In February, the National Academies of Sciences, Engineering, and Medicine issued the report Frameworks for Protecting Workers and the Public from Inhalation Hazards. I was honored to participate on the committee that produced the report. In this post, I describe the work of our committee and recount some of our recommendations. For a free PDF of the report, visit the website of the National Academies Press.

The National Academies Process

The National Academies follows a rigorous process that ensures committees are free of any conflicts of interest and are constituted with the appropriate expertise and diversity. Our committee included four Certified Industrial Hygienists, an air quality specialist, a pediatrician, a professor of mechanical engineering, a physiologist working with wildland firefighters, a psychologist, and five physicians. Most members were associated with academic institutions, but the private sector and union training programs were also represented. The committee was deftly chaired by Jonathan Samet, dean of the Colorado School of Public Health, who was supported with unfailing competence and good humor by the study director, Autumn Downey.

We held the first of eight formal meetings in November 2020. Several meetings were open to the public, but most of our deliberations were closed to allow for frank discussions. There were areas of significant disagreement, but everyone was treated with sincere deference by fellow members in the most collegial environment I have ever experienced, despite the long hours and endless editing of the 570-page document.

A major reason for our success was the National Academies support team, which conducted an extensive literature search that informed our deliberations and became an appendix to the report. The team focused their review on wildland firefighters, outdoor workers, indoor workers, and the public, examining studies of air pollutants and infectious agents.

When the committee needed further clarification of the relevant laws, regulations, and guidance documents impacting respiratory protection, the Academies engaged Arden Rowell, a professor at the University of Illinois College of Law. Rowell produced a remarkably comprehensive review that is included as an appendix in the final report. Her charge from the committee also included identifying new or revised regulations that should be considered to address gaps in responsibilities for protecting the public and workers who aren’t covered by a respiratory protection program. Her work made it abundantly clear that there was no governmental equivalent of NIOSH to ensure the public had access to adequate respiratory protection.

The document was not released for review until every committee member had signed a statement that they agreed with the report. One hallmark of the National Academies program is a robust review process. Thirteen nationally recognized experts accepted the invitation to serve as reviewers and produced over 100 pages of comments that were all addressed by the committee before the report was released to the study sponsors, NIOSH, EPA, the U.S. Department of State, and the CDC Foundation.

Recommendations Addressing Workers Without Respiratory Protection Programs

The following recommendations from the report address workers who aren’t currently covered by respiratory protection programs:

• Congress should revise the Occupational Safety and Health Act to grant OSHA the authority to ensure respiratory protection for all types of workers, including all private-sector workers. The revised Act should clarify that employers are required to ensure that the health of workers, consumers, and the public is not put at risk by inhalation hazards resulting from the business’s activities. OSHA should have primary oversight responsibility for this requirement and of related requirements and programs established by other federal agencies.
• NIOSH should expand its National Personal Protective Technology Laboratory to improve the timeliness and surge capacity of its respirator conformity assessment processes by using recognized consensus standards where appropriate and incorporating third-party laboratory testing into its respirator approval program.
• OSHA should establish and regularly update science-based, comprehensive workplace exposure standards for particulate matter indicators (for example, from wildfire smoke), as well as airborne infectious disease agents, that would trigger respiratory protection program requirements, including for workplaces in which respirators would not otherwise be required. The agency should also expand its technical assistance capabilities in this area. Congress should set deadlines for OSHA’s promulgation of these standards. In the interim, OSHA, in conjunction with NIOSH, should develop comprehensive guidelines, including the use of NIOSH-approved respirators, for workers who are at high risk of exposure to these hazards.
• When engineering and administrative controls fail to protect workers from inhalation hazards, OSHA and other agencies with authority over worker safety (such as EPA, MSHA, and the Department of Energy) should require that only NIOSH-approved respirators be selected. Other agencies that provide guidance for workers facing inhalation hazards but lack this specific regulatory authority should recommend that only NIOSH-approved respirators be used.
• OSHA and NIOSH should undertake an evaluation to understand and predict the increased need for respiratory protection associated with the expansion of worker coverage and the risk of future large-scale incidents or situations involving inhalation hazards, including environmental and infectious agents. This information should be shared with the Office of the Assistant Secretary for Preparedness and Response and other relevant federal authorities to inform stockpiling and distribution guidelines regarding respiratory protective devices.
• NIOSH, OSHA, EPA, the National Institute of Environmental Health Sciences, and other relevant federal agencies should facilitate the translation of existing technical information on respiratory protection into tailored and culturally appropriate guidance and training materials designed for workers, particularly those who may be using respirators outside of a respiratory protection program. These agencies should recognize the administrative structures and power dynamics, local contexts, and psychosocial and political factors that influence uptake, and increase their support mechanisms to ensure the training of more workers, including those from diverse communities that otherwise might not be reached through training programs. These support mechanisms should be targeted to labor organizations, worker centers, nonprofits, academic research centers, and other groups that have established relationships and regularly interface with end-user groups.
• NIOSH should launch expanded surveillance and intramural and extramural research programs to better meet the needs of all workers facing inhalation hazards. The surveillance program should generate data on the population sizes and characteristics, exposures to inhalation hazards and associated risks, and respiratory protection needs of these workers, including workers with disabilities, other underserved populations, and volunteers. The research program should include topics such as respirator design, characterization of source control effectiveness, innovative approaches for respirator manufacturing and distribution, implementation of respiratory protection, and methods for sampling and characterizing workplace inhalation hazards. An important objective of this research program should be to generate information that can help address knowledge gaps regarding the choice, acquisition, use, and disposal of respirators by employers and workers in this broader workforce. Additional appropriated funding from Congress will be necessary for this expanded scope.

Recommendations Addressing the Needs of the Public

One of the greatest concerns of the committee was how to reproduce for the public the regulatory authority of OSHA to require NIOSH-approved respirators as well as NIOSH’s demonstrated effectiveness in evaluating and approving respiratory protection. I and several other committee members worried that NIOSH’s mandate could be expanded to the public without sufficient funding from Congress, diluting the agency’s protection of workers. The committee eventually recommended that a different federal entity play this role. The following recommendations from the report address the needs of the public:

• Congress should establish a coordinating entity within the Department of Health and Human Services (HHS) to provide a unified and authoritative source of information and effective oversight in the development, approval, and use of respiratory protective devices that can protect the public health. The Secretary of HHS should immediately establish an interim office to take on priority near-term tasks of the coordinating entity until Congress establishes the coordinating entity. Pending such congressional action, the White House should establish an interagency task force focused on respiratory protection for the public to ensure that the activities of the interim HHS office are coordinated with other federal agencies.
• As the frameworks for workers and the public are implemented, the heads of the two agencies housing them—the Department of Labor and the Department of Health and Human Services—should establish mechanisms to support collaboration and cooperation between them.

A Rewarding Experience

Working on this report was my second experience with the National Academies. Prior to the COVID-19 pandemic, I participated on a committee that explored the practicality of regularly using elastomeric respirators in healthcare, but also—presciently—during an influenza pandemic or other large aerosol-transmissible outbreak when demand for disposable respiratory protective devices would outstrip supply. As I near the end of a rewarding career in industrial hygiene that began in 1978, I consider having served on two National Academies committees to be high points and distinct honors, and I am proud of the critical role industrial hygienists played on both. I encourage colleagues to participate if they are afforded the opportunity.