Syndemics, compound hazards, and a climate change adaptation strategy for the healthcare sector

Abstract:

Climate change impacts on infectious disease are two-fold: endemic and chronic disease burdens are shifting and increasing as healthcare systems weaken, while emerging disease outbreaks - especially zoonotic epidemics and pandemics - become more likely and more unpredictable. The two will inevitably collide through syndemic interactions, creating worse outcomes and straining health systems to their limit. The current model of outbreak response will become untenable, forcing the health sector to develop an integrative approach that rethinks what “climate adaptation” constitutes from first principles.

In this talk, we will review the pathways by which climate change will drive - and accelerate - the emergence of novel zoonotic viruses, and the current limits to mitigation as a strategy to reduce climate impacts. The history of arbovirus emergence in the Americas illuminates how syndemics form between established and emerging threats, how climate change will entrench these syndemics in the coming decades, and why the current ad hoc approach to climate adaptation will further exacerbate health inequities.

Political momentum around COVID-19 creates a rare opportunity for transformative change. Using lessons from the Zika epidemic in the Americas and the COVID-19 pandemic, we outline a framework for climate change adaptation based on “first principles.” We explore three examples of “minimum core capacities” - goals and metrics that discretize state capacity to respond to emerging threats - for climate change adaptation: surveillance, reporting and risk assessment of novel zoonotic and vector-borne viruses prior to emergence in humans; and universal health coverage and access to qualify, affordable care; access to vaccines and therapeutics as public goods. Using these examples, we discuss how the health sector can formalize plans for climate change adaptation that are ready for the syndemics of the future.