Italy’s Learnings From PFAS Disaster

The Veneto Region in the northeast of Italy is home to some of the most well-known and scenic locations in the world: Venice, the City of Water; Verona, the setting of Romeo and Juliet’s love story; and Lake Garda, the largest lake in all of Italy.

But it also has a dark side.

It is home to what is possibly the world’s largest per- and polyfluoroalkyl substances (PFAS) contamination.

In 2013, the widely used chemicals were found in the drinking water of a “red area” that encompasses 30 municipalities in the provinces of Vicenza, Verona, and Padua in Italy. 

“What happened in Veneto is a disaster,” Annibale Biggeri, PhD, a professor of epidemiology at the University of Padua, Padua, told Medscape Medical News.

Despite the establishment of a surveillance plan in the region in 2017, there is still a lack of published data on the incidence and prevalence of diseases in the area, according to Cristina Canova, PhD, a professor in public health at the University of Padua. Retrospective analysis of medical records and health data could allow researchers to establish stronger links between PFAS exposure and specific health outcomes; evidence that could inform targeted public health interventions and prevention strategies, she told Medscape Medical News.

Several programs have been established in the region and the broader European Union to address these challenges. The big question is: Are they enough?

What Is PFAS?

PFAS are a large group of human-made chemicals used since the 1940s for their waterproof, grease-resistant, and heat-resistant properties. They are in everyday products like nonstick cookware (Teflon), waterproof clothing (Gore-Tex), food packaging, and firefighting foams. They don’t break down easily and can accumulate in water, soil, animals, and human bodies.

“They are made to be resistant,” said Janek Vähk, the zero pollution policy manager at Zero Waste Europe.

Because PFAS chemicals are highly persistent and can accumulate over time, they are so widespread in the environment that it can be difficult to distinguish background levels from localized contamination sources.

“We don’t know if they are everywhere. But everywhere we look, we find them,” Vähk said.

The Veneto Case

For decades, residents of Veneto unknowingly drank and cooked with water contaminated with PFAS. The pollution was ultimately traced back to the Miteni chemical plant in Trissino in the province of Vicenza. The plant manufactured PFAS from the 1960s until its closure in 2018. It had been dumping wastewater into the Almisano aquifer, the second largest freshwater source in Europe.

The crisis became apparent in late spring 2013 when the National Research Council of Italy revealed dangerously high PFAS levels in groundwater and rivers. Some areas had concentrations 1000 times above international safety limits. Further investigations revealed that 350,000 people lived in the contaminated area, with 120,000 residents considered highly exposed due to prolonged consumption of polluted water.

“In response, authorities took immediate action,” said Biggeri. Within 6 months, double-filtration carbon systems were installed in affected water supplies. Residents were advised to drink bottled water and avoid consuming local produce. “It was a monumental and expensive effort,” he said.

Veneto launched a biomonitoring program between 2015 and 2016. This included a study that tested 507 people — some from contaminated areas, others from clean zones — to compare PFAS exposure levels. The results were alarming: Residents of the red zone had eight times more PFAS in their blood than those in noncontaminated areas.

In 2017, the regional government introduced a comprehensive Health Surveillance Plan that targeted 90,000 residents in the red area and former Miteni workers. Participants underwent blood tests to measure 12 different PFAS chemicals alongside screenings for kidney, liver, metabolic, and thyroid issues. By 2022, more than 55,000 people had participated, and nearly 60% showed signs of organ or metabolic damage linked to PFAS exposure.

A separate 2022 study confirmed just how deeply PFAS had infiltrated the community. Among the 105,000 residents tested, PFOA, the most common type of PFAS, was found in blood samples at levels 20 times higher than the Italian average. Other PFAS compounds, including PFOS and PFHxS, were also prevalent.

These high blood levels are not without impact. Recent research has revealed that Veneto’s red area experienced an excess 3890 deaths between 1985 and 2018. That is, one additional death every 3 days from cardiovascular diseases, kidney cancer, and testicular cancer; all illnesses linked to PFAS exposure.

Concerns have also been raised about the impact of PFAS on reproductive health, said Biggeri. He explained that when women go through pregnancy, the placenta and fetus absorb PFAS from the mother. Women who have been pregnant have lower PFAS contamination than those who have not had children. Their children, in turn, might experience the effects of prenatal exposure throughout their lives.

An interim analysis conducted by Biggeri, but not yet published, confirms what a Danish study previously found: Higher maternal PFAS exposure was associated with lower sperm motility and worse morphology in young adults.

The Psychological Impact of Contamination

Beyond physical health concerns, residents of contaminated areas face significant psychological challenges as they grapple with the implications of long-term exposure to these persistent chemicals, explained Marialuisa Menegatto, PhD, a psychologist and researcher at the University of Padua.

A qualitative study conducted with parents in the most affected areas revealed a journey through three distinct phases:

• Shock and disbelief, which was experienced by many parents in the region upon learning about the contamination. The realization that their environment, and even their homes, had been compromised led to feelings of betrayal and vulnerability. “It was almost an invasion of their privacy,” explained Menegatto.
• Lifestyle changes: As the reality set in, families had to alter their daily routines to minimize exposure. This included using bottled water and avoiding locally grown produce and swimming in the local pool. Some relocated. These adjustments disrupted established habits and added layers of stress to everyday life.
• Living with PFAS: Over time, residents reached a phase of adaptation, integrating new practices into their routines. However, this acceptance was often accompanied by a lingering sense of uncertainty. Concerns about long-term health effects persisted, especially regarding the wellbeing of children who had been exposed from a young age. “Mothers especially revealed a strong sense of guilt for having put their children’s health at risk during pregnancy and breastfeeding,” Menegatto said.

The invisible nature of PFAS contamination made it challenging for residents to assess their risk. This ambiguity fostered anxiety as the community was left wondering about potential health implications that might surface years later.

“Parents live in a chronic state of stress, anxiety, and depression,” Menegatto said. “In a human-made disaster such as PFAS contamination there is a high uncertainty of when people will experience the effects that has no end.” She explained that, unlike a natural disaster like an earthquake, where there is a recovery phase after the worst has passed, the PFAS contamination crisis will be ongoing for generations.

European Biomonitoring

While Veneto is one of the most well-known cases, PFAS contamination is widespread across the globe. In Europe, other known hotspots include parts of Belgium, particularly around Antwerp, where PFAS from chemical plants have polluted soil and water. In the Netherlands, high levels of PFAS have been detected near Dordrecht, linked to a major chemical manufacturing site. Germany, France, and the United Kingdom have also reported contamination in industrial areas and military sites where firefighting foams were used extensively. Globally, PFAS pollution is a concern in the United States, especially in Michigan, North Carolina, and areas near military bases; in Australia, particularly in rural New South Wales; and parts of China, where manufacturing and waste disposal practices have led to significant environmental contamination.

In 2016, the European Environment Agency, the European Commission, and 28 participating countries (the 24 EU member states plus Norway, Switzerland, Iceland, and Israel) launched the Human Biomonitoring for Europe (HBM4EU) project, which assesses human exposure to chemicals, including PFAS, by measuring their levels in human samples like blood and urine. It involves more than 100 organizations, including national public health bodies, research institutes, and regulatory agencies.

The goal is to generate evidence on chemical exposure levels across Europe, particularly among vulnerable groups such as children, pregnant women, and low-income populations, identify health risks, and inform policy decisions, explained Joana Lobo Vicente, PhD, an expert in chemicals, environment, and human health at the Pollution and Health Unit, European Environment Agency. “When we find that the population is exposed to these chemicals, we want to take action. Hence why these projects have to be closely linked with regulation,” she said.

A follow-up initiative, Partnership for the Assessment of Risks in Chemicals (PARC), began in May 2022 to improve chemical risk assessment and management of chemical exposure across the bloc.

As part of HBM4EU, a range of outputs has been produced, including fact sheets, infographics, and other communication materials to inform the public and healthcare professionals about chemical exposures and risks.

PFAS are persistent, widespread, and bioaccumulative, meaning that even patients outside known contamination zones may have been exposed through drinking water, food packaging, household products, or occupational settings. Physicians, particularly those in primary care, endocrinology, nephrology, and oncology, could consider PFAS exposure as a potential factor in cases of kidney disease, metabolic disorders, hormone imbalances, and certain cancers.

While routine screening for PFAS exposure is not standard practice, clinicians can identify high-risk patients, such as those with occupational exposure like firefighters and industrial workers, or residents of historically contaminated areas. Mental health professionals should be aware of the psychological toll that living with contamination can take on affected communities, including heightened stress, anxiety, and uncertainty about long-term health effects.

“It’s important that the medical community knows where to find this information,” Lobo Vicente said. “There is a lot of disinformation, so it’s crucial that people are informed and aware of the risks to make informed decisions.”

Despite years of research, biomonitoring, and policy efforts, the long-term health consequences of PFAS exposure are still unfolding, and affected communities will continue to grapple with it for generations.

Scientific evidence is mounting, regulatory action is tightening, and medical awareness is improving, but for those already exposed, the damage has been done. The challenge now is to mitigate future harm, support affected populations, and ensure that lessons from cases like Veneto drive stronger protections against these forever chemicals.

Biggeri, PhD; Vähk; Canova, PhD; Menegatto, PhD; and Lobo Vicente, PhD, disclosed no relevant financial relationships. HBM4EU was funded by the European Commission, and PARC is funded half by the European Commission and half by the member states.

Manuela Callari is a freelance science journalist specializing in human and planetary health. Her words have been published in The Medical Republic, Rare Disease Advisor, The Guardian, MIT Technology Review, and others.