Zambia Drags Heels on Mercury Amalgam Ban

LUSAKA, Zambia—Beating drums, tubas, trumpets, and saxophones filled the air as a marching band led a procession from Leopard Hills Mall to Bauleni Primary School on March 20 to celebrate World Oral Health Day.

Crowds gathered under the shade, surrounded by posters promoting dazzling smiles and salespeople showcasing dental products. Students, dentists, and industry leaders came together to champion oral health. The keynote speaker, Richard Nsakanya, assistant director of Clinical Care and Diagnostic Services at Zambia’s Ministry of Health, discussed preventable dental diseases and the importance of accessible, affordable health care.

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But one pressing issue was conspicuously absent from his speech—the controversy surrounding mercury amalgam fillings.

Mercury amalgam, a common material used to fill cavities, consists of liquid mercury mixed with silver, tin, and copper. While strong and long-lasting, these silver-colored fillings emit low levels of mercury vapor, which, when inhaled, can be absorbed by the lungs. 

The U.S. FDA states that mercury exposure from amalgam is generally safe, but developing neurological systems in fetuses and young children may be more sensitive to its toxic effects. Pregnant women are advised to avoid having fillings because of the risk to their fetus. Mercury amalgam fillings are not recommended for young children, who may inhale low levels of mercury vapor that can be absorbed by the lungs. Beyond health concerns, dental mercury poses significant environmental risks. It leaches into ecosystems through dental clinic emissions and human waste, as well as cremations and burials contaminating air, water, and soil. 

Just 0.6 grams of mercury—the average amount used in a single filling—can pollute 100,000 liters of water, about the size of a swimming pool, and make it unsafe to drink, according to the WHO. A 2017 report estimated that mercury amalgam fillings contributed 1,297 kilograms of mercury into Zambia’s environment. 

“It pollutes our water sources, it pollutes the crops that we grow, and it can pollute even the aquatic animals,” says Gabriel Mpundu, MD, a dental surgeon and president of the Zambia Dental Association. A 2022 study found two samples of fish collected from Zambia’s lakes and rivers contained up to 1.7X the legal maximum level for mercury. 

Mercury amalgam is only the sixth-largest source of mercury pollution in Zambia’s environment — trailing behind more familiar culprits like copper and gold mining, battery disposal, and informal waste burning. But with modern advances in dental fillings, it has become an unnecessary contributor. 

Some nations have already taken decisive steps to ban mercury amalgam. But in Zambia, progress has stalled despite the dangers.

In 2013, 140 nations—Zambia among them—signed the Minamata Convention on Mercury, committing to control and reduce mercury use across industries, including encouraging a phasedown of dental amalgam. While the Convention does not itself impose an outright ban, dozens of countries have since passed their own national laws fully banning the use of amalgam without exception, embracing environmentally friendly alternatives such as composite resins and glass ionomer cements that some studies suggest are just as durable, and perhaps cheaper when factoring in the environmental cost.

Not everyone agrees. After the European Union banned dental amalgam in January, the British Dental Association warned that there are “currently no alternative restorative materials that compete with amalgam on speed of placement or longevity.”

But unlike the U.K., Zambia is especially vulnerable due to harmful impacts of mercury to its limited resources.

“There’s no hospital equipped with proper disposal systems for dental amalgam—either the fillings we use or those we extract,” explains Mpundu. “For me, that’s an environmental hazard, because we’re throwing it out with other waste.”

The Minamata Convention calls for safe mercury waste management and encourages dental practices to use amalgam separators to prevent mercury releases into the environment. Without these, Zambia remains at risk. However, the official government line is that the issue has been addressed.

In 2021, the Zambian government declared that mercury amalgam was no longer in use, stating that dentists had switched to alternatives and that it was no longer taught in dental schools. However, the government’s lack of an official ban leaves room for ambiguity. 

Mpundu estimates that 10% of dentists still offer mercury fillings, though the real figure may be higher. GHN visited three randomly selected dentists in Lusaka, and two were still offering mercury fillings. Neither practice agreed to comment. Other dentists refused to discuss whether or not they used mercury amalgam at all.

Under the Minamata Convention, countries were required to submit reports by 2023 detailing their efforts to protect women and children from mercury exposure. 

Some met the deadline, but Zambia, despite ratifying the convention in 2016, has yet to do so.

Christopher Kapeshi, MD, Zambia’s national oral health coordinator at the Ministry of Health, states that the government aims to ban mercury amalgam by 2030. However, he acknowledges the slow progress, telling GHN: “These are legal matters, so we have to move carefully. We don’t want to force people; we want people to understand that this is for the benefit, for the greater good of humanity, and that is why it is dragging on.”

Florian Schulze, administrative vice president of the World Alliance for Mercury-Free Dentistry and head of the European Network for Environmental Medicine, which tracks nations’ progress under the Minamata Convention, says the delays are concerning.

In addition to missing a 2023 reporting deadline on efforts to protect children along with pregnant and breastfeeding women, he notes, another report, on the progress of phasing out mercury, is due by the end of this year. 

Kapeshi says Zambia wants to eliminate use of mercury amalgam in lactating mothers, children under the age of 15, and women of childbearing age, but did not address the UN deadline. “We are still on course; we don’t think we are lagging behind,” he says.

Titus Haakonde, PhD, president of the Zambia Institute of Environmental Health, is calling for stronger action and legislation.  

“Maybe our parliamentarians have not received adequate information,” he says. “We are still urging our government and the health authorities to phase this out, because the health implications associated with any material that contains mercury are so severe they’re not only affecting our generation, but future generations.”

“We want to see pieces of legislation, like Acts of Parliament that will ban use of mercury,” he adds.

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Mpundu agrees that better communication with policymakers is crucial: “We need to convince the government with research on the demerits of amalgam,” he says, adding that he was currently leading a research project on the issue and seeking funding. “Just advocating without research evidence is not enough.”

While progress has been sluggish in Zambia, some African nations have already successfully banned mercury amalgam—showing that with political will, change is possible.

In 2022, Tanzania instructed all oral health care providers to stop using it—not just for pregnant women and children, but for the general population. Uganda and Gabon have also enacted bans.

Baraka Nzobo, MD, assistant director of Oral Health Services at Tanzania’s Ministry of Health, says that while some Tanzanian dentists resisted the change initially, ongoing dialogue and education helped smooth the transition—adding that mercury amalgam and its alternatives cost about the same, and patients prefer the newer options.

Schulze hails Tanzania’s success as a “wonderful story,” proving that rapid change is possible.

“It shows how fast you can do it and how available the alternatives are,” he says, pointing to a desire in African nations with emerging dental industries to “leapfrog” amalgam technology and go straight to the alternatives.   

He notes that African countries are spearheading efforts to amend the Minamata Convention, aiming to set a 2030 deadline for phasing out mercury amalgam—currently, no such date exists. 

But Zambia’s delayed response stands in stark contrast to the proactive approach of Tanzania and other nations, missing crucial deadlines and lacking clear enforcement. Inaction could have dire consequences, jeopardizing the health of Zambians and the protection of the environment from mercury’s long-term dangers. 

 “We have a right to live in a clean and safe environment,” says Haakonde.

 
Ed. Note: The idea for this story came from Michael Musenga, an environmental health practitioner for the Children’s Environmental Health Foundation in Livingstone, Zambia. Musenga won an honorable mention for his entry, "Making Zambia a Dental Amalgam-Free Country" in the Untold Global Health Stories of contest, co-sponsored by Global Health NOW and the Consortium of Universities for Global Health. 

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