Abstract
BACKGROUND: Paraquat is one of the most widely used herbicides in the world, despite its high human toxicity and the overwhelming evidence of associated high morbidity and mortality. Due to the significant public health implications of the use of paraquat, there have been calls to severely restrict or ban it in many countries. In this paper, we aim to investigate the regulatory status of paraquat at the national, regional, and international levels, discuss the successes and challenges of regulatory implementation, and review the impact of regulation on the incidence of poisoning and death. METHODS: We conducted a systematic review of articles on the regulation of the herbicide paraquat. The review concentrated on interventions to mitigate the negative public health impact of paraquat use. To complement our findings, we also conducted region-wise and country-wise searches on paraquat regulations. We collected information on paraquat regulations and restrictions and regulatory aspects of regulation implementation. RESULTS: At least 74 countries do not authorise paraquat in their markets, with bans, phase-outs, and withdrawals from the market. National and regional bans and phase-outs were effective at reducing paraquat poisoning and deaths. Restrictions on the use and application of paraquat, however, did not always result in a significant reduction in poisoning or suicide mortality, and many countries introduced bans after restrictions proved ineffective. CONCLUSION: Our review highlights several important elements for the success of the implementation of these regulations, with reductions in harm and no effect on agriculture. It is now time for national, regional, and international authorities to pay attention to the scientific evidence of human toxicity and put people's lives and health ahead of economic and business considerations in regulating paraquat. Its use should be replaced by other of weed control. This should be a public health priority.