Manpower development in toxicology: report on a WHO consultation, Copenhagen, 11–15 December 1978

e-l EURO Reports and Studies tY) LT E HP OoG Mannowur, lleueltlrmgnl in Inxiuolouu Report on a WHO Consultation JUIN 1979 EO o. LIB $ m- 28 a] REGIONAL OFFICE FOR EUROPE World Health Organization COPENHAGEN \Y 'a (7, (ru(O ter,'a1 c \, /, Qtl t'o O +o n^ EURO Reports and Studies I l? Mannowgr lleuelomonl in Inximlouu Report on a WHO Consultation Copenhagen 1 1 - 15 December 1978 ililuiluiluilrur/uruilu///ulillil REGIONAL OFFICE FOR EUROPE World Health Organization COPENHAGEN 1 979 @ ISBN 92 9020 148 l @ World Health Organization I979 Publications of the World Health Organization enjoy copyright pro- tection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. For rights of reproduction or translation, in part ot in toto, of publications issued by the WHO Regional Office for Europe application should be made to the Regional Office for Europe, Scherfigsvej 8, DK-2100 Copenhagen @, Denmark. The Regional Office welcomes such applications. 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PRINTED IN DENMARK Reissued under ISBN: 9789289024419 (print) in 2025. Originally published under ISBN-10: 9290201487. ISSN 0250-8710 (print) CONTENTS l. Introduction 2 The existing situation in the field of toxicology Bulgaria Denmark Finland. Germany, Federal Republic of . Italy . . Sweden. Union of Soviet Socialist Republics. United Kingdom United States of America 3. The concept of toxicologY. 4. Prediction of manpower needs 5. Existing training facilities . . 6. Required training tacilities. . , 7. Internationalcollaboration 8. Conclusions 9. Recommendations Annex List of participants Page 2 2) 3 3 4 s 5 6 7 7 9 t2 l3 l5 15 l6 l9 CONSULTATION ON MANPOWER DEVELOPMENT IN TOXICOLOGY Copenhagen, I I - l5 December 1978 I. INTRODUCTION The purpose of the Consultation was to review manpower development in the field of toxicology, to discuss the present position in various coun- tries, to predict needs, and to recommend a programme for training toxi cologists. the Consultation was opened by Dr L"eo A. Kaprio, Director of the wHo Regional office for Europe, who stressed that society had become increasingly dependent on the products of the chemical and allied industries. The range was wide including drugs, pesticides, synthetic fabrics and ferti- lizers. The majority of these have been extensively tested to assess their potential toxic eflects but some have either not been tested at all or, at best, inadequately. There is now a growing awareness of, and concem fbr, the potential adverse effects on health that such materials may have. In particu- iar, concern is expressed regarding the consequences oflong-ternr exposure to low doses of chemicals. countries are beginning to introduce legislation to ensure better control over the manufacture, use and disposal of chemicals. No system of legislative control, however, is practicable unless adequate resources exist for its im- plementation and enforcement. These resources include inter alio those in industry, in commercial toxicology laboratories, in academic institutions and in regulatory bodies responsible lbr assessing and evaluating information from industry and elsewhere. As there is a widely held view that currently available resources in toxi- cology are inadequate, there was a need to make an accurate assessment of how large the manpower deficiencies are, to define areas of particular short' age and suggest means by which such deficiencies can be made good as quickly as possible. ' M; J.I. Waddington, Director, Promotion of Environmental Health, WHO Regional Office for Europe, then relerred to WHO's long-standing involve- m.nt in programmes conceming the potential toxicity of chemicals, in technical cooperation and in dealing with chemical emergencies. In addition, following resolutions of the Thirtieth and Thirty-first world Health Assem- blies, an International Programme on chemical Safety is now being developed I and will be discussed by the WHO Executive Board at its next rneeting in January 1979. An important element of this comprehensive programme is the development of trained manpower. The deliberations of the present Con- sultation were therefore both timely and of considerable importance. Dr E. Poulsen was elected Chairman and Dr F.A. Fairweather Rapporteur. 2. THE EXISTING SITUATION IN I'HE FIELD OF TOXICOLOGY Bulgaia It was stated that in Bulgaria, at the present time, approximately 75 people were engaged in toxicological research, the majority of whom worked in the Institute of Environmental and Occupational Health in Sofia. The main purpose of the work of this Institute concemed the potential long-term ef- fects of industrial and agricultural chemicals. Metabolic studies are also under- taken, together with investigations to determine maximum allowable concen- trations of chemical pollutants in air, soil and water. The Institute also carries out epidemiological studies and prepares literature surveys to assist the registration of pesticides and other toxic com- pounds. Some toxicological research is also carried out in the Faculties of Medicine and Pharmacy. While most toxicologists are medically qualified, biologists, biochemists, microbiologists and epidemiologists are also involved in toxicological studies. This team works in close collaboration with mathematicians and statisticians. In the practice of environmental and occupational health, and especially in sanitary<pidemiological work, the medical toxicologists work in close association with the toxicological chemists. Toxicology is recognized in Bulgaria as an additional specialty for phys- icians and involves several years' postgraduate study. Denmark It was reported that in Denmark, one of the few laboratories with specific responsibility for toxicological research was the Institute of roxi- cology (part of the Danish Food Institute). Until recently, medical doctors have shown little interest in the subject which remains only a small part of the medical curriculum. As a consequence, both the Institute, and partitularly the pharmaceutical industry, have found difficulty in attracting medically- qualified personnel to toxicological work and have relied on veterinarians and 2 pharmacologists - a reflection of the existence of a Chair in Pharmacology ind Toxicology in the Veterinary School and of the inclusion of some toxi cology training in pharmacology courses. Dralt legiilation at present under discussion and the development of a new Institute of ihe Worklng Environment will both create a further demand for trained toxicologists. While there are as yet no plans for lormal training in the subject, this will almost certainly be at postgraduate rather than undergraduate levil. Where such training is offered to nonmedical graduates, the need for additional instruction in pathology was stressed. It was argued that where possible, those engaged in regulatory activities related to toxicology should irave had previous experience in the subject at a practical level. Without this background, there was the danger that people might consider a short course of triining sufficient to make them knowledgeable in all aspects of toxicology. Finland In discussion on the situation in the Nordic countries, it was reported that Finland has some l5 units - mainly university departments or insti- tutes - engaged in research or training in toxicology. Of these, the largest is the Institute of Occupational Health which contributes 6Q%o of the ap- proximately 100 annual publications on industrial and environmental toxi- cology. Two categories of experts are recognized: (l) those professional toxicologists who work in toxicological research on a full-time basis, but also assist in the teaching of students - they number approximately 50 and in nearly all cases are medically qualified; (2) those experts in other disciplines who need some knowledge of toxi- cology as part of their professional profiles - the latter number about I 250 and include those employed in occupational and environmental health, industry, administration and university teaching' Although a new Chair of Toxicology has recently been created and some training in loxicology is given as part of courses in pharmacology, lormal training in the subject, and in appropriate research methodology, is normally at postgraduate level and is undertaken largely by the Institute of occupa- tionat Heatth. The Institute also runs courses designed for occupational health workers, nurses, engineers and laboratory technicians. With regard to international courses, the Institute organizes each year a postgraduate training course in toxicology in Finland, and has been active in iunning related courses in developing countries such as Tanzania and Zambia. Federal Republtc of Germany In the Federal Republic of Germany, specific interest in resources in toxicology dates from 1972 when a group of people from some of the 3 German-speaking countries met to discuss the problem. A study was sub- sequently undertaken to review the present situation, to assess future demand and to gather ideas on the developrnent of the subject. The findings ol the study were published in Denkschrift Toxikologie.4 Toxicology has been brought into focus because of the interest of the general public and the increasing concern about long-terrn exposure to low doses of chemicals. There is also the growing realization that health risks linked to the use of pesticides, food additives, industrial chemicals and pol- lution of air, soil and water are less easy to control than is the case with the use of drugs. In addition, the effective implementation of new legislation on toxicological problems is hampered by the shortage of toxicologists. As in ltaly, pharmacology and toxicology have historically been united, mostly in the same university department. During the last l5 years, however, some independent departments or institutes for toxicology have been estab- lished, distinct from the existing departments of pharmacology/toxicology. outside the universities, toxicological work is carried out in laboratories belonging to the chemical and pharmaceutical industries or in institutes responsible to the public health authorities. However, the available resources are by no means sufficient to cope with all the new tasks, especially in the field of environmental protection. To date toxicologists in the Federal Republic have required a medical qualification, with a further five years'postgraduate experience in toxicology and pharmacology. Because demand is expanding rapidly, however, it is no longer possible to rely solely on recruitment via medicine, and therefore graduates in biology, chemistry, biochemistry, pharmacy and physics are being regarded as indispensable. Such recruits will receive four to jix years' training in toxicology, with some background medicine. Additional experi- ence in industry is also recognized by the German pharmacology Society. There are no plans, as yet, for formal government recognition of toxi- cologists in the Federal Republic of Germany. Italy In Italy, pharmacology and toxicology have historically been combined in the same department in universities and various institutions. During the last decade, however, some distinction has been made in the universities and both industrial and forensic toxicology are recognized as discrete subjects. Toxicological resources - both laboratories and trained personnel - are found in the pharmaceutical and chemical industries, and ouiweigh those in the universities. A central public health organization also exists to deal with related problems, but there is, on the whole, a general lack of expertise. a B&, F. er aL Denkschift toxikologie. Bonn-Bad Godesberg, Deutsche Forschungs-gemeinschaft, 1975. 4 The tiequency with which problems related to chemicals and environ- mental health arise was cited to illustrate the urgent need to train manpower in this field and to seek expert guidance. A new chair of industiial toxicology has been envisaged, but a more basic approach to the subject is needed. Laboratories with adequately trained per- ,onn.l .re needed to carry out short- and long-term toxicity tests, with par- ticular emphasis on carcinogenicity and teratogenicity. Recent events in ltaly had demonstrated that epidemiologists should play a much greater role in aiding the toxicologist in his appraisal of various situations. Further, wtdle the involiement ol chemists, biochemists and biologists in toxicological problems was welcome, they clearly needed guidance tiom both medical and public health authorities. In summary, there was a marked lack of expertise in toxicological rnat- ters in Italy, which required an expeditious solution- Sweden It was reported that in Sweden the number of people engaged in toxi- cological research was approximately twice that in Finland. Several units have activi research programmes, particularly in the field of industrial toxicology and occupational health. These include the Karolinska Institute, the National Board ol Labour Protection and the University of Lund, where a chair of Toxicology was established in 1977 . The Swedish National Food Administration (which responds to the Min- istry of Agriculture) is serviced by a toxicology laboratory carrying out food research. the Natlonal Environment Protection Board is concerned with problems related to the general environment.and, for example, grants licences ior permission to use cirtain hazardous substances. While one task of the Board is the implementation o[ the Environment Act of 1969, the available resources for enforcement are inadequate. Union of Soviet Socialist Republics In the USSR, toxicology has a wide meaning and its importance is reflected in the number of institutes involved in the science. There are 84 medical institutes preparing people for medicine, 28 of which have a Hygiene Faculty, dealing with environmental hazards. Research institutes dealing with occupational health number 16, while a further 6 are concerned with environ- mental health and 2 with nutrition. All these have laboratory facilities and carry out experimental work on a variety of compounds. carcinogenicity assessments aie the particular concern of the Institute of Oncology, while the Institute of Ecological Toxicology gives special attention to the potential adverse effects of chemicals on ecosystems. The majority of these institutes 5 offer special postgraduate training courses. Postgraduate training lacilities for certain aspects of toxicology are also available at the lnstitute of Toxi- cology in Kiev. The main responsibility lor environmental health matters lies with the Ministry ol Health, but other ministries are also involved. Thus laboratories responding to the Ministry of Technology are carrying out increasing amounts of basic toxicological work, particularly on industrial chemicals. Plans to develop such resources require the provision of more trained toxicologists. Those working in the field of toxicology typically have qualifications in medicine, veterinary medicine or one of the biological sciences. It is custom- ary, however, for the final recommendations concerning permissible levels of pollutants or hygienic standards to be made by medically qualified specialists, as these limits are based solely on health considerations. United Kingdom In the United Kingdom, attitudes to toxicology have changed noticeably over the last 5 years, and particularly in the last 18 months. Toxicologists are employed h 3 main areas. The first group, by far the largest, is found in industry. Experienced medical and nonmedical graduates work in the chemical, pesticide, pharmaceutical and food producing industries. A great deal of toxicological testing is carried out within the various industrial labor- atories, but private contract laboratories also fulfil an important role. Toxicologists are also employed in some universities, such as those of Surrey and l,ondon (Hammersmith Hospital), which offer special postgraduate training courses, and in research institutes. The Medical Research Council, for example, employs experienced toxicologists, but the emphasis of their work is on basic mechanisms of toxicology, rather than routine testing. Finally, a minority of toxicologists are employed in govemment service for assessment of experimental data on drugs, food additives, insecticides, industrial chemicals, etc.: they include both medical and nonmedical grad- uates. Particular difficulties have been experienced in recruitment to this area. Recent interest by the Royal College of Pathologists, and the establish- ment of a Toxicology Laboratory by the Department of Health and Social Security at St Bartholomew's Hospital, London, have led to improved pos- sibilities for postgraduate training and examinations in toxicology. Two types of training courses are at present envisaged: one for those with basic qualifi- cations in human or veterinary medicine, the other for science graduates. Both will entail approximately five years' study, with particular emphasis given to comparative pathology. Further assistance to government departments is available from a series of expert committees, covering areas such as general toxicity, carcinogenicity, mutagenicity and environmental health. Such committees are chaired by eminent individuals from academic institutions. 6 In the evaluation of health hazards and risks, it was stated that medically qualified personnel should play a major role. United States of Ameica It was reported that in the United States, a series of factors have com- bined to intensify interest in expanding the training of toxicologists- Among these have been a growing concern, both among the public and in congress, with potential heaith hazards from environmental chemicals, and the signif- icant volume of new relevant legislation, particularly the Toxic Substances Control Act. The matter has been under active discussion and development for several years. It has been estimated that there are approfmately 5000-6000 practis- ing toxicologists in the United States. These individuals have diverse educa- tiJn backgrounds but, typically, include postdoctoral graduates in pharma- cology, physiology, biochemistry and, to a limited extent, medicine' Charac- t.rirti. of -tnir gioup, however, is practical experience developed over many years. The priniipal employers of professional toxicologists in the United States ar. govemment agencies and private industry, including contract laboratories. In this conteit, the National Institute of Environmental Health Services will have an increasingly important role through its involvement in a new National Toxicolory Programme which gives the Institute responsibility for some of the resources of other units such as the National Cancer Institute and the National Centre for Toxicological Research. The creation of this Programme and the implementation of the Toxic Substances control Act are .r.iting considerable demand for toxicologists. There is a belief that moves to upgradi the professional status and salaries of toxicologists, particularly in goi.rnrn.nt sirvice, will attract more high<alibre people to the field' - Formal training in toxicology is likely to remain at the postgraduate or postdoctoral levels. In the latter instance, three'year fellowships are available ior those wishing to reorientate their careers or to participate in research programmes in ioxicology institutes. Accreditation of prolessional toxi- cologists by the Society of Toxicology is likely within the next two years. 3. THE CONCEPT OF TOXICOLOGY with ever-growing worldwide industrialization, increasing dependence is being placed upon chemical products of all kinds. Modem food production, for Ixample, depends on the widespread use of pesticides, fertilizers and animal husbandry products. In convenience foods, the increased use of ad- ditives has become apparent. Chemicals are also used in a wide range of 7 household products such as detergents, cleaners, polishers, cosmetics, toiletry products and other consumer goods. The appearance of plastics in everything from food packaging and toys, to cars and building materials is further proof of current dependence on chemicals. Since such materials may be synthesized in one country, and then exported to many parts of the world, the possibility of their release to the environment is clear. The Consultation recogrized that, in effect, the community at large comes into contact with these chemicals. Some persons in particular environ- ments, e.9., the working environment, may be exposed to higher concen- trations than those to which the general population is exposed. The chemicals contained in various products may have direct effects on health or may find their way by various routes into air, soil or water where they may damage animal or plant life or, as pollutants, they may simply inhibit enjoyment of the environment. With growing public awareness that some of these chemicals are potentially dangerous, it is imperative to consider means by which their adverse effects may be assessed and by which the safest of particular com- pounds may be selected for use. The need toestablishsystemsof assessment and surveillance of these compounds is worldwide. The difficulty lies not in the acceptance of the general philosophy of human health protection, but in the convincing presentation of the findings on safety and risk to human health arising from defined pollutants. At present insidious adverse effects, such as carcinogenic, teratogenic or muta- genic effects, that may result from long-term exposure to a pollutant or pol- lutants, are ofgreater concern than the acute or subacute adverse effects. Since it is the task of the professional toxicologist to investigate and evaluate these effects and as the field of study is rapidly expanding in size, scope and methodology, the consultation wished to record its understanding of the terms "toxicology" and "a toxicologist". In so doing, it excluded from consideration both forensic toxicology (the science related to determining causes of death in cases of poisoning) and clinical toxicology (as applied to the clinical assessment of drug efficacy/toxicity under controlled conditions).It was agreed that toxicology is a distinct subject concerned with the detrimental effects of chemicals on living organisms. It is concerned primarily with effects on the human organism, but includes potential adverse effects on all animals and plants. The science is concerned with reducing the risk as- sociated with exposure to chemical substances to a tolerable level. Modern toxicology is a highly complex multidisciplinary field drawing together the individual expertise of medical, veterinary and science graduates. Such individuals may study the basic mechanisms underlying the effects observed and the biochemistry associated with abnormal cellular processes. The pharmacokinetics may be elucidated, and assessment of risk from both mimal experiments and epidemiological studies may be carried out. The toxi- cological influence on ecosystems including plants may be studied and both the analytical and quantitative aspects of toxicology may be considered. 8 A toxicologist is thus one who has expert knowledge in several toxico- logical fields, as defined, and who uses this expertise to assess the hazards of chemicals to human, animal or plant life. In accepting this definition, the Consultation gave considerable weight to the need for medically qualified toxicologists (particularly for the assess- ment of the significance of experimental data for man), but wished to in- clude those nonmedically qualified personnel whose contribution to rhe multidisciplinary subject of toxicology was considered essential. 4. PREDICTION OF MANPOWER NEEDS It has become evident, from the Toxic Substances Control Act in the United States, the Health and Safety at Work Act in the United Kingdom and other new Acts being prepared, that new environmental health legislation has created major new demands for toxicological studies and for a large pool of professionally trained toxicologists capable of generating and in- terpreting such studies. In predicting future resource needs, however, the Consultation recognized the dangers of overestimation, as the production of well quaiified toxicologists is costly. It was accepted that a logical step-by-step process was essential in as- sessing the toxicity or potential toxicity of a chemical. The need to assess both the exposure and effect of the compound was also appreciated. The Consultation discussed at length the complex issue of balancing perceived need for additional toxicologists against actual demand. certain criteria should be borne in mind when deciding the number of toxicologists needed within the various countries. These included the social needs of the community, its size, the pattern of trade, e.g., the number of chemicals in use or being introduced, existing or developing legislation or the effect that regulations in other countries or organizations might have on a com- munity. Activities in the European Economic Community, the Councilfor Mutual Economic Assistance and United States regulatory agencies were cited as examples of the latter category. The consultation agreed that when such factors had been consideredit was necessary for governments not only to invest in training programmes for toxicologists, but also to ensure that adequate administrative arrange- ments exist to deal with the components of a systematic evaluation pro- gramme of various pollutants, whether in food, air, water or soil. Such a programme might include: (a) identification of pollutants; (b) assessment of health effects of environmental pollutants; 9 (c) promotion of research on health effects of environmental pol- lution; (d) establishment and enforcement of environmental quality standards necessary to protect public health, including standards for the quality of waier used for drinking, other domestic purposes and t.cterlion; ambient air quality standards; maximum permissible limits for occupational exposure to toxic chemicals; standards for the exposure of man to various forms of radiation, noise, and other physical hazards; and maximum daily intakes and tolerances for toxic substances in food; (e) evaluation ofenvironmental health projects; (0 participation in licensing procedures; (g) inspection of factories and other workplaces; (h) control of the use of toxic substances in agriculture and in house- holds; (i) provision of guidelines lor the disposal of toxic solid wastes; () monitoring of environmental influences on health; (k) monitoring of air pollution in urban and industrial areas and of the quality of community water supplies, sources of drinking-water, and of recreational waters; (l) development and use of public health criteria lbr the siting of potential sources, such as power plants or industries, and the estab- lishment of Protective zones; (m) training of health workers in pollution control; (n) provision of guidance in all aspects of pollution control that may have public health implications. Where legislation related to the control of environmental pollutants is enacted, the consultation strongly asserted that its quality depended on the knowledge of administrators and their toxicological advisers. It stressed that "decision makers" or advisers to ministers must have a scientific back- ground with a strong toxicological component or that they should have taken a course in the basic principles of toxicology, and be constantly ad- vised by professional toxicologists. The multidisciplinary nature of the subject lends itself naturally to the concept of a "toxicological team". The consultation agreed that in addition to medical, veterinary and biological science graduates, those qualified in disciplines such as microbiology, immunology and epidemiology should be encouraged to participate. l0 Concem was expressed at the time it would take to produce the nurn- ber of toxicologists required, and to blend them into the various integrated functioning units that are necessary. In some cases, this could take three to five years, in others a decade. In considering approaches to the problem, however, the Consultation lelt it necessary to: (l) Define the knowledge, skills and attitude of the professional toxi- coligst. The fundamental criteria should be knowledge of the subject in depth. Experience in experimental studies was considered essential. The at- titudes necessary for assessment of data should be those of neutrality, im- partiality and independence, the ultimate objective being the protection of human health. (2) Define the education objectives. While these may be defined in a number of ways, and appropriate methods devised for measuring their at- tainment, the foundation flor this specitic and highly specialized type of training must be a broad basic education. A particular challenge is the need to provide different levels of training in toxicology to produce both pro- fessionals who will use their skills daily, and also those who must be familiar with the basic principles of the subject, but who will use this knowledge sporadically. The Consultation was unanimous that this type of specialization should be undertaken at the postdoctoral level. Course content should include: (a) general test methods used in toxicological investigations; (b) mechanisms of action and behavioural studies; (c) biochemistry of foreign substances and their subcellular effects; (d) pathology and histopathology of animals; (e) mutagenicity testing; (f) testing for effects on reproduction; (g) chemical carcinogenicity; (h) allergy to foreign substances; (D clinical toxicology; () epidemiology and statistics. (3) Plan a study programme. The Consultation agreed that individual countries may wish to follow their own programmes in this respect. Some 11 countries may opt for short- or long-term teaching courses with special- ization in ceitain subjects, such as carcinogenicity testing or teratology. on the other hand, universities rnay develop training programmes on the ..module system", in which participants may select those elements most suited to their needs. Each approach had its advantages, provided that in- tellectual versatility, open-mindedness and continuing education in new techniques were encouraged. (4) Provide proof of achievement of goals. Discussion here related to proviiions, such as examinations or the preparation of doctoral theses, to iemonstrate achievement in toxicology training courses' The Consultation felt it inappropriate to lay down any intemational standards on this matter, but left the decision to individual countries. A logical training sequence, with research experience was necessary, but in the end only the country itself could be tire judge of the system as it related to the toxicologist's performance or e*peitisi. lt was strongly emphasized that with a constantly ieveloping subject such as toxicology, there was a continuing need to keep abreasi of new developments. With five or more years' postgraduate ex- perience, however, a specialist status could be recognized. Following this long and detailed discussion, some countries were able to give u preli-in.ry assessment ol the probable numbers of toxicologists the| needed over the next flew years. Thus, on an annual basis, the following estimates were given: Finland 7- l0toxicologists Federal Republic of Germany 50 toxicologists United Kingdom 40- 50 toxicologists United States of America 150 - 200 toxicologists 5. EXISTING TRAINING FACILITIES within the various countries represented, the consultation recognized three distinct resources at present engaged in training toxicologists. The first of these was the universities, within which faculties of human and veterinary medicine, biology, agriculture and chemistry were providing training programmes. It was agreed, however, that there was an . urgent need to create more schools to cope with the problem. It was emphasized that the educational level should be postgraduate or postdoctoral, and that courses should be of not less than three years'duration. Where possible a multidisciplinary approach should be followed for general training with specialization in particular aspects of the subject being encouraged' t2 In this context, institutes of occupational health and workshop groupsin toxicology are currently assisting in the toxicological training of medical students and environnrental hygienists in Finlana, wrute in the-USSR somel6 institutes of occupational health, 28 medical institutes and l6 environ- mental and food institutes offer relevant training. In the USA it was reported that at least 20 programmes, sited mainly in environmental medical schools,pathology and biochemistry departments and veterinary schools, are pro- ducing high-calibre postdoctoral toxicologists. The second source of toxicologists at the moment is industry. In Den- mark and the United Kingdom, on-the-job training is considered an essential feature of education, and the consultation agre.d th.t this should be en- couraged, provided the training was of a multidisciplinary nature and was accompanied by day-release schemes for extra tuition, or attendance at other specialized courses. In this context, the consultation noted that the International Agency for Research on cancer has a scheme for research training fellowships, with an annual budget of $ 250000, and that it was en- couraging extra training in the fleld oI chemical carcinogenesis. Finally, it was reported that some governments fiave introduced train- ing schemes for toxicologists. For example, a programme has been establishedin the United Kingdom which gives particular emphasis to training in com- parative _histopathology. The consultation considered this to be iirportant as specialists in this aspect of toxicology are in notably short supply. encouraging note is that some of the above schemii are already leading to international collaboration and exchange ofideas. 6. REQUIRED TRAINING FACILITIES The Consultation agreed that people are living in an era in which enor- mous progress is being made in catering for the needs of man and his society,but unfortunately many of the important decisions on limiting damage to human health by chemicals are being taken by the uninitiated.'Thus a well developed scheme of training, with a sound career structure, is essential so that a critical review of toxicological testing procedures and their applicationto the protection ol human health may be forthcoming. The chailenge in modern toxicology is to develop and evaluate research and testing pro- grammes which are truly predictive of the potential of chemicals to produce injury to health, under a variety ofexposure conditions. Since governments have enacted legislation with the intention ol' pro- tecting human health - laws which in effect have created the need for toxi- cologists - they must be told of their responsibilities tbr long-term train- ing of this required manpower. There is the further need to criate suitable l3 career structures, particularly within government service, to attract high- calibre candidates. by *ay of comparison, it was stated that within industry, toxicologists are attracted by good salaries, secure funding ol research, con- tinuity uf man.ge*ent planning, respected status within an organization, and the possibility of contributing to the welfare olsociety. It was agreed that existing training resources - whether in universities, industry or government agencies - should be actively developed. The Con- sultation t'eli that courses in general toxicology should be supplemented by specialized training in, for example, food, industrial or pesticide toxicology. An interdisciplinary approach was considered essential, whatever the nature of a specific course. The Consultation recognized the advantages of a national centre em- bracing all the necessary disciplines, but appreciated that practical constraints might dictate the need to use a "building block" system for training, in wilch the expertise in various departments or institutes could be combined to offer " .ore diverse range of education and activities than could be found in any single department. In smaller countries, the combination of domestic courses with ap- propriate internationally recognized special courses should be encouraged. ihe Consultation particularly stressed that WHO had a vital role to play in this area and thought it essential that within the European Region, a survey should be undertaken of institutes capable of offering training at the post- graduate level. The preparation of lists of names of national experts in the field of toxicology would be most helpful. The Consultation considered the retraining of personnel with post- doctoral qualifications in other fields and agreed that this should be en- couraged, particularly with respect to pharmacologists and biochemists. It wai again emphasized that administrators working in environmental health should be familiar with the principles of the tests that were carried out and with their predictive value. Medically qualified personnel working in oc- cupational health should also receive training in the basic principles of toxi- coiogy. This would include the concept of dose-response relationships, the major adverse reactions that could occur in man, species variation in effects (particularly between animals and man), pharmacokinetics, and the primary elements of epidemiology. With regard to other groups, there was agreement that chemists, chemical engineers, laboratory and animal technicians should all receive training, aciording to their needs. This would considerably improve the ability of such indlviduals to work constructively with other members of the toxi cological team when necessary. Finally, while the Consultation agreed that there was an overall shortage of toxicologists, it considered that certain neglected areas of the subject needed special attention, in terms of the provision of training courses- These t4 include inhalational toxicology, behavioural toxicology, epidemiology, neuro- and cardiovascular toxicology, teratology, the study of allergic reactions and comparative histopathology. 7. INTERNATIONAL COLLABORATION In discussing the subject of international collaboration, the consultation agreed that there was an urgent need to promote international recognition of toxicology as an independent science, with wider understanding of the train- ing methods and modules used in the various Member States, so that essential reciprocal recogrition and acceptance of this training might be achieved. In response to resolution WHA30.47, with its call for the development of manpower, there was a need to prepare, in the European Region, a list of national experts in specific disciplines, to foster full cooperation and to make the best use of this important manpower resource.It was agreed that the accent must be on postgraduate training and that potential toxicologists should be encouraged to pursue a broad course of ,training in the subject, with subsequent specialization where necessary, rather than to enter narrow or restricted fields of study. where necessary, Member states should help others in the provision of training facilities, courses and exchange ofexperienced personnel in order to produce specialists of the highest calibre. The consultation felt that its meetinp had been held at an expedient time and recommended that the views expressed in its report should be borne in mind with respect to manpower development for the proposed International Chemical Safety Programme. 8. CONCLUSIONS In the Region, and indeed worldwide, there is a dearth of experienced professional toxicologists, particularly those capable o[ evaluating data in terms of their practical significance to man. It is also important that administrators and auxiliary personnel working with these experts have some experience and basic knowledge of the science. There is a diversity both of practice in the training of toxicologists and the curricula followed. However, this should not stand in the way of developing an integrated approach to the topic. lrssons could be drawn from the experiences of each Member State, to make a more rapid advance in the solution of mutual manpower problems. l5 wHo could play an active role in explaining to governments the need to employ properly trained and experienced toxicologists in any assessment of experimental and epidemiological data. Furthermore, all the recommen- dations given below should be carefully considered, and taken into account in developing the proposed International Chemical Safety programme' 9. RECOMMENDATIONS l. To attract highquality graduates to the field of toxicology, govemments should: (a) recognize that toxicology is a specialist subject in its own right; (b) create sound career structures for toxicologists, with salary levels commensurate with those of professionals in more established fields and, particularly, comparable to those in industry- 2. The final assessment of data should be carried out by multidisciplinary teams, including medical, veterinary and science graduates experienced in toxicology, with priority given to human health criteria. 3. While there is general agreement on the shortage of toxicologists, a distinction should be made between "perceived need" and "actual demand" for such professional expertise. For this purpose, national studies of the present and anticipated situation should be carried out in the Member States lo clarify the quantitative estimates of need and assess the pattems. Em' phasis should be given to such areas as behavioural toxicology, immunology, comparative pathology, and epidemiology. Countries should be encouraged to make a concerted effort to predict the number of new chemicals which will be manufactured and ultimately released into the environment, so that a realistic estimate may be made of the toxicological manpower required within the next few decades. 4. Harmonization of curricula in Member States is needed to guarantee the production of toxicologists with comparable qualifications in the various WHO regions. Specialized curricula should also be developed for suitable postgraduate and postdoctoral training of toxicologists. 5. Every country should integrate the resources of all its institutions to develop the necessary training schemes. A coordinating institution at national level should be recognized, but in certain situations where one does not exist as such, an institution serving several countries could be used. l6 6. Countries which cannot themselves organize all parts of the training should be encouraged through WHO or by other arrangements to use in- ternational training facilities or centres in other Member States. International collaboration in producing adequate manpower in this held is strongly recommended. 7. To avoid unnecessary duplication of effort, with consequent uneconomic use of manpower, the possibility of international collaboration in toxico- logical testing should be explored. 8. Within industrial organizations, encouragement should be given for on- the-job training, accompanied by attendance at suitably designed toxico- logical courses to provide broad training and knowledge within the discipline. Governments should be encouraged to approve training courses of other countries, and there should be a mutual recognition of qualifications' 9. Attention should be paid to meeting the shortage of ecotoxicologists ancl developing widely accepted methods to assess the effects of chemicals on non-human fauna and flora in the environment. 10. WHO could undertake a survey of institutes in the Region which can provide training in toxicology at postgraduate or postdoctoral level. Such a survey should in particular identily institutes able to offer international courses, and should indicate the specialty ofeach institute. I l. WHO could prepare for the Region a list of national experts in various fields of toxicology and ensure that appropriate groups are in contact with each other. Such arrangements would ensure that regional philosophies are shared and common opinions, where appropriate, reached on particular problems such as nitrosamines, nitrites and saccharin. 12. The Regional Office should convene, as soon as possible' a working group to discuss the design of model progriunmes for teaching basic toxi- cology to physicians, postgraduate scientists and related specialists. The group would also have to discuss in broad terms ways in which graduates in given disciplines could be retrained to become effective toxicologists. Attention should also be paid to defining criteria for the estimation of future needs for toxicologists. 13. WHO could promote further development of training facilities in various countries, stressing the need lor a multidisciplinary work profile. 14. Encouragement by wHo for the use of mathematics and statistics in toxicological research would stimulate the development of mathematical t7 models for prediction and calculation of possible safe levels of toxicity and exposure. Utilization of toxicokinetics is essential, and studies of long- term effects on the central nervous and cardiovascular systems are of para- mount importance. 15. As a basis lor education in the principles of toxicology, encouragement should be given for use of the WHO publication "Environmental health criteria. 6: Principles and methods for evaluating the toxicity of chemicals".a d Published under the joint sponsorship of the United Nations Environment Pro- gramme and the World Health Organization, Geneva, 1978. l8 Annex LIST OF PARTICIPANTS Dr F.A. Fairweather, Senior Principal Medical Officer, Department of Health and Social Security, London, United Kingdom (Rapporteur) Professor F. Kaloyanova-Simeonova, Director, Institute of Hygiene and Occupational Health, Sofia, Bulgaria Professor W. Koransky, Institute of Toxicology, University of Marburg, Federal Republic of Germany Professor N. Nelson, Institute for Environmental Medicine, New York University Medical Centre, USA Professor B. Paccagnella, Institute of Hygiene, University oI Padua, Verona, Italy Dr E. Poulsen,a Director, Institute of Toxicology, National Food In- stitute, Sdborg, Denmark ( Chairman ) Dr J. Rantanen, Director-Ceneral, Institute of Occupational Health, Helsinki, Finland Professor Schmidt-Bleek, Federal Agency lor Environmental Protection, Berlin (West) Dr I.P. Ulanova, Institute of Industrial Hygiene and Occupational Ds- eases, Academy of Medical Sciences of the USSR, Moscow, USSR Representatives of O ther Organizattons Intemational Agency for Research on Cancer Mr J. Wilbourn, Lyon Cedex, France a Participation expenses not paid by WHO. l9 Temporary Advisers World H ealth Organization Regional Office for Europe Mrs B. Blomberg, Regional Officer for Food Safety Prograrnme (Secretary ) Dr D.M. Ferguson, Regional Officer for Toxicology Mr C. Ferullo, Regional Officer lor Strengthening ol Environrnental Health Services Dr L.A. Judin, Medical Officer for Education and Training Dr M. Mikheev, Regional Officer for Workers' Health Mr J.l. Waddington, Director, Promotion of Environmental Health Dr A.H. Wahba, Regional Officer for Appropriate Technology lor Health 20