On March 6, 2001, an Ohio-based environmental lawyer named Robert Bilott sent a 19-page letter to the Environmental Protection Agency warning of an imminent public health threat.

Bilott had been working on a lawsuit involving a West Virginia farmer who suspected that his livestock were dying off because of chemicals being dumped on his property. After researching the case, Bilott wrote to federal officials about a remarkable—and potentially deadly—discovery. He had uncovered the presence of a little-known toxic chemical that was so robust that scientists questioned if it would ever degrade over time.

The substance, which was manufactured by DuPont to create products like nonstick pans, “may pose an imminent and substantial threat to health or the environment,” Bilott wrote.

Last week, more than two decades after his letter warned of the harms of one “forever chemical” called perfluorooctanoic acid, or PFOA, the EPA announced that it was proposing to take the first steps to regulate and limit this group of man-made chemicals, commonly known by the acronym PFAS, in the nation’s water.

“It’s taken way, way too long for the agency to act,” said Bilott, whose pioneering work in environmental litigation has made him an icon in the field. “It’s great that they’re finally proposing to do it. You know, it still hasn’t actually happened. This was a proposed rule and hopefully it’ll be finalized. But it’s just been an incredibly tedious, time-consuming process to watch over decades. And in the meantime, people continue to be exposed.”

Even as many environmental activists welcomed news that federal officials had taken steps to recognize the harms of the substances, those who study so-called “forever chemicals” say that the battle to mitigate their harms is just beginning. 

PFAS (pronounced: pee-fahs) stands for per-and polyfluoroalkyl substances. They are believed to be so widespread that one estimate indicated that they are in the bloodstream of virtually everyone on the planet. 

The substances are so prevalent that babies are born with PFAS. Bilott said the chemicals were first created in the 1940s and once they got out into the water, the soil or into us, they “stay there and unfortunately do not break apart. And that’s why you hear them referred to as ‘forever chemicals,’” he said. 

There are now thousands of these chemicals as well as replacements for them, and researchers say exposure can increase the risk of cancer, liver damage and preeclampsia in pregnant people. Agency officials noted in the announcement that these chemicals are also linked to high cholesterol levels and hormonal irregularities, reducing the ability of the body’s immune system to fight infections and developmental effects or delays in children.

In a statement, the EPA said that the agency proposes to restrict two types of PFAS—PFOA and PFOS—and to regulate a mixture of PFAS—including PFNA, PFHxS, PFBS and GenX chemicals. According to the agency, the guidelines, if fully implemented, will prevent thousands of deaths and reduce tens of thousands of serious illnesses that can be attributed to forever chemicals. 

Forever chemicals, which were commonly used in the manufacture of nonstick pans, firefighting foam and water-resistant products, are also believed to be present in most of the planet’s waterways, even in rainwater and in ice in the Arctic.

It is in everything and it’s everywhere, said Linda Birnbaum, former director of the National Institute of Environmental Health Sciences and the National Toxicology Program.

“The words omnipresent and ubiquitous, I think are absolutely appropriate,” said Birnbaum. “They are in dental floss, they can be found in toilet paper, anytime you see something that says stain repellent or water resistant, it’s likely that they’re present.”

Lipsticks, nail polish and mascara contain the substances. Disposable food containers such as pizza boxes also contain forever chemicals. Menstrual underwear, cleaning products and rain boots, too.

Birnbaum, who is a scholar in residence at Duke University’s Nicholas School of the Environment, noted that the chemical bond at the heart of most forever chemicals—carbon fluorine bond—is one of the strongest that exists. “And since it barely exists in nature, nature hasn’t figured out a way to get rid of it.” 

EPA officials said the Biden administration’s Bipartisan Infrastructure Law will provide $9 billion to invest in drinking water systems impacted by forever chemicals and other emerging contaminants.

Eric Burneson, director of standards and risk management in the EPA’s Office of Water, said the agency estimated there would be a national cost savings of $1.2 billion a year if people did not have illnesses related to forever chemicals. Burneson said treatment technologies and monitoring is estimated to cost $772 million a year, adding that “we’re seeing benefits in excess of the cost.”

Federal officials plan to start their remediation efforts by addressing contaminated water, and then turn their attention to improving chemical safety, pollution prevention and air emissions.

Given the extent of forever chemical contamination, some activists say it’s fair to question whether environmental officials are setting realistic goals for any potential future remedies.

But since forever chemicals are virtually everywhere, people like Melanie Benesh of The Environmental Working Group say there’s “a lot of work yet to be done. 

“But this is a big step in the right direction, maybe even a leap in the right direction,” said Benesh, who is vice president of governmental affairs for the nonprofit, which t researches water pollutants and toxic chemicals. 

Officials with the American Chemical Council, a lobbying group for chemical manufacturers, called the EPA’s decision “misguided.” The group said the agency’s decision would result in companies having to pay “billions of dollars in compliance costs.”

The council noted that it had “serious concerns with the underlying science used to develop” the EPA’s standards. It also noted that “new peer-reviewed research also calls into question the basis for EPA’s overly conservative approach” to assessing the impact of “forever chemicals.”

“The proposals have important implications for broader drinking water policy priorities and resources,” the council said, “so it’s critical that EPA gets the science right.” 

Zachary Schafer, senior advisor in EPA’s Office of Water, said the science is “clear that long-term exposure is linked to significant health risks.”

“Safe drinking water is so fundamental to healthy people and thriving communities,” said Schafer. “We know that. We rely on it from the moment we wake up and make a cup of coffee to when we brush our teeth at night. And we fundamentally believe that every person should have access to clean and safe drinking water.”

The agency said exposure to forever chemicals over long periods, and during certain critical life stages, like during pregnancy and in developing babies, may lead to negative health effects.

“It’s a good day to be getting rid of PFAS,” said Tracey Woodruff, who co-wrote one of the largest studies in the nation examining forever chemical exposure and pregnancy outcomes.

The study, which was published in Environmental Health Perspectives on March 15—the day after the EPA issued its proposal—found that higher levels of forever chemicals resulted in lower birth weights among babies. Researchers looked at 3,000 pregnant people for the study, which was funded by Environmental Influences on Child Health Outcomes Program (ECHO) at the National Institutes of Health.

Some of the same forever chemicals that are part of the EPA’s proposal had also reached the study’s participants, said Woodruff, who is the director of the Environmental Research and Translation for Health (EaRTH) Center at the University of California, San Francisco. Tests found the presence of those substances in the bloodstreams of at least 96 percent of the study’s participants.

And researchers found that regardless of when the exposure to forever chemicals occurred during a pregnancy—early in fetal development, during the second trimester or in the weeks before birth—childrens’ birth weights were negatively affected. 

Amy Padula, who co-wrote the study, said pregnant people are not normally tested for forever chemicals and may be uncertain of the potential harms. She’s happy to see that the first steps to regulate the substances in water are being taken, but there’s “so much more to do.”

“I think understanding where it is and who’s exposed will help us be able to reduce exposures moving forward,” said Padula, an ECHO Program investigator at the University of California, San Francisco.

Padula, who noted there are a number of ways that one can be exposed to forever chemicals, said the health implications for low birth weights can follow children for longer than just the first few years of life.

“I think sometimes people think, ‘Oh, well, like what’s a few grams,’ but on a population level it really is kind of notable,” she added. “Lower birth weight in general is associated with a whole host of adverse outcomes, and some have even connected lower birth weight to more chronic diseases later in life. So I think some of the impacts can be even more long lasting.”

For now, Burneson said there will be a 60-day public commenting period on the proposal, and the agency is hoping to have a final rule in place by the end of the year. Water systems will have three years to bring their systems in line with the guidelines.

“This is a really important action that is going to protect Americans’ drinking water,” he said. “But it’s not the only thing the agency’s doing—we’ve got significant research underway to understand more of the PFAS.”

There are now thousands of forever chemicals; some estimates say over 12,000. The EPA proposal would examine six.

“Remember, there’s lots more in our water, lots more,” Birnbaum said. “There’s the PFOA and the PFOS, plus the four others. But we know that in different situations, sometimes that can only account for 20 percent or 25 percent of the total PFAS in the water. We don’t even know what’s there most of the time.”

“I think we’re looking at the tip of the iceberg here,” she added. 

The production of forever chemicals produces greenhouse gases which accelerates the effects of climate change, according to federal data. And some say that one of the issues is the replacements for these chemicals. Bilott said scientists and regulators say we may be having what they call “regrettable substitutions.”

“We’re just moving from one to another, potentially bad chemical,” said Bilott. “And that’s what’s leading folks to say maybe we need to be doing more to address this whole class of chemicals.”

In other nations, the authorities are doing just that: The Europe Union is proposing one of the largest bans on forever chemicals that would include over 10,000 chemicals.

“I think we’re going to be spending a lot of time trying to figure out what to do about what’s already out there in the environment in the U.S. and dealing with the health impacts of these materials,” Bilott said. “And hopefully we’ll be able to make sure that the right people are held responsible here.”

Bilott noted that these are man-made chemicals. “We know who made them,” he said. “We know who pumped them out knowing this was going to happen. And it’s important that those companies who profited billions for a long time, they’re the ones who are held responsible for the damage they caused.” 

Bilott said he wants to make sure that the costs don’t get shifted to taxpayers and the innocent victims of the contamination. He’s currently representing water systems, states and others who have been affected by forever chemicals.

“That’s going to be, I’m sure, a fight that goes on for a while,” he added. “I’m in that fight right now.”