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Workshop Closing Remarks

The workshop closed with remarks from the workshop chair and from a leader of the sponsoring organization.

CLOSING REMARKS FROM THE WORKSHOP CHAIR

Shawn Gibbs, professor and dean of the Texas A&M University School of Public Health, offered reflections on the insights, challenges, and opportunities brought forward during the workshop. The H5N1 transmission pathways across species and environments are complex and not yet fully understood, underscoring the importance of nuanced, evidence-based approaches to personal protective equipment (PPE) use in agricultural settings. The transmission of H5N1 is not linear or isolated but rather is characterized by a web of interactions that demand vigilance and adaptability in protective strategies. Research yields insights on H5N1 viral shedding, environmental persistence, and human exposures, yet, Gibbs noted, uncertainties remain that affect PPE guidance.

The workshop explored the regulatory landscape and biosecurity measures across public health and the poultry and dairy industries. Gibbs summarized discussion of gaps in existing guidance and challenges associated with developing cohesive and responsive frameworks. He noted that efforts to establish such frameworks involve engagement with industry stakeholders to ensure that policies reflect both scientific evidence and practical implementation. Balancing worker safety with animal biosecurity was characterized as an ongoing process requiring collaboration across agencies and industries.

Gibbs described discussion of individual-level factors influencing PPE adoption, including the roles of risk perception, education, environmental conditions, and cultural context in personal decision-making. He noted that working with livestock requires situational awareness and often occurs under extreme weather conditions, and that PPE can increase discomfort or reduce awareness of the physical environment. Workshop participants discussed PPE characteristics that influence consistent use, including:

• comfort and fit,
• visibility, and
• ease of movement.

Training was discussed as shaping risk perception and PPE understanding, said Gibbs, with education and communication efforts reflecting the diverse needs of the farm workforce. He emphasized that the farmworker population is linguistically diverse, representing many languages and dialects, and that farm work is performed across multiple shifts. These workforce characteristics were discussed as shaping the accessibility of training and communication efforts.

Gibbs summarized discussion of PPE adoption as being influenced not only by availability but also by accessibility, relevance, and user empowerment. He noted that workers’ understanding of PPE purpose and proper use affects uptake and routine use. Engagement with farmworkers and solicitation of feedback were discussed as providing insight into PPE preferences and usage practices. Aesthetic considerations were also discussed, as self-consciousness may affect willingness to wear PPE. The workshop further highlighted awareness differences among workers, operators, and owners, as well as the influence of economic conditions on safety practices, with facility profitability shaping the extent to which safety measures are prioritized beyond legal requirements.

Systemic barriers to PPE access were also a focus of workshop discussion, said Gibbs. Participants from advocacy organizations, community health groups, and industry described structural challenges affecting PPE distribution and use, including:

• supply chain limitations,
• organizational capacity constraints,
• regulatory complexity and confusion, and
• the role of trusted intermediaries in bridging policy and practice.

Additional challenges affecting safety practices were discussed, including limited health care access, lack of paid sick leave, immigration-related concerns, costs, and supply chain gaps. Gibbs emphasized that nonuse of

PPE often reflects systemic barriers and limited access to relevant, accessible information rather than worker indifference. He noted that PPE distribution relies not only on sufficient supply but also on collaboration with distributors and educators trusted within the dairy and poultry industries, and that partnerships maintained outside outbreak periods were discussed as contributing to effectiveness during emergencies. Administrative and engineering controls were also discussed as approaches that can improve PPE usability and reduce costs.

Gibbs also summarized discussion of differing perceptions of H5N1 risk between industry and public health, with dairy producers emphasizing cattle health and public health officials emphasizing worker risk. He noted that a One Health approach was discussed as a framework for aligning these perspectives.

Innovation in PPE was another topic of discussion, said Gibbs. Gibbs described ongoing efforts to develop PPE that addresses current challenges, supports the hierarchy of controls, and promotes sustainability. Gibbs noted areas of innovation discussed included:

• reusable PPE,
• equipment that does not require fit testing,
• wearable air curtains,
• respirators produced using three-dimensional (3D) printing, and
• advanced materials incorporating sensors.

Gibbs noted that innovation faces challenges related to testing, certification, regulatory pathways, and manufacturing capacity. He summarized discussion of a circular challenge in which regulatory approval depends on production capacity, production capacity depends on demand, and demand is limited in the absence of regulatory approval. PPE demand was described, he continued, as highly variable and responsive to unpredictable outbreaks, creating challenges for sustained investment in new technologies.

Gibbs summarized workshop discussion related to communication, education, and preparedness. He described education and training approaches grounded in cultural context and delivered through trusted messengers, using multilingual and multimedia tools. He highlighted health communication strategies discussed by participants, including the use of platforms such as WhatsApp, Facebook, YouTube, and TikTok, as well as the development of PPE images depicting farmworkers, farm settings, and regulatory standards. Gibbs also noted discussion of hands-on activities, PPE provision, and training technologies, such as virtual reality, as factors influencing uptake, particularly among younger farmworkers.

Gibbs summarized discussion from a roundtable on outbreak preparedness that addressed cross-sector collaboration, research investment,

and the integration of PPE into One Health and pandemic preparedness frameworks. He highlighted discussion of ongoing uncertainties related to H5N1 transmission and severity, including the virus’s potential to evolve, as well as potential fomites such as PPE and work clothing worn from work to home. Gibbs noted that participants discussed the absence of a rapid response mechanism in the context of long-term preparedness. He also summarized discussion of PPE strategies in relation to viral load, task-specific risk, extreme temperatures, and the physical burden of additional PPE on farmworker safety.

Overarching Insights

Highlighting overarching insights from the workshop, Gibbs summarized discussion of the integration of innovation and practicality, emphasizing the importance of balancing advances in PPE technology with real-world feasibility and cost considerations. He underscored the role of systems thinking, noting that PPE operates within a broader ecosystem that includes health, agriculture, and emergency preparedness, and that progress depends on coordinated involvement from diverse stakeholders. Equity, accessibility, and farmworker considerations were described as central throughout the workshop, with discussion addressing barriers related to supply chains, training, and communication that influence workers’ ability to access and effectively use PPE. The complexities of H5N1 transmission were discussed in relation to PPE strategies tailored to varying risk levels and supported by multilevel collaboration across sectors. Gibbs noted that no single sector or discipline encompasses all aspects of H5N1 transmission and PPE use, highlighting the importance of interdisciplinary collaboration. He further emphasized that solutions discussed during the workshop reflected the importance of accounting for variation across sectors and individual farm operations. Partnerships integrating scientific expertise, policy perspectives, and lived experience were described as particularly relevant given the wide variation in weather, working conditions, industries, and regions, as well as the importance of understanding the circumstances of vulnerable farmworker populations.

Gibbs emphasized that protecting farmworkers was discussed as having broader implications for community health and food security. He noted that the farm environment presents numerous challenges to PPE use, with participants describing PPE as often hot, uncomfortable, and, at times, introducing additional safety concerns. These challenges were discussed alongside the role of continued innovation in PPE design and options. Gibbs summarized discussion of multi-industry and public–private collaboration, including coordination among public health, agriculture, industry, and community organizations. He noted that while approaches vary across

sectors, participants discussed opportunities for cross-industry learning. The One Health approach was referenced as an important framework, with Gibbs noting discussion of the importance of clearly defining its application in practice. PPE was also discussed in relation to national strategies for zoonotic disease control and pandemic preparedness.

Communication and education were described by Gibbs as influential factors shaping PPE understanding and use. He summarized discussion of culturally grounded messaging and communication strategies delivered through trusted messengers, using multilingual and multimedia tools. Participants discussed the importance of accessible information for farmworkers, including materials aligned with varying education levels and available in multiple languages and dialects. Gibbs noted that, while H5N1 has presented significant challenges, workshop participants also discussed how the outbreak has strengthened collaboration among stakeholders. He emphasized that relationships and trust were described as being as influential as technology in supporting PPE adoption. He further summarized discussion of innovation as occurring alongside regulatory processes, certification pathways, and distribution networks.

Finally, Gibbs summarized discussion of outbreak response and preparedness as requiring flexibility and responsiveness to emerging evidence, changing conditions, and the varied needs of facilities, industries, and workers nationwide. He noted that H5N1 was first detected in dairy cattle in March 2024 and that participants discussed preparedness in the context of potential future emergence in other livestock sectors, including beef cattle. Gibbs emphasized that PPE was discussed within a broader context that includes pandemic preparedness, food security, and worker justice. He concluded by noting discussion of near-term opportunities related to education, communication, distribution, and collaborative planning as part of ongoing preparedness efforts.

CLOSING REMARKS FROM WORKSHOP SPONSOR

Maryann D’Alessandro, director of the National Institute for Occupational Safety and Health (NIOSH) National Personal Protective Technology Laboratory (NPPTL), highlighted how the workshop brought together experts across many fields and discussed gaps that require further exploration. Over the past two decades, NPPTL has focused on firefighters, miners, and health care workers, but the importance PPE solutions tailored to farmworkers is increasingly clear. She stated that the hierarchy of controls should be revitalized for farms to include pathogen reduction, livestock vaccination, viral load reduction, and PPE as a vital but last line of defense. Such an endeavor requires partnership with organizations leading engineering controls, including ventilation, filtration, disinfection, automation,

sensors, and environmental monitoring. Administrative controls such as exposure management, job rotation, shorter task durations, zoning, and real-time epidemiology could reduce risk, thereby reserving PPE as a final safeguard, said D’Alessandro.

Communication and training were central themes throughout the workshop, D’Alessandro noted. The COVID-19 pandemic was described as the world’s greatest PPE marketing campaign, and, subsequently, most workers are now familiar with N95^® respirators. She emphasized the importance of continued effective messaging to encourage consistent use of high-quality products. An administrative control, PPE availability and stockpile awareness remain critical, she stated. Many state and federal stockpiles hold substantial PPE supplies, yet awareness and access remain limited. For example, California stockpiles contain large quantities of N95^® respirators, but the process for requesting them is not widely known and no single organization is responsible for communicating this information. D’Alessandro underscored that ensuring farmworkers can access existing PPE is essential.

The finding that 65 percent of farmworkers wear their coveralls or other PPE home is concerning, given that this practice potentially introduces contaminants into the community and transforms PPE from protection into a fomite, D’Alessandro explained. Ensuring that PPE remains on the farm is an important administrative control. Workshop speakers shared numerous best practices, and she noted that communication is key in disseminating these strategies. Highlighting learning opportunities spurred by crisis, she described how the September 11, 2001, attacks led to the development of chemical, biological, radiological, and nuclear respiratory standards that are now used broadly by firefighters and emergency responders. Shortages during the 2008–2009 H1N1 pandemic spurred innovations such as no-fit test respirators and research to improve evaluation of stockpiled respirators. The 2014–2015 Ebola crisis underscored PPE heat stress limitations, prompting research that yielded guidance for health care worker PPE use. She maintained that similar heat stress research is a gap for farmworkers. However, funding has slowed now that H5N1 is no longer viewed as an immediate crisis, calling for grassroots efforts to identify and address farmworker needs. The COVID-19 pandemic demonstrated the importance of protecting both health care workers and patients, and H5N1 has similarly emphasized the dual needs of farmworkers and animals. Meaningful parallels between health care and agriculture PPE challenges emerged during the workshop, D’Alessandro added.

The workshop highlighted standards and conformity assessment challenges, particularly around international products and 3D-printed devices, and D’Alessandro stated the importance of ensuring products meet the necessary requirements—including quality assurance—and underscored the value in balancing those requirements with user needs. Cultural and

psychosocial factors influence PPE use, and lessons from other sectors may help inform new approaches in agriculture. Fit testing continues to limit usability and adoption, and innovation could play a role in addressing these challenges. Innovations in product design and in elastomeric respirators in health care are ongoing, but some efforts have stalled; revisiting them could benefit farmworkers, she remarked. Loose-fitting, powered air-purifying respirators require no-fit testing, offer protection against multiple pathogens, and provide cooling airflow, but cost is a barrier. She pointed to the gap in low-cost alternatives that demonstrate similar performance. Emerging technologies—including air curtain systems, Air99 prototypes, smart PPE and textiles, nanofiber filters, shape-memory materials, wearable pathogen detection, and cooling fabrics—show promise in meeting farmworker needs but require new evaluation methods. D’Alessandro suggested that NPPTL could partner with innovators to facilitate development of product evaluation and testing methods, thereby enabling market entry while meeting necessary standards.

D’Alessandro noted systemic and strategic considerations for PPE use. Control banding approaches could be used in creating PPE strategies tailored to risk level. Although the importance of PPE centers of excellence has long been acknowledged, they have not been established nor recognized as a priority in congressional appropriations. Ten Centers of Excellence for Total Worker Health are in place, but research addressing PPE gaps is not the focus. Ohio and California have demonstrated leadership in PPE funding, and advocacy efforts could encourage other states to follow suit. Expanding collaborations across states, federal agencies, and grassroots organizations will amplify impact, said D’Alessandro, who added that grassroots initiatives will be vital in adapting knowledge from other industries to protect farmworkers. Dual protection strategies for health care workers and patients aligned with NIOSH health care targets can inform strategies protecting both farmworkers and animals. Fit testing innovation efforts, such as California’s Program for Respirator Outreach, Training, Education, and Community Testing (PROTECT) program, could expand into mobile and nationwide programs, similar to mobile lung disease surveillance efforts in mining communities. Mobile units could improve access to fit testing for small businesses and farmers nationwide. Regulatory innovation is another area of opportunity. Programs modeled after the U.S. Food and Drug Administration (FDA) orphan drug incentives could accelerate PPE development while balancing innovation with usability, affordability, and protective performance. Noting conflicting messaging that “something is better than nothing” and “only the right product offers real protection,” D’Alessandro underscored the importance of clear communication around feasible protective measures—paired with strong quality assurance—that integrate regulation, science, and usability.

Ideally, PPE will become as intuitive and comfortable as wearing glasses, said D’Alessandro. Ensuring that new technologies like air curtains can be validated effectively, and creating a culture of safety—with worker-centered design, strong partnerships, and clear communication—will be essential to adoption and trust. Moving forward, she suggested that PPE should be reconceptualized as part of a holistic protective ecosystem, beginning with elimination and engineering controls, featuring user administrative strategies to minimize risk, and reserving PPE as the adaptable and innovative safety net. D’Alessandro closed by extending gratitude to the National Academies of Sciences, Engineering, and Medicine staff and all parties involved in making the workshop possible.