Toxicity in the supply chain: cobalt, orthopaedics, and the Democratic Republic of the Congo
Authors: John T Williams, Achim Mambu Vangu, Habib Balu Mabiala, Honore Bambi Mangungulu, Elizabeth K Tissingh
Journal: The Lancet Planetary Health (2021)

Over two-thirds of the global supply of cobalt originates in the Democratic Republic of the Congo, a country rich in mineral and agricultural resources.1US Geological SurveyMineral commodity summaries 2020. US Department of the Interior, 2020https://pubs.usgs.gov/periodicals/mcs2020/mcs2020.pdfDate accessed: May 6, 2021Google Scholar Substantial concern exists regarding exploitative mining practices, including human rights abuses and child labour.2The Organisation for Economic Co-operation and DevelopmentOECD due diligence guidance for responsible supply chains of minerals from conflict-affected and high-risk areas.third edition. OECD Publishing, Paris2016Google Scholar The negative environmental and socioeconomic effects of poorly regulated mining operations on Congolese communities are also well documented.3Otamonga J-P Poté JW Abandoned mines and artisanal and small-scale mining in Democratic Republic of the Congo (DRC): survey and agenda for future research.J Geochem Explor. 2020; 208106395Crossref Scopus (6) Google Scholar International demand for cobalt is increasing due to its application in lithium-ion batteries for smartphones, laptops, and electric vehicles. In the medical industry, cobalt has been widely used as an orthopaedic implant material since Austin T Moore pioneered his hip replacement stem in the 1940s. Cobalt alloys have excellent fatigue resistance and strength characteristics, lending themselves to use in long-term, highly loaded implants such as hip and knee replacements. According to National Registry data, cobalt-chrome knee replacements are the most frequently implanted type in the UK. EU4EURegulation (EU) 2017/821 of the European Parliament and of the Council of 17 May 2017: laying down supply chain due diligence obligations for Union importers of tin, tantalum and tungsten, their ores, and gold originating from conflict-affected and high-risk areas.https://op.europa.eu/en/publication-detail/-/publication/8b0e378b-3c59-11e7-a08e-01aa75ed71a1/language-en#Date accessed: May 6, 2021Google Scholar and US5US Securities and Exchange CommissionSection 1502 of the Dodd-Frank Wall Street Reform and Consumer Protection Act.https://www.sec.gov/rules/final/2012/34-67716.pdfDate: 2012Date accessed: May 13, 2021Google Scholar trading regulations focus only on the traditional so-called conflict minerals—tin, tungsten, tantalum and gold, also referred to as 3TG—meaning due diligence reporting for cobalt is not legally mandatory. Nevertheless, in the past decade, criticism of the human and environmental costs in the cobalt supply chains of major electronics and vehicle manufacturers has been well publicised, with some resultant voluntary improvements in corporate practices.6Amnesty InternationalDemocratic Republic of the Congo: time to recharge: corporate action and inaction to tackle abuses in the cobalt supply chain. Amnesty International, Nov 15, 2017https://www.amnesty.org/en/documents/afr62/7395/2017/en/Date accessed: May 6, 2021Google Scholar New standards and tools to ensure ethical and sustainable cobalt supply are now gaining momentum; however, the take-up and progress in the medical implant sector is less clear. Most cobalt is found in the Tanganyika, Haut-Lomami, Lualaba, and Haut-Katanga provinces of the Democratic Republic of the Congo, within the dark grey mineral heterogonite. An estimated 20% is excavated by hand by a workforce of approximately 150 000 artisanal miners (also known as creuseurs) working in highly hazardous conditions.7Callaway A Powering down corruption: tackling transparency and human rights risks from Congo's cobalt mines to global supply chains. The Enough Project, Oct 30, 2018https://enoughproject.org/wp-content/uploads/PoweringDownCorruption_Enough_Oct2018-web.pdfDate accessed: May 6, 2021Google Scholar The environmental impacts of informally monitored small scale mining are numerous, including toxic trace metal contamination of local waterways and soil.3Otamonga J-P Poté JW Abandoned mines and artisanal and small-scale mining in Democratic Republic of the Congo (DRC): survey and agenda for future research.J Geochem Explor. 2020; 208106395Crossref Scopus (6) Google Scholar This contamination results in animal habitat destruction and arable farmland pollution. Miners often work without basic protective equipment and experience dangerous exposure to dust, chemicals, and potential mine tunnel collapse.6Amnesty InternationalDemocratic Republic of the Congo: time to recharge: corporate action and inaction to tackle abuses in the cobalt supply chain. Amnesty International, Nov 15, 2017https://www.amnesty.org/en/documents/afr62/7395/2017/en/Date accessed: May 6, 2021Google Scholar Children as young as age 7 years have been reported to be working in artisanal cobalt mining operations.7Callaway A Powering down corruption: tackling transparency and human rights risks from Congo's cobalt mines to global supply chains. The Enough Project, Oct 30, 2018https://enoughproject.org/wp-content/uploads/PoweringDownCorruption_Enough_Oct2018-web.pdfDate accessed: May 6, 2021Google Scholar, 8Amnesty InternationalDemocratic Republic of Congo: “This is what we die for”: human rights abuses in the Democratic Republic of Congo power the global trade in cobalt. Amnesty International, Jan 19, 2016https://www.amnesty.org/en/documents/afr62/3183/2016/en/Date accessed: May 6, 2021Google Scholar Most artisanal cobalt mining is unauthorised, although a 2016 report by Amnesty International suggested that cobalt from artisanal cobalt mining sources still enters the global supply chain via poorly regulated trading practices.8Amnesty InternationalDemocratic Republic of Congo: “This is what we die for”: human rights abuses in the Democratic Republic of Congo power the global trade in cobalt. Amnesty International, Jan 19, 2016https://www.amnesty.org/en/documents/afr62/3183/2016/en/Date accessed: May 6, 2021Google Scholar Cobalt ore obtained through artisanal cobalt mining is reportedly mixed with legitimately mined material by local exporters before being shipped for refinement and processing in overseas plants, and onwards into the global supply chain.8Amnesty InternationalDemocratic Republic of Congo: “This is what we die for”: human rights abuses in the Democratic Republic of Congo power the global trade in cobalt. Amnesty International, Jan 19, 2016https://www.amnesty.org/en/documents/afr62/3183/2016/en/Date accessed: May 6, 2021Google Scholar In a stark reflection of the gap in health-care provision between the Democratic Republic of the Congo and the richer countries it exports to, almost no cobalt in the form of knee replacements will ever arrive back to benefit Congolese patients. Technology and automotive companies in particular have come under increased scrutiny from various non-governmental organisations to ensure their supply chains respect human rights laws and consider environmental issues. In 2017, Amnesty International released a further report on 29 leading manufacturers regarding their cobalt sourcing.6Amnesty InternationalDemocratic Republic of the Congo: time to recharge: corporate action and inaction to tackle abuses in the cobalt supply chain. Amnesty International, Nov 15, 2017https://www.amnesty.org/en/documents/afr62/7395/2017/en/Date accessed: May 6, 2021Google Scholar However, medical implant companies have remained largely out of the investigative spotlight, despite many being large publicly traded entities. Two key international guidelines exist that aim to establish industry standards: the UN guiding principles on business and human rights,9UN Human Rights Office of the High CommissionerGuiding principles on business and human rights: implementing the United Nations “project, respect and remedy” framework. UN Human Rights office of the High Commissioner, New York, NY, and Geneva2011https://www.ohchr.org/documents/publications/guidingprinciplesbusinesshr_en.pdfDate accessed: May 6, 2021Google Scholar and Organisation for Economic Co-Operation and Development (OECD) due diligence guidance for responsible supply chains of minerals from conflict-affected and high-risk areas.2The Organisation for Economic Co-operation and DevelopmentOECD due diligence guidance for responsible supply chains of minerals from conflict-affected and high-risk areas.third edition. OECD Publishing, Paris2016Google Scholar The UN guidelines state that companies should maintain responsibility for preventing human rights breaches “independently of States' abilities and/or willingness to fulfil their own human rights obligations”.9UN Human Rights Office of the High CommissionerGuiding principles on business and human rights: implementing the United Nations “project, respect and remedy” framework. UN Human Rights office of the High Commissioner, New York, NY, and Geneva2011https://www.ohchr.org/documents/publications/guidingprinciplesbusinesshr_en.pdfDate accessed: May 6, 2021Google Scholar In practice, this means companies are responsible for continuously and proactively taking steps to ensure their own international supply chains fulfil strict human rights criteria. The OECD guidelines previously dealt only with the 3TG metals but were expanded in 2017 to cover all minerals, partly in recognition of the specific risks associated with cobalt and copper in the Democratic Republic of the Congo. It details a five-step framework against which companies can self-assess and ensure compliance. This framework has been reflected to some degree in legislation in many territories, including China, the EU, and the USA, although, as mentioned, current law still only pertains to 3TG in the EU and USA.4EURegulation (EU) 2017/821 of the European Parliament and of the Council of 17 May 2017: laying down supply chain due diligence obligations for Union importers of tin, tantalum and tungsten, their ores, and gold originating from conflict-affected and high-risk areas.https://op.europa.eu/en/publication-detail/-/publication/8b0e378b-3c59-11e7-a08e-01aa75ed71a1/language-en#Date accessed: May 6, 2021Google Scholar, 5US Securities and Exchange CommissionSection 1502 of the Dodd-Frank Wall Street Reform and Consumer Protection Act.https://www.sec.gov/rules/final/2012/34-67716.pdfDate: 2012Date accessed: May 13, 2021Google Scholar Disappointingly, the most recent version of EU regulation enacted in January, 2021, still does not broaden its scope beyond 3TG. Since formation in 2008, the Responsible Minerals Initiative (RMI) has offered companies tools and resources to voluntarily improve compliance with the OECD guidelines. The RMI now has over 380 member companies from a range of industries, including health care, although only one orthopaedic implant manufacturer to date. In a 2019 US annual review of conflict mineral and cobalt due diligence reporting, medical devices as a sector compared favourably against many other industries with regard to 3TG metals.10Deberdt R Jurewicz P Frechette S Mining the disclosures 2019: an investor guide to conflict minerals and cobalt reporting in year six. Responsible Sourcing Network.https://www.sourcingnetwork.org/mining-the-disclosures-2019Date: 2019Date accessed: May 6, 2021Google Scholar However, in relation to cobalt, the paucity of published due diligence reporting meant only automotive, technology, and jet engine sectors were audited. Electronics and vehicle manufacturers are leading the way in terms of so-called beyond compliance cobalt supply chain due diligence and reporting, largely as a result of pressure from consumers, non-governmental organisations, and the media. Less publicly prominent industries, such as the orthopaedic sector, can do more. In the absence of legislative framework to rely on, we would like to see more companies voluntarily complete and publish cobalt-specific due diligence reports. By raising awareness among consumer stakeholders—hospitals, surgeons, and patients—we can encourage our industry partners to engage with newly available international benchmarks and pave the way for others to follow. A real opportunity exists for cobalt mining to benefit the lives of Congolese people, but realising this opportunity will require a collaborative effort between policy makers, non-governmental organisations, industry, and consumers. The beneficiaries of items that use cobalt—in orthopaedic implants or car batteries—have a duty and a responsibility to ensure it is sourced and traded safely and equitably. We declare no competing interests.