INSIGHT: Blood letting, pills, plasma removal… The Jersey PFAS treatments under consideration

Nearly half-a-decade after Express first revealed the plight of St Ouen residents concerned that a toxic chemical used in firefighting foam near their homes had left them seriously ill, and details of a secret deal between Government and the foam’s maker came to light, an expert panel has been examining what treatments could be the most effective for removing it from their bodies.

But what are those treatments? And how much could they cost?

How Jersey PFAS pollution came to light…

PFAS (perfluoroalkyl and polyfluoroalkyl substances) are a group of man-made chemicals, often referred to as ‘forever chemicals’ due to their inability to break down in the body or the environment. PFAS was an ingredient added to everyday items such as frying pans, outdoor jackets and floor tiles because of its ability to repel water, heat, and oil.

Mains drinking water in Jersey contains only trace amounts, and a report recently published by Jersey Water said that 99.95% of water samples across the island meet regulatory standards, although some islanders disagree with the current limits.

The chemicals can, however, be found in higher concentrations in some parts of the island.

One type of these ‘forever chemicals’, called PFOS, was an ingredient of firefighting foam sprayed at Jersey Airport for several years until the chemical was banned in the 1990s.

Concerns that this may be affecting the health of St Ouen residents living under the runway were first raised publicly by Sarah Simon, who suffers from skin, thyroid and autoimmune disorders, as well as joint and nerve pain and revealed to Express how she had tested her own blood to prove that she had elevated levels.

Pictured: St Peter resident Sarah Simon believes that the health of Islanders has been adversely affected by drinking water contaminated with PFOS.

Her concerns were backed by others living in the area.

The following year, an Express investigation uncovered a secret contract between the Government and the foam’s manufacturer, US multinational 3M.

Agreed by the States Assembly in January 2005 after a behind-closed-doors debate, the deal resulted in 3M giving the government of the day £2.6m, which went towards cleaning up the contaminated training ground and building a new rig on the site.

It also meant the Government was legally bound to help the manufacturer defend any claims made against it, including by islanders who believe their health had been damaged.

LISTEN: The secret deal with 3M was explored in a Bailiwick Podcasts episode – listen above or via your favourite podcast provider.

Two years later in 2022, 78 islanders volunteered to have their blood tested for PFAS as part of a Government-sponsored programme. Every one of them was found to have it in their blood, with 80% having at least one type of PFAS at a high concentration.

The PFAS Scientific Advisory Panel, a group of experts who make recommendations to Ministers and the Director of Public Health, was set up the following year to explore options to support approximately 50 islanders affected by elevated exposure to PFAS.

One of their earliest recommendations in September 2023, which was accepted by Government, was to “investigate the introduction of a therapeutic phlebotomy service”.

But it’s now emerged that other types of treatment are on the table – and the Government has confirmed to Express that it will be considering whether “less invasive and more effective options” should be pursued instead.

What treatments are being explored?

Haemodialysis

The most intensive treatment under consideration is haemodialysis, a process typically used for kidney failure

During haemodialysis, blood is diverted through a machine that uses semi-permeable membranes to filter toxins before returning the cleansed blood to the body. Each session lasts between three and five hours.

This method has shown promise in reducing PFAS levels in individuals with high exposure. However, it is resource-intensive and not a practical solution for large populations. Regular sessions may also be required to maintain low PFAS levels.

According to papers presented to the PFAS panel on 11 December, side effects include low blood pressure, muscle cramps, and itching. Rare but serious complications, such as sudden cardiac events or allergic reactions, can also occur.

Setting up a haemodialysis program for PFAS treatment is costly, with initial equipment costs exceeding £100,000.

Annual operating costs, including staffing and consumables, are estimated at £1.38 million for 50 patients receiving 10 treatments each.

Probenecid

Probenecid, traditionally used to treat gout, is another option. It works by preventing the kidneys from reabsorbing certain substances, potentially including PFAS.

While promising as a non-invasive treatment, side effects include stomach problems, headaches, and dizziness. Rarely, complications like kidney stones or allergic reactions can occur.

With minimal setup costs, annual treatment expenses are approximately £45,000 for 50 patients, covering medication and training, according to papers presented to the PFAS panel on 7 November.

Any doctor can prescribe probenecid and so the service could be delivered using existing resources in primary care.

However, different studies show different levels of effectiveness, the expert panel heard at a recent meeting.

Psyllium Husk

A simpler option under consideration is psyllium husk, a natural fibre supplement from plant seeds that may help remove PFAS through the digestive system.

While generally safe and inexpensive, it can cause bloating and stomach cramps, with rare cases of allergic reactions or bowel blockages if taken without enough water.

Annual costs vary between £1,533 and £26,206, depending on the specific formulation and training requirements, according to papers presented to the PFAS panel. At a meeting in November, the panel’s Chair Dr Steve Hajioff, noted three options for administering the intervention – generic powder, branded powder or capsules – and said costs could range from £30.66 to £434.13 per patient per year.

The panel noted that a study on psyllium husk in Denmark has received funding but has not yet started. Dr Fletcher proposed that the panel make a formal recommendation to include fibre in diets, rather than using fibre in a medical manner – ideas that will be discussed further at a meeting this month.

Plasma removal

Plasma removal, or therapeutic plasma exchange, involves separating plasma (the liquid part of blood) from other blood components, filtering it to remove PFAS, and then reinfusing the treated plasma.

Side effects typically include bruising, fatigue and temporary calcium deficiencies, though some patients experience fainting or allergic reactions.

Dr Hajioff explained that there are “sizable equipment and personnel requirements and the necessity of conducting the procedure in hospital”, going on to note that “the costs in this paper do not include on-costs and so are systematic under-estimates of the actual costs, and estimated that the first year costs would be approximately £300,000, and around £250,000 for every year beyond the first year”, according to papers presented to the PFAS panel.

Bile acid sequestrants

The final option, bile acid sequestrants, uses medications that bind to substances in the intestines to prevent reabsorption.

Side effects are generally mild, with constipation and gastrointestinal discomfort being the most common.

However, the drugs can interfere with the absorption of vitamins and other medications, according to papers presented to the PFAS panel.

Annual treatment costs range from £8,760 to £23,255, depending on the specific medication used and training costs.

How would this be funded?

Each of the costs remains an estimate at present, and it’s not yet clear how exactly any of the treatments would be funded.

At a meeting in November, Deputy Public Health Director Grace Norman, said understanding the possible funding requirements was “very important”. However, meeting minutes noted, “these estimates are likely to under-estimate the cost to Government as they do not include on costs, some implementation costs and the costs of evaluation and monitoring for any programme or intervention implemented”.

Screenshot

Pictured: Cost estimates considered by the expert panel.

Dr Hajioff agreed – and also noted that islanders should be aware that “there may be additional burden on the Government of Jersey and Islanders via taxes, as there are for delivering any new services”.

When for an update on its considerations of different treatments by Express, a spokesperson responded this week: “The Government accepted the recommendations in Report 1, which is to investigate the introduction of a therapeutic phlebotomy service.

“Before implementing these recommendations, the Government is awaiting findings of Report 3 Clinical Interventions and Blood Testing and Re-testing, which is expected this quarter (Q1 2025).

“This intervention can then be considered alongside less invasive and more effective options.”

Meanwhile…

The update on different types of treatments comes as hundreds of islanders are urging the Government to invest in a water treatment plant to remove all traces of PFAS in Jersey’s water supply.

Signed by almost 500 islanders since its launch just weeks ago, Paul Le Claire’s petition calls on the Government to adopt global best practices for regulating PFAS and set up healthcare services for testing and treatment.

Jersey Water however maintains mains drinking water is fully compliant with current regulations and that it already carries out regular testing, with 16,656 tests conducted in 2024 alone, and has said it will work to remain fully compliant should regulations change in future.

Changing standards

With growing global recognition of the potential health impacts of PFAS exposure, international standards are due to change, with EU and UK regulations tightening in 2030.

Jersey Water CEO Helier Smith told Express last year: “Once those UK regulations come into place, it’s always going to be our intention to be fully compliant.”

The company has also conducted promising trials of treatment technologies, with one filtration system which separates PFAS from water using small air bubbles called SAFF being trialled back in 2022.

Mr Smith said the trial of SAFF had been “widely successful”, though Jersey Water clarified that this was a small-scale laboratory test and that they had not yet made a decision on which treatments to use.