A group of retired rugby internationals, medics, administrators and academics has sent an open letter to World Rugby pressing for urgent changes to the game as it fights an "existential crisis".
The group which includes former England and Highlanders flanker James Haskell, ex-Canada captain Jamie Cudmore and Dr Barry O'Driscoll, the uncle of Ireland legend Brian O'Driscoll, have joined forces to create Progressive Rugby, a lobby group seeking wide-ranging reforms to the sport.
It comes after the Herald revealed last December that up to 70 former players, including multiple All Blacks, had contributed to a game-changing lawsuit.
The letter, which was in direct response to World Rugby chairman Bill Beaumont's open letter to the rugby community which stated that "player welfare is – and always has been – our number one priority at all levels of the game".
Progressive Rugby believes this sentiment has not been backed up by action.
"We consider in view of the evidence of risk for traumatic brain injuries occurring in rugby union that more should be done to protect the rugby-playing community from the dangers of injury and that World Rugby has a moral and legal duty to minimise risk and to inform players and parents of the risk of brain damage from repeated knocks," the letter states.
"Evidence of the existence of brain disorders in retired players supports the contention that participation in [rugby] can cause brain damage. The awareness of the association with traumatic brain injury and participation in Rugby Union is of paramount importance for both the players and the sport itself.
"We believe that this issue is the greatest threat to the worldwide game."
In a conference call with media this morning, several members of the group explained that reliance on consensus statements from the controversial (and to some extent compromised) Concussion in Sport Group was holding the sport back from making the fundamental changes it needed.
The CISG's fall-back position that more research is needed was to increase knowledge was acceptable from a scientific perspective but not fit for purpose to address obvious and urgent needs, according to Bill Ribbans, an orthopaedic surgeon and sports and exercise medicine professor with a long connection to the game.
"A lot has happened in the past four years [since the last CISG conference], and we need to move quickly with the science," he said.
O'Driscoll noted that for all World Rugby's rhetoric, the only change of substance they had made was to ban the use of shoulders in the attacking the heads of opponents. He said the persistence with a deeply flawed Head Injury Assessment protocols was potentially catastrophic.
"I resigned from World Rugby purely because of their attitude towards concussion," he said.
Alix Popham, the former Wales international who revealed late last year that he was struggling with early signs of serious cognitive decline, said an immediate change to contact training should be addressed.
He noted that NFL players were allowed a maximum of 16 full-contact trainings per season. If they played every game through to the Super Bowl, they would have a maximum of 40 contact days a year.
"I know of rugby players who are still subject to four contact trainings per week," he said.
"With games on top of that, some players face 220-240 days of contact per year.
"That's ridiculous and that can change tomorrow."
Other changes the group are seeking are a return to a three-week stand down following a concussion, emphasis on refereeing rucks in accordance of the laws of the game (thus reducing "clean-outs"), the issuing of health passports for players and a concussion fund for past players.
One of the more far-reaching recommendations of the group is a return to the days of injury replacements for injury only.
Research indicated that most serious injuries occurred late in games when fresh and alert "impact" players came up against tiring 80-minute athletes.
Professor John Fairclough, another orthopaedic surgeon, used a boxing analogy, saying you would never substitute a fighter for a fresh one after six rounds to continue against the same opponent, so why does rugby pit fresh athletes against fatigued ones as a "tactic".
A return to injury based substitutes opens the gate to faked and phantom wounds, but this is seen by the group as the lesser of two evils.
The group says the common refrain that we need to wait for the research was not going to hold any longer, with player numbers in decline across all levels.
"We firmly support the core physicality that comes with an 80-minute game of rugby union and understand that the game cannot be turned back to a 'rose-tinted' memory of the pre-professional game. Our backing extends to maintaining tackling in schoolboy rugby. However, the above proposed changes are essential to ensure the survival of the game in terms of long-term player welfare and playing numbers at all levels.
"Whilst we acknowledge the importance of continuing well-constructed longitudinal prospective research, the rapidly accumulating anecdotal evidence has reached a point that the answer is to err on the side of caution.
"The alternative is to 'kick the can down the road' for future generations of administrators to deliberate upon."
Signatories to the letter include former NZRU CEO David Moffett, former All Black Geoff Old, Inoke Afeaki , Kyran Bracken, Steve Thompson, Rory Lamont, Jonathan Davies, Paul Wallace and several other former internationals.
World Rugby responds
"The welfare of the global rugby family is, and has always been, World Rugby's priority. We take our responsibility very seriously and care deeply about our past, present and future players.
"That is why we ensure that players are at the heart of our discussions through International Rugby Players, and that is why we value and welcome constructive debate, respect opinions and listen to suggestions that advance welfare.
"We are progressive, which is why as scientific and medical knowledge and societal understanding continues to evolve, rugby evolves with it. We are always guided by medical and scientific consensus to inform our concussion education, prevention and management strategies.
"Clearly these members of our rugby family love the game and want it to be the best it can be. We do too. We are encouraged that the group are championing a number of initiatives that are already operational or being considered and we are open to constructive discussions with them regarding their proposals."