On June 26, 2026, the French National Authority for Health (HAS) issued its recommendations on the appropriateness of measuring chlordecone levels in the blood and the management of exposed individuals. This report was eagerly anticipated, given that the so-called «tolerable» thresholds set over the years had fueled controversy. In this op-ed, Dr. Josiane Jos-Pelage, president of AMSES, traces the history of this fight, analyzes the HAS’s 26 recommendations, and explains why they reinforce a principle long championed by committed physicians: aiming for zero chlordecone, both in food and in the body. Although the KANNARI 2 study reveals only a marginal decrease in population exposure between 2013 and 2026, she sees it as a roadmap to break Martinique out of this public health impasse.
RELEVANCE OF CHORDECONEMIE TESTING
INTRODUCTION. BACKGROUND
On June 26, 2026, the French National Authority for Health (HAS) published its recommendations on the appropriateness of measuring chlordecone levels in the blood and the protocols for managing patients exposed to chlordecone, a report that had been requested by the Ministry of Health.
WHY THESE RECOMMENDATIONS?
Action Item 5S of the Chlordecone Plan 2 (2011–2013) provided for the possibility for any person « to gain insight into one’s own level of chlordecone exposure as a precautionary measure »Volunteer organizations then contacted biomonitoring laboratories across France to have their volunteer members tested. In 2015, the Regional Union of Private Practitioners allowed doctors who wished to do so to perform the hair test.".
Noting that a significant percentage of test results were positive, organizations such as AMSES and «ZERO POISON» contacted a local private laboratory to send blood samples from volunteers to laboratories in mainland France that were conducting this research. These tests were not free.
Following the results of the KANNARI 1 study in 2018, which examined the extent of chlordecone exposure among the population, many Martinicans sought to find out whether they were among the 92% of the population poisoned by the chemical chlordecone.
Starting in January 2021, the Martinique Regional Health Agency (ARS) decided to cover the cost of these tests and to allow any resident of Martinique who wishes to do so—with or without a prescription—to determine their chlordecone status and to follow or disregard the official recommendations based on the results. It is important to recall this background because, until then, the management of chlordecone poisoning among the population had been the responsibility of the Regional Health Agency. This is still the case in Guadeloupe, where there has not been this level of mobilization by associations. The Ministry of Health was therefore considering whether or not to inform each individual of their chlordecone status. Wasn’t a blanket management approach based on indices developed by ANSES sufficient? AFFSA and later ANSES formulated management indices called « Limitations maximum residue limits »MRL« or " External Toxicological Reference Value and internal VTRe, VTRi »These MRLs were set in 2005 by the AFFSA at the request of Ms. Roselyne BACHELOT, Minister of Health, at 50 µg/kg for certain foods, 100 µg/kg for others, and 200 µg/kg for others. Using these high MRLs, the ARS found that 20% of children aged 3 to 10 exceeded the toxicological reference values—that is, the acceptable toxic limit! It was not until June 2008—three years later—that the European Commission, concerned about these levels (given that under European regulations, residues of unused pesticides were not supposed to exceed 10 µg/kg), to secure a reduction of these MRLs to 20 µg/kg from the French government for the overseas departments; the standard for other European countries remained at 10 µg/kg. .
Residue limits and VTRs, which represent the daily dose of chlordecone that each resident of Martinique could consume « risk-free ». have always been contested by AMSES. There are several reasons for this. Indeed, since chlordecone is recognized as a persistent organic pollutant, it should not be present in food at any level whatsoever. Furthermore, it has been known since 1991 that an endocrine disruptor such as chlordecone does not act in a dose-dependent manner; low doses cause endocrine disorders in particular, while high doses cause other disorders, such as neurological disorders. Furthermore, it has long been known that MRLs and TRLs are relevant only when exposure is recent and occurs in a population that has not previously been exposed. This was not the case in the French West Indies in 2005, since the use of chlordecone dated back to 1972—thirty years earlier. .
It seemed unimaginable that a daily dose of a toxic substance would be tolerated across a population of all ages and with all medical conditions—a poison that takes three or even four years to be eliminated from the body.
Despite the objections that the Martinican Association raised with the National Health and Safety Agency (ANSES), the agency maintained its management standards. .
Professor MULTIGNER Santé Publique France conducted consumption simulations using these management indices, and these simulations revealed inconsistencies among them (MRL and VTRe) and that, when applied to a daily dietary intake of 150 g, they resulted in blood levels in the population exceeding acceptable limits.
Organizations such as AMSES then campaigned vigorously for the elimination of these MRLs and TRVs and for an immediate decision to protect the public from poisoning by establishing a ZERO CHLORDECON level in foodstuffs and setting thetarget level for the population at ZERO—that is, below the limit of detection—rather than 0.4 µg/l of blood chlordecone, as recommended by ANSES.
But also that every citizen be informed, upon request, of their level of chlordecone exposure and be able to make the health decisions they wish upon receiving the results. At the same time, we must urge them to aim for zero chlordecone in both their diet and their bodies. It was against this backdrop of controversy during the chlordecone COPILS meetings that the Prefect and the ARS decided to refer the matter to the Haute Autorité de Santé. This referral is important for all parties because it clears up misunderstandings by An Overview of Medical Conditions which, according to published, rigorous studies, may be linked to chlordecone, and provides guidance in its recommendations for the care for communities .
PROCEDURE ESTABLISHED BY THE HAS
The RBP Best Practice Recommendations are rigorous syntheses of the state of the art and scientific data at a given time, as described in the scientific rationale. They are developed using a rigorous methodology through the work of a multidisciplinary working group and reviewed by a multidisciplinary panel of reviewers, with the entire process validated by the institution following a thorough review.
The working group on chlordecone brought together not only scientific experts (toxicologists, epidemiologists, pharmacists, public health physicians, urologists, and a pediatric neurologist), but also civil society, represented by associations from Martinique (AMSES, ASSAUPAMAR, LLYANAJ, ZERO POISON), Guadeloupean organizations (ENVIE SANTE), and organizations from mainland France (AMLP and ASEF) specializing in health and environmental advocacy, as well as sociologists. This working group met for two years.
The report includes recommendations and a rationale explaining the reasons behind those recommendations. .
SALES PITCH
The report provides an overview of the health impacts. What diseases are associated with chlordecone poisoning? This overview, which is based on a solid body of evidence, can be considered reliable. Chlordecone is toxic to the nervous system; it causes tremors and motor disorders, the mechanisms of which are well established. It is toxic to the liver and affects bile excretion. It is toxic to the heart and causes heart rhythm disorders in animals through identified mechanisms. It is toxic to the reproductive system and leads to a decrease in female fertility. A positive chlordecone level during pregnancy is associated with an approximately 60% increase in the risk of preterm birth. Prenatal or childhood exposure to chlordecone results in early impairment of fine motor skills, increased hand tremors, a decrease in IQ, increased behavioral difficulties, and visual impairments. The observed effects suggest that the developing nervous system is a sensitive target for chlordecone. In humans, according to the HAS, ’ Chlordecone is classified as a confirmed endocrine disruptor (EU Category 1, 2000) »This endocrine disruption affects thyroid hormone levels, which are reduced in cases of in utero chlordecone exposure, as well as sex hormones. No renal impairment in humans was found in the various studies analyzed. Based on current data, it cannot be concluded that chlordecone disrupts the immune system in humans. Chlordecone does not cause DNA damage, which explains why its carcinogenicity has not been definitively established in humans.However, it may be carcinogenic through other mechanisms related to its endocrine-disrupting properties, which is why it has been classified as a Group 2B “probable” carcinogen. Nevertheless, in rats, it induces liver cancer beyond doubt. All of these recommendations issued by the French National Authority for Health (HAS) are intended to alert healthcare professionals to the risks posed by chlordecone exposure in the human body. The presence of chlordecone in thethe body—as evidenced by chlordecone levels in the blood—is a risk factor for a wide range of conditions that healthcare providers must be able to screen for in patients. Hypothyroidism, heart rhythm disorders, fatty liver disease, reduced fertility in women and men, and in children, a lower IQ, neurodevelopmental disorders, dyslexia, dyspraxia, hyperactivity, attention disorders, prematurity, and low birth weight can be improved by completely weaning the patient off chlordecone. .
RECOMMENDATIONS FROM THE HIGH HEALTH AUTHORITY
These 26 recommendations have three objectives:
- to specify the rationale for and procedures related to measuring chlordecone levels in individuals who are exposed or likely to be exposed to this substance; ;
- to provide healthcare professionals with guidelines for the care and follow-up of these populations; ;
- to inform the affected population about the details of the care provided
There are 26 of these recommendations
Measuring chlordecone levels in the blood allows for an assessment of population exposure, while measuring levels in the umbilical cord allows for an assessment of fetal exposure. .
In its Recommendation No. 5, the HAS points out that The target is to achieve a chlordecone level below the detection limit itselfapproximately 0.01 µg/liter of blood. Exposure must be reduced as soon as chlordecone levels are detectable. This recommendation is much stricter than what health authorities had previously proposed, which set the intervention threshold at 0.4 µg/L. Some even claimed that the level « »normalized" The level of chlordecone in the blood was 0.4 µg/L. As if it were normal to have poison in your blood! In support of its recommendation, the HAS lists all the conditions that may be attributed to chlordecone, even though no link can be established between a specific level and a particular condition. Chlordeconeemia is a risk factor. Everyone should reduce this risk by testing negative—that is, by having a result below the detection limit.
Recommendations 6 and 7 reiterate the populations Groups for whom chlorodecone levels must be monitored because they are at risk of developing health problems: children—including those under 7 years of age—who live in contaminated areas; farmworkers; newborns; pregnant women; and couples of childbearing age.
Recommendations 8 and 9 call on the authorities to cover the full cost of these tests, with no out-of-pocket expenses, including when they are renewed once a year.
Recommendation No. 10 is intended for the general public, who should avoid getting infected neither through food nor through water.
Recommendations 15 and 16 are directed at public authorities, which are advised to label products as "chlordecone-free" so that they can be more easily recognized by the public:
« R15 – In addition to measures aimed at reducing exposure, it is recommended to support initiatives promoting local food that is free of chlordecone (expert consensus).
R16 – It is recommended to clearly label and explain to the public the products with a chlordecone content below the limit of detection and to support producers who are taking steps to ensure the safety of their products (expert consensus). The goal is to reinstate the “zero chlordecone” label. .
Recommendation 23 pertains to Chlordecone concentration in the water column which, if positive, must be followed up to enable the early detection of neurodevelopmental disorders through the age of 18
If a positive chlordecone test result is detected above the detection limit, it is important to be vigilant if you experience any warning signs, such as Parkinson’s disease, an irregular heart rhythm, or liver disease. .
Given all the often contradictory allegations regarding this particular situation in the two departments of Guadeloupe and Martinique—where virtually the entire population is exposed to chronic poisoning at very low doses—it was important for a health authority to provide an update based on scientific data. This is the rationale behind these recommendations. They are not unnecessary and must be followed scrupulously if we truly wish to decontaminate the population. The measures adopted to date have proven insufficient, as the KANNARI 2 study reveals that between 2013 and 2026, there was only a negligible decrease in population exposure—from 921 TP3T to 85.51 TP3T—after 10 years.Meanwhile, the elimination of chlordecone following complete cessation of use takes three years. Simply reducing exposure through residue limits is largely insufficient.
If the HAS’s recommendations to the public, healthcare professionals, and public authorities are analyzed and followed, they will help Martinique emerge from the public health crisis in which it is currently mired.
Dr. Josiane JOSPELAGE
President of AMSES
