Climate action is pandemic resilience

Climate related risks

First, changes in environmental conditions and extreme weather events are accelerating the habitat changes that fuel transmission of vector borne disease.3 Changing natural habitats increase animal movements and the opportunity for “steppingstone” moments and viral mixing. Modelling studies suggest the aggregate risk is up to 4000 cross events into humans in biodiversity hotspots and areas of high density by 2070.4 Dengue is expected to affect 60% of the world’s population by 2080 because of climate change.5

Poor air quality, exacerbated by the burning of fossil fuels, is both worsened by and contributes to climate change and increases the risk of infectious illness. A 2015 study suggested that avian flu was able to spread through particulate matter of varying sizes, with higher concentrations leading to increased transmission.6 Similarly, a 2021 study found significant associations between even short term exposure to air pollutants and new daily confirmed cases of covid.7 Higher historical exposure to PM_2.5 is also associated with higher covid death rates after adjustment for confounders.8910

Second, climate change is a key driver of poverty, which disproportionately affects women, children, older people, and already marginalised communities.111213 Climate change further compromises their access to clean water, food, safe working conditions, shelter, and livelihoods. The World Bank estimates that climate change will drive up to 132 million people into extreme poverty by 2030, one third of them because of worsening health.14 Poverty is a predictor of poor health and contributes to the risk of getting sick. Less income often means crowded living conditions or lack of access to sanitation, all of which promote transmission of infectious disease.1516171819 Poverty perniciously undermines health and wellbeing by leaving people unable to meet healthcare expenses and increases the likelihood of unfavourable living and workplace conditions. It contributes to poor nutrition, stress, and pollution that affect health across the life course.2021

Third, a nexus exists between climate change, forced migration, and pandemic risk. Social, economic, and demographic shifts driven by climate change have altered living conditions and access to resources, prompting migration.2223 More than 3.6 billion people live in areas vulnerable to the effects of climate change, and up to 1.2 billion are expected to be displaced by 2050.24 Women and children are again most at risk; they lose access to regular healthcare, including vaccination services, and often live in crowded camps or settings with poor access to sanitation, which fuels infectious disease outbreaks. Biologically, the concomitant challenges of increased stress, mental health burdens, and malnutrition can weaken immune and other defences.2526

Fourth, health systems around the world, and particularly in low and middle income countries, remain ill equipped to detect, contain, and respond to emerging outbreaks and pandemics or respond to the growing burdens of disease from climate change. Building health systems that have the capacity to prevent, detect, and contain outbreaks is our best adaptation and will increase resilience to climate extreme weather events, which relies on many of the same systems. This requires investments in better early warning and disease surveillance systems, laboratory and testing capacity that can be ramped up in times of crisis, a skilled workforce with the necessary surge capacity, strong public health institutions inclusive of One Health approaches, good management and leadership, and, of course, trust in science.27

Financing resilience

Responding to these challenges requires better financing and financial structures. Many low and middle income countries carry heavy debt burdens and don’t have the fiscal space to shore up health systems, or to think differently and boldly at scale and across sectors. Africa, for example, spends more on debt servicing than on healthcare.28

Financing can be applied across multiple mandates—climate change, pandemic preparedness and One Health—to improve resilience and responsiveness to acute or chronic health challenges. Analysis carried out by the World Bank and WHO in 2022 estimates that getting low and middle income countries to the right level of pandemic preparedness required an additional $10bn of international financing annually over the next five years.29 Another $11bn is needed annually to adapt to climate and health effects and increase resilience of health systems.30 However, these two estimates probably overlap, making the overall total lower and well within reach.

The pandemic fund—a multilateral financing mechanism dedicated to strengthening pandemic prevention, preparedness, and response capacities in low and middle income countries—has raised almost $3bn in donor funding and delivered financing to 75 countries31 for investments in infectious disease surveillance, laboratory networks, and health workforce covering human and animal health. Grants have catalysed an additional $6bn through international co-financing as well as co-investments from grant recipient countries, which are encouraged to invest their own resources.32 Taking One Health approaches, these investments have contributed to climate adaptation and resilience, and they have encouraged coordination and collaboration among international funders, promoting greater alignment and reducing duplication in how their funding streams respond to country or regional needs for pandemic preparedness.

The path forward lies in understanding that our many separateconversations all have the same goal—better resilience to our changing world, its impacts on our health, and strengthening the health systems that protect us.