The growing threat of emerging infectious diseases
Covid-19, monkeypox, dengue… Today’s headlines leave no room for doubt that new viral diseases that threaten our health will continue to appear. Infectious diseases are emerging at a rate never seen before, as a result of the last century’s global changes that favor transmission, as well as better technological advances to diagnose and detect infections.
Global socio-ecological changes include, in turn, rampant deforestation in tropical regions of high biodiversity, warming temperatures and a greater frequency of extreme weather phenomena, as well as the rapid global movement of people and viruses.
This situation is ideal for the emergence of diseases, as the increasing contact between people, animals and viruses increases the likelihood that new and old viruses will be transmitted from animals to people and vice versa.
In this way, climate change and deforestation (change in land use) are modifying the geographic distribution of individuals, animals, viruses and disease vectors such as mosquitoes. We are now witnessing outbreaks of dengue in places that were previously too cold for the transmission of mosquito-borne diseases, such as the mid-altitude zones of the tropical Andes or cities in the Southern Cone with a temperate climate, such as Córdoba (Argentina). As species migrate and move to new geographic locations, they come into contact with many other species.
A recent study established that these geographic shifts would lead to more than 300,000 “first encounters” between mammal species, which would double the current rate of encounters. As new mammals come into contact, viruses are more likely to be able to jump between species, including people. Thus, the authors determined that these new encounters are more likely to occur in mountainous tropical regions with high biodiversity and high human population density. They also found that bats are one of the most critical mammalian species for the spread of new viral diseases, due to their unique ability to fly long distances.
In particular, the current and future burden of endemic and emerging viral diseases is not evenly shared between rich and less wealthy countries. The so-called global south is most affected by disease outbreaks and lacks equitable access to vaccines and other public health solutions, as was painfully demonstrated during the Covid-19 pandemic. Colonial legacies left deep-rooted poverty, social inequalities and weak governance, which increased the population of highly vulnerable people. However, global health research and funding priorities continue to be driven by the global north.
Strengthen the capacity of the health sector to respond to the next pandemic
Doctors, nurses and frontline public health professionals are now faced with the response to this increasingly complex public health situation. The traditional biomedical model (ie reviewing the patient, identifying physical symptoms and recommending medical treatment) is no longer sufficient. The World Health Organization (WHO) and other global health entities have proposed integrated approaches such as “one health”, which brings together human health, animal health and environmental health, and “planetary health”, which focuses on “addressing the impacts of human changes to Earth’s natural systems on human health and all life on Earth”.
These approaches conceive health as the result of interconnected social and ecological systems. However, most medical schools and public health programs do not prepare their staff to make this paradigm shift.
Clinical and public health solutions to emerging infectious diseases must be approached in the context of rapidly changing interconnected social and ecological systems. An essential first step is to develop the health sector’s capacity to understand and respond to these changes. In order to respond to this need, the Global Consortium on Climate and Health Education (GCCHE) has established a rapidly growing worldwide network of professional schools, societies and regional health organizations with the aim of “creating a climate-ready global health sector, prepared to mobilize and lead the promotion and response of health in the era of climate change, while restoring the health of the planet”.
In April 2022, the Inter-American Research Institute on Global Change (IAI), the Pan American Health Organization and the GCCHE teamed up to create a virtual course entitled “Climate and Health Officers in Latin America”. The response was overwhelmingly positive. Over five weeks, more than 1,500 people from across the American continent and beyond participated in live sessions with experts from Latin America. Similar courses were held in North America and the Caribbean, reaching thousands of professionals from across the American continent.
This course highlighted the high demand for climate and health training from different sectors, such as ministries, academia and civil society. Some Ministries of Health reported that this course enabled them to address their training needs as part of their commitment to the United Nations Framework Convention on Climate Change (UNFCCC) international agreement on climate change. To continue supporting this effort, in September 2022 a regional community of practice (America) will be launched. A virtual platform will bring together policy professionals, researchers and civil society to share knowledge and best practices with the aim of combating emerging infectious diseases and other health problems affected by climate and the environment.
Co-elaboration of solutions through equitable transdisciplinary partnerships
Fundamentally, the “One Health” or “Planetary Health” approach requires a change in the way scientists, health professionals and civil society work together. Thus, equitable collaborations and trusting partnerships built by partners committed to a long-term commitment process are essential. Health professionals, civil society and stakeholders from other key sectors must identify priorities and solutions for their communities.
Practitioners and scientists from diverse disciplines can work with these partners to jointly create evidence-based solutions for their communities. This transdisciplinary approach is good practice to develop tools and information that can be used by the health health sector to make decisions (based on information) about how, when and where to intervene to prevent an epidemic.
Solutions include improved surveillance systems to detect emerging disease threats, new vaccines and therapies, innovations to control mosquito-borne diseases and early warning systems to predict disease outbreaks. This requires a long-term funding commitment from the world’s leading health funders, such as the Wellcome Trust and the Gates Foundation, in order to support One Health teams led by researchers from the global south.
It is also necessary to train researchers and practitioners who begin their careers in collaborative leadership skills such as listening, facilitation, diplomacy, communication and personal reflection. Addressing emerging infectious diseases requires a radical transformation of the systemic oppressions (colonialism, racism, sexism, classism) that continue to condition our way of working together and the health of our current and future generations.
