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May 1 is the final day to provide comments to the Environmental Protection Agency (EPA) in response to the Trump administration’s proposal to severely weaken rules designed to curb emissions from facilities that emit ethylene oxide, a colorless carcinogenic gas. 

Since taking office for the second time, President Donald Trump has pursued his aggressive anti-regulation agenda by slashing bedrock environmental laws in order to pave the way for industry to increase profits. If the EPA finalizes the proposed reductions to ethylene oxide emissions, communities living near 90 facilities that use the toxic gas face risk of increased exposure to cancer, with few methods for accountability at their disposal.

“[Ethylene oxide] should not be used in an area with any kind of population in a casual way. The way that they were handling it was very casual, and has been since the 1970s,” said Janet Rao, a retired educator and community organizer with an Atlanta-based group called Stop Sterigenics. The group is named after the international company Sterigenics, which has a location in Atlanta that sterilizes medical equipment with ethylene oxide. Since 2019, Stop Sterigenics has advocated for public health monitoring and safety measures as well as corporate accountability from state and federal environmental agencies and Sterigenics.

Rao’s community was one of many across the country that advocated for more stringent EPA monitoring provisions of facilities that utilized ethylene oxide to sterilize medical equipment. In 2024, communities succeeded in pushing the EPA to adopt a slate of regulatory provisions nationwide that raised and standardized the floor-level protections for ethylene oxide monitoring, doing away with a previous patchwork of regulation that allowed some communities to enjoy more protections than others. The 2024 rule, as approved by the Biden administration’s EPA, would have regulated against easily preventable emissions leakages and mandated continuous monitoring for affected communities. 

The rulemaking was a long time coming, said Janet McCabe, former deputy administrator at the EPA. Its revision under the Trump administration is “definitely a setback, [one] that doesn’t really account for the public health impact of what that setback would mean,” McCabe told Prism. 

The agency first established regulations for the harmful gas in 1994, then finalized its risk review under the National Emission Standards for Hazardous Air Pollutants (NESHAP) in 2006. A decade later in 2016, the EPA established that ethylene oxide is carcinogenic—far more toxic than previously established. By that point, people living and working near sterilizers had unknowingly breathed in the cancer-causing gas for decades. Though causal links have yet to officially be established, many community members and legal advocates attribute chronic illness and cancer to ethylene oxide exposure. 

In 2025, the Trump EPA announced that it was reconsidering the 2024 final rule, citing onerous compliance requirements for companies that operate sterilization facilities. 

“If you’ve read the rule, you know that they focus a lot on the cost to industry. They do not focus very much on the cost to the public of the increased health impact,” McCabe said. The proposed change to the 2024 rule is estimated to save companies about $280 million and an annual cost savings of about $50 million, given that they won’t have to spend on monitoring technologies.

More than 14 million people live within 5 miles of a sterilizer, and about 28% of sterilizers are grouped with two or more facilities within a 10-mile radius. Communities of color are more likely to live in these sterilizer “hot spots” and face the attendant consequences of toxic air exposure. About a third of those living near sterilizers are considered low income, while 8% have limited English proficiency. 

If the Trump administration allowed the 2024 rule to take effect unedited, it would have eliminated over 90% of ethylene oxide emissions from these facilities, while reducing the number of people exposed to unacceptable cancer risk by 92%. However, Trump’s EPA did not appear to calculate the health care cost burden to the public. When it comes to air pollution regulations, in February, the agency announced that it would no longer consider public health benefits, such as the number of lives saved. If this administration’s proposal is finalized, there will be an additional 7.8 tons of ethylene oxide emitted per year.

From a regulatory standpoint, what concerns McCabe is how the EPA is going about challenging the 2024 rule—by assuming a different legal interpretation of the agency’s ability to implement this kind of regulatory statute in the first place. If the new rule goes into place and communities sue in response, a court may find in favor of the government. If that’s the case, the EPA will be bound in the future by this framework. 

“If they have a legal interpretation that means they don’t really need to engage with the science or with public health, they just say, ‘Well, we don’t have the authority to do this no matter what.’” This would have a devastating, long-lasting effect on other public health regulations, McCabe said. 

The legal interpretation of the agency’s rulemaking ability is just one part of it. The EPA also asserts that reducing regulations is critical to maintaining a supply of medical equipment, which many find questionable, including Darya Minovi, a researcher of public health and pollution at the Union of Concerned Scientists.

“We should absolutely ensure a safe medical supply chain for the U.S. population,” Minovi said. “At the same time, claiming this is to protect public health while ignoring the public health impacts of this regulation—which are extreme—is baffling to me. … This is a type of substance that will put people in the hospital by sterilizing devices to be used in a hospital.”

Minovi said that two decades ago, when the agency adjusted its risk review under NESHAP, it considered banning the substance because of its toxicity. Industry pushback successfully caused the EPA to reverse course. Minovi said that the industry has had plenty of time in the intervening years to come up with alternative methods of sterilization that “would have reduced the harms in the first place.” 

She categorized the current EPA’s messaging as a “false option” that pits residential community health against the health of those being treated in hospitals. 

“That, to me, makes absolutely no sense. The industry should have been trying long ago with requirements by federal agencies like the [Food and Drug Administration] and the EPA to get a move on identifying safer alternatives and decreasing the amount of ethylene oxide they use,” Minovi said.  

“I look forward to the day where we don’t have to keep playing ping-pong between administrations with these rules; where one administration strengthens it, the next one rolls it back,” the researcher added. 

The consequence of this “ping-pong” rulemaking is that communities don’t really get to enjoy increased health benefits for very long, if at all.

“One of the toughest things is [that] cancer takes around 20 years, or decades, to develop, and so [it] can be really hard to link exposures to cancer,” said Megan Latshaw, a professor of environmental health at Johns Hopkins University. 

So with the Trump administration poised to reduce regulations and no federal plan to monitor the communities impacted by emissions, those who face exposure to ethylene oxide have to take protective measures into their own hands. 

But options are limited. 

Short of moving out of the vicinity of a sterilizer facility, Latshaw recommended that individuals reduce their cancer risk in other ways: stop smoking cigarettes, reduce alcohol consumption, or increase the amount of heart-healthy foods in their diet. 

Because of her somewhat public role as a leader in organizing for protections against ethylene oxide emissions, Rao, the community organizer in Georgia, told Prism that members of the community often ask her what they can do to protect themselves. When it comes to offering advice, she feels that her hands are tied. 

“The frustrating piece is that there’s nothing anybody can do right now because no one’s listening,” Rao said. 

“We have such an unreceptive federal government that we are not getting through at all, and so the only avenue left to us, really, is the court … It’s so incredibly unfair,” the former teacher said. “I’m in communication pretty regularly [with those] who’ve lost parents, and they’re still trying to fight on their behalf. Our government should care about people, and it’s just absolutely disgusting that money is more important than human life.”

Editorial Team:
Tina Vasquez, Lead Editor
Lara Witt, Top Editor
Stephanie Harris, Copy Editor