COP4: Minamata Convention Parties further strengthen phase-down approach to dental amalgam
African region proposal to ban dental amalgam rejected while the current phase-down approach is further strengthened with two new provisions.
At the second in-person segment of the fourth meeting of the Conference of the Parties to the Minamata Convention on Mercury (COP4.2), Parties rejected the Africa region’s proposal to ban dental amalgam and adopted a decision to further strengthen the current phase-down approach. They approved two new provisions to limit the use of mercury in bulk form and recommend against the use of dental amalgam in deciduous teeth, of patients under 15 years and of pregnant and breastfeeding women, except when considered necessary by the dental practitioner.
The Minamata Convention has nine provisions for the phase down of the use of dental amalgam in Annex A, Part II. At COP4.2, which took place in Bali (Indonesia) from 21–25 March 2022, two proposals to amend this section were up for discussion. The EU proposal (MC/COP4/2021/27) aimed to further regulate the phase-down approach by adding a series of restrictions on the use of dental amalgam by 2024. On the other hand, the Africa region’s proposal (MC/COP4/2021/28) asked to replace the current Annex A, Part II with a phase-out strategy by 2029.
FDI World Dental Federation (FDI) was especially concerned with the phase-out proposal from the Africa region, as it focused on the ban of dental amalgam with no actions on prevention, coverage and research into mercury-free alternatives for dental restorations, and waste management. Such a proposal, if supported, would be very detrimental to public health and specifically efforts around caries prevention. It would also result in only widening the existing oral health inequalities.
Preparations for COP4.2
In the lead up to COP4.2, FDI mobilized its network of national dental associations (NDAs) to raise awareness about its public health concerns among Ministries of Health and Environment. Moreover, on the sidelines of COP4.2, FDI, the International Association for Dental Research (IADR) and the American Dental Association hosted an official COP4.2 side event on Accelerating the Phase Down of Dental Amalgam, on 11 March 2022.
Different mechanisms needed to successfully accelerate the phase down of dental amalgam use were discussed, at the event, in a comprehensive and inclusive manner. Presentations included research advancements into mercury-free alternatives, and other elements for consideration, such as the importance of action and investment into prevention and best environmental practices even in a phase-out scenario.
Supporting a phase-down approach at COP4.2
FDI participated at COP4.2 virtually and were also represented by two members from the Indonesian Dental Association at the event, in person. FDI and IADR submitted a joint statement, echoing the main concerns from the oral health community. If a global phase-out deadline is prematurely established without allowing Parties to implement phase-down strategies adapted to their national contexts, the provision of quality treatment for dental caries will be negatively impacted and an increase in tooth extractions will be observed – threatening to widen oral health inequalities.
During COP4.2, many Parties shared their concerns about the restrictiveness of both the African and EU amendment proposals, asking for the review of annex A to consider different national circumstances. There were negotiations throughout the week to agree on a way forward regarding the review of annexes A and B. For dental amalgam, draft decision UNEP/MC/COP.4/CRP.16 on the review of annexes A and B was finally approved, adding the following text to the existing nine phase-down provisions in Annex A, Part II:
“In addition, Parties shall: (i) Exclude or not allow, by taking measures as appropriate, the use of mercury in bulk form by dental practitioners; (ii) Exclude or not allow, by taking measures as appropriate, or recommend against the use of dental amalgam for the dental treatment of deciduous teeth, of patients under 15 years and of pregnant and breastfeeding women, except when considered necessary by the dental practitioner based on the needs of the patient.”
The official decision documents will be posted here after translation into the six official UN languages. Importantly, at COP4.2, it was also decided that the next Conference of Parties (COP5) will take place from 28 October to 4 November 2023 in Geneva, Switzerland.