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with AS cases; however, such products should not be considered inherently safe, as the substituted materials could still contain respiratory hazards. In parallel, interim strategies must include stricter adherence to and enforcement of OELs; strict use of properly selected, fitted, used, and maintained respirators; and outright bans on dry cutting. Worker and employer education and training are essential, as are proactive inspections and enforcement to ensure regulations are consistently followed.
Early detection and surveillance systems should be strengthened. Medical screening, including consideration of CT imaging, spirometry, and DLCO, should be offered to all current and former workers in the AS industry. Silicosis should be made a reportable disease in every jurisdiction, with national registries established to monitor disease burden and long-term outcomes. Such data are critical for policy evaluation and international coordination.
Worker protection must also extend to fair compensation. In line with ILO principles, no worker should bear the financial or social cost of a disease contracted at work. This requires coverage for medical care, rehabilitation, job retraining, income support, and survivor benefits, including for migrant and informal workers who are often excluded from formal compensation schemes.
Finally, governments should commit to international collaboration. A global task force, operating under the joint auspices of ILO and WHO, could coordinate action, facilitate data sharing, and drive research into safer substitutes. Emerging efforts— such as Australia’ s elimination strategy, California’ s initial regulatory steps framework, and Spain’ s tentative regulatory steps— illustrate both progress and ongoing challenges. These experiences underscore that while important groundwork has been laid, substantial action is still needed to achieve true prevention and elimination of AS silicosis.
The emergence of AS silicosis demonstrates how ineffective regulatory implementation and the influence of industry interests can harm workers. It also shows the inadequacy of relying on partial preventive measures when elimination is both possible and necessary. Australia’ s decision to ban crystalline silicacontaining AS has set a precedent; the challenge now is to extend this approach globally, ensuring that all workers are provided the fundamental right to a safe and healthy working environment. By aligning national policies with ILO conventions and the WHO / ILO GPES, and by committing to eliminating silicosis, governments can bring the global community closer to the long-standing goal of making silicosis a disease of the past.
Research Priorities and Future Directions
Key research priorities related to exposure control include quantifying exposures among installers and manufacturers, developing and evaluating affordable engineering controls that small businesses can implement, and identifying determinants of effective respiratory protection programs( Box 3). Beyond exposure control, additional priorities include elucidating disease mechanisms, particularly the roles of non-silica constituents and potential therapeutic targets, optimizing screening and occupational health monitoring through comparative evaluation of imaging, physiologic tests, biomarkers, and screening intervals, and improving outcome measures to better predict disease progression. Finally, rigorous clinical trials are needed to evaluate potential treatments, including anti-inflammatory therapies, antifibrotic agents, and whole lung lavage, across different stages of artificial stone – associated silicosis.
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Box 3. Research priorities
Research Area |
Major Research Questions |
Proposed Research |
Exposure Control |
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