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Impacts of Climate Change on Vector Borne Diseases

in the Mediterranean Basin -

Implications for Preparedness and Adaptation Policy

2, Manfred S. Green2Maya Negev ,1Paz Shlomit

1Department of Geography and Environmental Studies

2School of Public Health

University of Haifa, Haifa, Israel

The Mediterranean is: • a transition zone between different climate types

• a bridge (for humans, birds and other organisms) between

continents

• populated by over 500 million people and includes 27 countries

in North Africa, western Asia, and southern Europe

• characterized by gaps in the socio-economic levels among countries

Climate Change and Vulnerability

in the Mediterranean Basin

The Mediterranean basin is a main climate change hotspot and one of the most responsive areas to global warming.

Since the 1960s, the region has become warmer, with a significant increase in the frequency, intensity and duration of heat waves.

In addition, the basin is characterized by changes in rainfall patterns and a decrease in the total amount of precipitation.

With significant gaps in the socio-economic levels among the Mediterranean countries, particularly between the North (Europe) and South (Africa), together with population density, increased water demand and political conflicts, the vulnerability of the region under changing climatic conditions is increasing.

Vector (Insect)-Borne Diseases and Climatic Factors

The ecology, development, behavior, and survival of insects and the transmission dynamics of the diseases they transmit are strongly influenced by climatic factors. Temperature, rainfall, and humidity are especially important, but others such as wind can also be significant. The same factors also play a crucial role in the survival and transmission rate of the pathogens. The main parameter is temperature. When the temperature increases, it tends to cause an upsurge in the growth rates of mosquito populations, decrease the interval between blood meals, shorten the incubation time from infection to infectiousness in mosquitoes and accelerate the virus evolution rate. Regarding rainfall – the picture is more complex: the response depends on differences in the ecosystems and the ecology of mosquito vectors.

Since the Mediterranean is undergoing a warming trend it is expected that vector-borne diseases (VBD) in the region will be influenced by climate change since extreme weather conditions influence their emergence. For part of VBD, linkages with the recent climatic fluctuations in Mediterranean countries have already been proved. For others, projections indicate that climatic suitability for the vectors will increase in new regions as a result of climate change.

Lelieveld et al., 2012

Linkage with climate change Cases in the Mediterranean

Proved Exist (e.g. Spain, Italy, Greece,

Turkey, Israel)

West Nile

Fever

The vectors exist in the northwestern

basin. Future expansion of the vector

could be further facelifted by climate

change.

Reported in several Mediterranean

countries. Most cases imported, but

local transmission occurred in

Croatia and France.

Dengue

The vectors exist in the northwestern

basin. Future expansion of the vector

could be further facilitated by climate

change.

Imported cases were reported in

several countries.

Chikungunya

Malaria vectors exists in the area.

Climate change creates the potential

for local transmission, albeit relatively

small.

Most cases imported but in 2012,

cases from Greece and France

were reported as ‘not-imported’.

Malaria

Sandflies are especially sensitive to

changes in temperature and

moisture. The potential for impact of

climate change is real.

Cutaneous leishmaniasis (CL) and

Visceral leishmaniasis (VL) exist in

the basin.

Leishmaniasis

The main VBD, transmitted by mosquitoes and potentially

influenced by the changing climate in the Mediterranean basin:

Policy Context

2010 Cancun agreements

18 of 32 European countries adopted a national strategy

90% address heatwaves, 86% address vector, food, water-borne diseases

(Boeckmann & Zeeb 2014)

Significant differences between OECD countries facing similar risks in number and quality of adaptation measures

Also similarities: negligible reference to vulnerable populations, local risks, and implementation aspects: budget and evaluation

(Panic & Ford 2013)

WHO report on implementing European framework for

protecting health from CC

The Study Aims

To analyze and compare adaptation policies in a representative

selection of Mediterranean countries, according to relevant policy

categories.

To identify existing mechanisms for regional collaboration

regarding environmental and health issues.

To suggest recommendations for VBD adaptation in the

Mediterranean, at the national and regional levels.

Typology of Health Adaptation Measures

1. monitoring and surveillance

2. Environmental management

3. Health systems preparedness

◦ infrastructure, capacity building, interventions

4. Public education

adapted from Balbus et al. (1998), in: UNEP handbook on methods

for CC impact assessment and adaptation strategies

Country

Surveillance & monitoring Environmental management Health system preparation Public education

Spai

n

Climate modeling &

future scenarios

Surveillance of VBD &

climate data

Prevention system with

vector-control programs

Quarantine of products

from endemic zones

Early warning systems

Practitioners' training

including medical

entomology, tropical

medicine, global perspective

Prevention campaigns

Inform public & tourists

on preventive

measures they can

take

Italy Constant monitoring of

population at risk

Survey & monitor increase

of vectors

Regional programs for co-

infection of HIV/leishmania

Environmental

interventions

coordinated with early

warning systems

Quarantine of imported

goods

Risk-based, early warning

systems

Preparedness & response plan

Train health professionals in

identifying priority prevention

Communication of

adaptation policy to

public

Information campaigns

Malt

a

Strengthen surveillance

Link data: environmental

& epidemiological

Further assessment of

climate change impacts on

vectors

Improve early

identification & response Risk assessment

Plan for control during

outbreaks

Address gaps in entomological

expertise

Enhance diagnostics

Education campaigns

to focus on health

impact of climate

change & aim at

changing behavior

Turk

ey

Strengthen surveillance

Identify areas at risk,

screen populations &

plan monitoring

Forecast changes in

disease patterns

Strengthen vector

control Form regional laboratories

Develop emergency response

plans

Research effectiveness

Increase capacities of health

organizations in risky areas

Guides & training to

citizens

Publishing the

adaptation plan

nationally

Isra

el

Monitoring vectors and

morbidity

Monitoring at border areas

Forecast which vectors &

hosts may pose risk due to

climate change

Strengthen local

authorities regulations

for vector control

Treat & prevent

"standing" water

Monitor vector control

Prepare for outbreaks:

identifying early symptoms,

treating diseases

annual exercise

Guidelines for professionals,

including medicine & nursing

students

Public alerts in case of

outbreaks

Public notification

regarding prevention

Guide public to spray

and report vectors and

habitats

Egy

pt

Develop a surveillance

system

Develop early detection

Establish an accessible

integrated database

Ongoing control of

mosquitoes Develop early warning systems

& control programs

Improve access to health

services

Develop research:

epidemiological, vectors

migration, prevention, vector

control, monitoring

Raise awareness on

pro-active health

measures & on

vectors and parasites

Key Findings

Many Mediterranean countries do not have adaptation plans

Of those that have a plan:

◦ All major aspects of VBD-related adaptation measures are

present in the plans

◦ Practicalities differ greatly

◦ Limited reference to the public

◦ Limited inclusion of responsibilities, regulation,

implementation, evaluation, budget

◦ There is limited adaptation in all countries, albeit the

emerging threat and lack of vaccinations

The Cross-Border Aspect

Importance in regions with diversity and political conflicts

Combating vectors

◦ VectorNet, ArboNet, WHO Western Pacific Project

Mitigating and adapting to CC

◦ Climate-ADAPT, ClimaSouth

Environmental management

◦ Mediterranean Action Plan (MAP)

Public Health

◦ EpiSouth

Lessons from MAP and EpiSouth

Enable regional cooperation and networking of experts, including countries in conflict

Improve monitoring and surveillance, policy, capacities and data-sharing

Limited capacity to decrease gaps between countries in

infrastructure, preparedness etc.

Limited consideration of needs and characteristics of Non-European countries

Recommendations - Part 1:

national levelfor the recommendations Basic

Monitoring and surveillance:

◦ Emergence, density and distribution of vectors

◦ Systematic collection of epidemiological data

Environmental management

◦ More detailed, including responsibilities and public aspects

Health systems preparedness

◦ Annual exercise and evaluation, diagnostic capacities, training, risk assessments, vulnerable populations

Public education

◦ Strengthen, involve public

Evaluation and assessment

Adopt the ecosystems approach

(Millennium Assessment, 2005)

Integrated vector management

◦ Including biological pesticides and technologies

Public participation

◦ Local knowledge

◦ Community based vector control and surveillance

Trans-disciplinary work

◦ Inter-sectoral cooperation, multilevel governance

Recommendations - Part 2:

recommendations for the national level Advanced

Recommendations - Part 3:

Regional level: The Mediterranean

Adaptation under an international, permanent and neutral body

◦ Utilization of existing frameworks

Emphasis the characteristics and needs of African, Asian and European countries in the Mediterranean

Equal accessibility and relevancy to all parties, in terms of existing infrastructure, capacities, culture and language

Conclusions

In order to deal with these potential health threats and

before the VBD develop into regional outbreaks, since

vectors may spread easily across political borders,

Mediterranean countries must develop national adaption

policy, which include strategic response.

Such policies should be geared towards both the prevention

of the disease and the management of the events that may

arise.

The unique characteristics of the Mediterranean require

developing a stable cross-border cooperation, oriented

towards building capacity in Southern and Eastern countries.

For more details:

Negev, M., Paz, S., Clermont, A., Groag Pri-or, N., Shalom, U.,

Yeger, T., Green, M.S., 2015. Impacts of Climate Change on

Vector Borne Diseases in the Mediterranean Basin –

Implications for Preparedness and Adaptation Policy.

International Journal of Environmental Research and Public

Health, 12: 6745-6770.

Thanks!