This document outlines a paper on Agent Orange and its impacts. It provides background on Agent Orange, how it was used in Vietnam, potential health effects on veterans and civilians from exposure, current cleanup efforts, and implications for public health. An estimated 19.5 million gallons were sprayed, exposing up to 4.8 million Vietnamese civilians and affecting the health of many US veterans through various illnesses and diseases. Current efforts focus on identifying and cleaning up 28 "hot spots" of dioxin contamination, with $18.5 million approved for assessments and interventions. The long term impacts underscore the need to thoroughly evaluate chemicals prior to wartime use to protect soldiers and civilians.

1. Agent Orange
THE HISTORY AND LEGACY OF A WARTIME HERBICIDE
Muoi Nguyen
University of San Francisco
Fall 2013

2. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

3. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

4. Learning Objectives:
(1) Provide background on Agent Orange and chronicle
its deployment during the Vietnam War.
(2) Discuss some of the associated illnesses and diseases
and extent of exposure on:
I. Vietnam War Veterans
II. Vietnamese Civilians
(3) Update on current policies and discuss implications
for future public health efforts.

5. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

6. Use of chemicals such as Agent Orange during the Vietnam War
have lead to a multitude of negative health impacts. There is a
need for further exploration into the toxic effects of chemicals
employed during wartime to prevent future exposures.
Problem Statement

7. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

8. Historical Background: Vietnam War
•The United States Armed Force
employed an herbicide strategy
plan.
•Produced a variety of “Rainbow
Herbicides”, such as Agent Blue and
Agent Orange.
The Aspen Institute, 2013

9. What is Agent Orange?
A tactical defoliant to limit the
coverage and reduce the food
supplies of war opponents.
U.S. Department of Veterans
Affair, 2012

10. Agent Orange was a phenoxy-herbicide.
Agent Orange = 2,4-dichlorophenoxyacetic acid (2,4-D) + 2,4,5-
trichlorophenoxyacetic acid (2,4,5-T)
U.S. Department of Veterans Affair, 2012
What is Agent Orange?

11. Main ingredients 2,4-D and 2,4,5-T, degraded within a weeks’
time.
By-product, TCDD, in the mixture continued to be a persistent
contaminant in the environment for many years and can lead to
damages to human health, even in small exposures.
Schecter et al., 1995
TCDD is also known as “dioxin”.

12. 1961 - President John F. Kennedy sent a group of advisors to South
Vietnam and began testing Agent Orange.
1962 - The first aerial spraying of the herbicides started southern region
of Vietnam in an operation known as “Operation Ranch Hand”.
1962- 1971 - The operation continued for roughly ten years.
Stellman et al., 2003
Timeline: Agent Orange

13. Only stopped after a study in 1970 found that the compound,
2,4,5- T in the mixture caused birth defects in lab animals.
Projected that the levels of dioxin sprayed during the war were
at a significantly higher level than for the purpose of domestic
agricultural defoliation.
Stellman et al., 2004

14. An estimated 19.5 million gallons of herbicides were sprayed,
covering one-tenth of the land in South Vietnam, spilling
roughly 500 pounds of TCDD into the 5.6 million acre region
The Aspen Institute, 2013
The military use of Agent Orange during the Vietnam War was
historic for being the largest contamination of dioxins
documented.
Stellman et al., 2004

15. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

16. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

17. Exposure: Vietnam War Soldiers
~ 1.5 million soldiers served during the period in which the spraying
occurred (American Cancer Society, 2013).
Agent Orange was sprayed by helicopters, boats, trucks, and backpacks.
Mode of exposure:
•involvement in spray itself (with no protective gears)
•displacement in the air (aerial spraying)
•in the water (in the rivers and lakes)
•in the land (during combat)
•In the food supplies (contaminated foods and water supplies)

18. Health Impact on Vietnam Veterans
Many Vietnam Veterans returned home with reports of a variety
of health problems.

19. High levels of TCDD linked to various
health complications and illnesses
Diabetes
• Veterans with high levels of TCDD
in the blood  higher prevalence of
diabetes
• Shorter onset of diabetes
• Increased risk of developing insulin
resistance
Cranmer et al., 2000

20. Prostate Cancer
• Higher incidence of prostate
cancer
• Twice as many as unexposed men
• Earlier development and more
aggressive variation of the cancer
Chamie et al., 2008

21. Effects of Dioxins on Human Health
According to the World Health Organization (WHO):
Short term exposure: skin lesions, altered liver functions
Long term exposure: impairment of immune system, nervous system,
endocrine system, and reproductive functions
Research on chronic exposure in animals
•Cancer
•TCDD classified as “known human carcinogen”

22. Veterans’ Fight for Compensation
Hunger Strike

23. Agent Orange Settlement Fund
Chemical manufacturers such as Dow Chemical and Monsanto Corporation produced
the herbicide for its military use during the Vietnam War.
◦ Although scientists were aware of the high amounts of TCDD contaminants in the
mixtures and its toxic effects have on humans, the product was still released for
military use.
Stellman et al., 2003
In 1979, U.S. veterans filed a class action lawsuit against the producers of Agent
Orange and were compensated with $180 million through the Agent Orange
Settlement Fund.
American Cancer Society, 2013

24. Agent Orange Act of 1991
• Passed by Congress in 1991
◦ Aimed at promoting more medical
and scientific research done by the
National Academy of Science on the
health effects of the exposure
during the Vietnam War
◦ Recent findings are published by
IOM in Veterans and Agent Orange.
(The Aspen Institute, 2012)

25. Agent Orange Act of 1991
• Required the United States Department of Veterans Affair to recognize a list of
“presumptive diseases” that can be compensated for and are associated with
exposure to Agent Orange such as:
AL amyloidosis, Chronic B-Cell leukemia, Chloracne, Diabetes mellitus
type 2. Hodgkin’s disease. Ischemic heart disease, Multiple myeloma,
Prostate cancer, Respiratory cancers, Soft tissue sarcoma…
(U.S. Department of Veterans Affair, 2012).

26. Compensation
As of 2010, the U.S. Department of Veterans Affairs have
compensated over $16.2 billion dollars to the 1,095,473 Vietnam
Veterans.
The Aspen Institute, 2012
Note: Compensations from the VA are solely their “services” during the war and
not the effects of Agent Orange itself.

27. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

28. Exposure: Vietnamese Civilians
An analysis of the Hamlet Evaluation System (HES), a comprehensive
survey of rural census accounting for the numbers of hamlets and size of
the Vietnamese population sprayed found:
◦ 3,181 hamlets/villages
◦ Between 2.1 and 4.8 million people were present during the spraying
*Not accounting an additional 1,430 known hamlets with
unknown populations
Stellman et al., 2003

30. Health Impacts on Vietnamese Civilians
◦ High levels of TCDD in Blood:
Recommended monthly limits of TCDD in blood (WHO): .07 ppt
◦ 1970- Tests of Vietnamese mothers following spraying showed levels of TCDD as high as 413 ppt!
Schecter et al., 2006
◦ Persistent in human tissue, blood, and milk:
◦ Levels of TCDD in blood, milk, and tissue of Vietnamese living in South Vietnam found at elevated levels
of TCDD after pooling blood tested in 1991 and 1992, almost 20 years after spraying stopped.
◦ Regional effects:
◦ Compared to levels of TCDD in the blood for Vietnamese from south vs. north Vietnam was 33 ppt and
below 2.9 ppt, respectively. The difference supports the effects of Agent Orange spraying and its impact
on the inhabitant of the region.
Schector et al., 2002

31. Health Impact: Birth Defects
In animal studies done in the labs, large doses of
Agent Orange caused tumors and birth defects.
American Cancer Society, 2013
Estimated about 150,000 births with congenital
deformities such as neural tube defects as well as
developmental disabilities associated with
exposure.
Vietnamese Red Cross

32. Legacy of Agent Orange in Vietnam
TCDD continue to leach into the soil or travel by
runoff to the rivers where fish may be caught,
sold, and consumed by uninformed citizens
(Scheter et al., 2006).
In 2004, similarly to the U.S. Veterans, the
Vietnamese citizens filed a law suit again the
chemical companies.
◦ Case was dismissed the following year (The
Aspen Institute, 2011).
Without intervention, generation after
generation will continue to be plague by the
deadly and persistent toxin, dioxin, in the
environment and in their bodies.

33. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

34. Update on Efforts
Fortunately, some changes have
occurred in the recent years to help
combat the issue.
2003 - The U.S. Environmental
Protection Agency (EPA) collaborated
with Vietnamese officials in a joint
project to deal with the hot spot in
Vietnam (The Aspen Institute, 2013).
Hatfield Consultant and Vietnamese
officials have identified 28 hot spots.

35. Hot Spots
Location where the herbicides were
stored during the Vietnam War or areas
where dioxins are of high concentration
from leaching soils and erosions such as
Da Nang Airport, Phu Cat Airport, and
Bien Hoa Airport.

36. Hot Spot: Da Nang Airport

37. Hot Spot Cleanups
April, 2011 - U.S. Congress approved an
appropriation of $18.5 million towards
investigating and assessing the
contamination at the sites and developing
an intervention plan.
Former Secretary of State, Hillary Clinton,
announced the U.S. government support for
a project to clean up the Da Nang hot spot at
$43 million a year (The Aspen Institute,
2013).

38. Outline
Learning Objectives
Problem Statement
What is Agent Orange?
Effects from Exposure
• Vietnam War Veterans
• Vietnamese Civilians
Current Efforts
Implications for Public Health
References

39. The ultimate purpose of revisiting these issues is to ensure that future uses of
military chemicals are thoroughly evaluated to protect soldiers and innocent
civilians.

40. Implication for Public Health
• More comprehensive testings on military chemicals prior to
the manufacturing or production for human use.
• Closer look at soldiers’ exposure to toxic chemicals at war.
Monstantos Corporation

41. Iraq War and Burning Pits:
Second Agent Orange?
Military burn pits emit toxins such as sulfur dioxide, arsenic,
dioxins and hydrochloric acids which are linked to serious
health ailments.

42. American Cancer Society. (2013, March). Agent Orange and cancer. Retrieved from
http://www.cancer.org/cancer/cancercauses/othercarcinogens/intheworkplace/agent-orange-and-cancer
Chamie, K., deVere White, R. W., Lee, D., Ok, J. and Ellison, L. M. (2008), Agent Orange exposure, Vietnam War veterans,
and the risk of prostate cancer. Cancer, 113: 2464–2470. doi: 10.1002/cncr.23695
Cranmer, M., Louie, S., Kennedy, R. H., Kern, P. A., & Fonseca, V. A. (2000). Exposure to 2,3,7,8-Tetrachlorodibenzo-p-dioxin
(TCDD) is associated with hyperinsulinemia and insulin resistance. Toxicological Sciences, 56(2), 431-436.
Schecter, A., Quynh, H., Päpke, O., Tung, K. C., & Constable, J. D. (2006). Agent Orange, dioxins, and other chemicals of
concern in Vietnam: Update 2006. Journal of Occupational & Environmental Medicine, 48(4), 408-413.
doi:10.1097/01.jom.0000194153.77646.7d
References

43. Schecter, A., Dai, L. C., Thuy, L. T., Quynh, H. T., Minh, D. Q., Cau, H. D., ... & Baughman, R. (1995). Agent Orange
and the Vietnamese: the persistence of elevated dioxin levels in human tissues. American Journal of
Public Health, 85(4), 516-522.
Stellman, J. M., Stellman, S. D., Christian, R., Weber, T., & Tomasallo, C. (2003). The extent and patterns of usage
of Agent Orange and other herbicides in Vietnam. Nature, 422(6933), 681-687.
Stellman, J. M., Stellman, S. D., Weber, T., Tomasallo, C., Stellman, A. B., & Christian Jr, R. (2003). A geographic
information system for characterizing exposure to Agent Orange and other herbicides in Vietnam.
Environmental Health Perspectives, 111(3), 321.
The Aspen Institute. (2013). Agent Orange in Vietnam program. Retrieved from
http://www.aspeninstitute.org/policy-work/agent-orange/history.

44. The Aspen Institute (2013). Chronology. Retrieved from http://www.aspeninstitute.org/policy-work/agent-orange/program-
home/chronology
U.S. Department of Veterans Affair. (2012, February). Facts about herbicides. Retrieved from
http://www.publichealth.va.gov/exposures/agentorange/basics.asp.
U.S. Department of Veterans Affair. (2012, February). Exposure to Agent Orange in Vietnam. Retrieved from
http://www.publichealth.va.gov/exposures/agentorange/vietnam.asp.
U.S. Environmental Protection Agency. (2007, July). Exposure and human health reassessment of 2,3,7,8 -
Tetrachlorodibenzop-Dioxin (TCDD) and related compounds national aademy sciences (NAS) Review Draft.
Retrieved from http://www.epa.gov/ncea/pdfs/dioxin/nas-review/#part2