.1850241). We demonstrated that, in certain circumstances, the state has an obligation to take positive measures to protect the right to life and the right to health of individuals in the situation of vulnerability from self-inflicted harm. By allowing easy access to highly hazardous substances such as pesticides by vulnerable rural individuals, States violate their duty to protect life. Preventing access to HHPs at moments of suicidality markedly increases the chance that the person will use a less lethal method, thereby surviving, or not harm themselves at all. Thus, states’ failure to eliminate HHPs violates the rights to health and life of vulnerable LMIC agricultural communities.
The wide availability of HHPs at moments of crisis particularly affects people in low-income agricultural societies. Poorer, disadvantaged, and marginalized people are affected by pesticide self-harm more profoundly because they live in rural areas, lack choice of other employment options, have unimpeded access to pesticides, and lack literacy skills to understand the risks associated with HHPs. The negative effect on the vulnerable groups is even more evident when combined with poor access to information and awareness of the risks associated with pesticide use, and adverse social and economic conditions.
LMIC governments are often ill-equipped to meet the general health and mental health needs of their populations, even more so in the poorer agricultural areas. Services are scarce and, where they do exist, are difficult to access and often under-resourced. In the situation of a mental health crisis, counseling and medical treatment are needed but are often not available in the rural agricultural communities where most pesticide self-poisoning occur. To protect these vulnerable communities from pesticide poisoning and suicide, the state has an obligation to adopt positive measures to protect their human rights, including bans on the acutely toxic highly hazardous pesticides that kill members of these communities.
Plans for the future
In order to fulfill our plans for the next three years, the Centre is expanding. We are pleased to announce that Ms Gemma Watson started as CPSP Manager and Dr. Lisa Scholin joined as a part-time researcher in June 2021. In September, Ms Heshani Sothiraj Eddleston became CPSP’s official film-maker videographer, and soon we will welcome a communications and development officer and colleagues working with FAO and WHO.
Conferences and presentations:
At the recent conference of British Association for South Asian Studies (BASAS), CPSP presented a panel consisting of four papers by CPSP staff. The panel highlighted the importance of pesticide regulations and bans for pesticide suicide prevention and prevention of pesticide harms in general. CPSP’s consultant Gael Robertson will present a paper at a conference in… CPSP’s director Michael Eddleston gave virtual presentations to the University of Copenhagen’s Summer School of International Health and to GiveWell staff. CPSP’s agriculture and outreach director Mark Davis made multiple presentations to regional regulation bodies on the issue of HHPs and suicide.