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 t