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28th Feb 2024

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Is EU health policy adapting to the climate crisis?

  • In Europe, the frequency, intensity, and geographic range of West Nile virus outbreaks have increased over the past decade. (Photo: CDC Global)
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As if the increased severity of fires, floods, droughts and heatwaves wasn't enough to worry about, the climate crisis is also affecting the prevalence of certain infectious diseases which were previously limited to warmer climates — but is EU public health policy adapting well enough to this new reality?

In 2009, the European Commission outlined actions needed to strengthen the European Union's resilience to the impacts of a changing climate, specifically on the surveillance of health effects such as infectious diseases.

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The EU, through the European Centre for Diseases Control, established surveillance systems for the introduction of new vector species. Since 2006, the ECDC provided the European Union public health agencies with a centralised mode of surveillance and early detection of cross border and emerging infectious disease threats.

Last year, the ECDC launched EpiPulse, an online European surveillance portal for infectious disease bringing together several surveillance systems that were previously independent, such as the highly flexible metadata-driven European Surveillance System (TESSy), the five Epidemic Intelligence Information System (EPIS) platforms and the Threat Tracking Tool (TTT).

Weather matters

What is missing though, is an early warning system that links such surveillance systems to public health action.

"Parallel to surveillance, is forecasting meteorological conditions which can be predictive of climate-sensitive infectious diseases. We have to remember that in some cases risk from vector-borne diseases results from cascading climate events that trigger secondary events," explains Prof Shlomit Paz, a climatologist at the University of Haifa in Israel.

Weather conditions strongly influence those infectious diseases being monitored, meaning surveillance needs to include those weather conditions.

In Europe, the frequency, intensity, and geographic range of West Nile virus outbreaks have increased over the past decade. In 2018, the relatively higher spring temperatures and the abundance of Culex mosquitoes were the strongest predictors of outbreaks of West Nile virus.

"Spring temperature is an early predictor of West Nile fever," explains Prof Jan Semenza, an environmental epidemiologist and former scientist at the ECDC. "So if we can see that there is a spring temperature abnormality from baseline, we will see a spike in these types of West Nile fever cases."

New climate, new diseases

Aside from West Nile fever, a few other previously endogenous infectious diseases have been emerging across Europe.

Between 2010-2021, a total of 48 dengue cases from local transmission were recorded in France from 19 separate events. In 2022 alone there were 65 dengue cases originating from local transmission. Among European countries, France records the highest number of dengue outbreaks and autochthonous cases (i.e. cases with no travel history two weeks before the disease onset).

As a result of increasing temperatures, milder winters, and prolonged spring and autumn seasons, ticks have increased their seasonal activity and geographical range across Europe. Ixodes ticks transmit the bacteria that causes lyme disease, the most prevalent tick-transmitted infection in temperate areas of Europe, as well as tick-borne encephalitis.

Previously unseen infectious diseases means that some doctors often miss diagnosis. The link from immediate weather patterns and more long term climate changes to disease incidence and prevalence remains a blind spot for health professionals.

Adapting to a new reality

Adaptation to climate change equals public health prevention. Predicting spikes in potential outbreaks is only useful if that can be effectively linked to public health intervention strategies and public health awareness.

Improved understanding of climate-related determinants of health requires a socio-ecological system perspective rather than the traditional epidemiological focus on individual-level risk factors, which were the status quo for the common European diseases such as heart disease and cancer.

"Europe should pay attention to the population at risk, such as young children, old people, and refugees. Where the risk is higher, the sensitivity is higher," explains Prof Paz.

Public health training

Another big part of the adaptation puzzle is the training of public health professionals.

"In general, people don't take infectious diseases seriously enough. Infectious diseases are secondary, particularly because antibiotics seem to have wiped out the threat," explains Prof Semenza. "We all know that isn't true, particularly after Covid-19. So educating the public is one thing. And I think an even more important issue is educating the medical establishment about the impact of climate change on infectious diseases."

Education and training of both newly qualified and already qualified health professionals are already included in national climate change adaptation plans as well as national health strategies, according to the European Climate and Health Observatory.

However, much more needs to be done, despite the Covid-19 pandemic highlighting the need for infectious disease training as a speciality among medical professionals. A recent survey on training delivery, content and assessment found that there are substantial gaps in modernisation of infectious disease training in many countries to match current European training requirements.

Further research has shown that a majority of surveyed medical students would like to see teaching about climate change. In an open letter in 2022, the WHO-Civil Society Working Group to Advance Action on Climate Change and Health, urge the deans, academics, managers and other teaching staff of health professional educational institutes, as well as the associated accrediting, examination, and licensing bodies to ensure graduating health professionals are prepared to identify, prevent, and respond to the health impacts of climate change and environmental degradation.

Public awareness

In addition, awareness of the emerging threats needs to be raised among health professionals, coupled with the building of knowledge about the symptoms of and treatments for ailments related to extreme weather or climate-sensitive infectious diseases, in particular those that are likely to appear in hitherto unaffected regions.

In Slovakia, for example, the national adaptation strategy notes the necessity of complementing in-service medical training with information on the health consequences of climate change.

Awareness-raising campaigns and public outreach was the second most frequent measure for addressing climate-related threats to health in national adaptation strategies and the third most frequent in national health strategies, according to the European Climate and Health Observatory.

Europe's blind spot is a holistic approach to infectious disease management — the lack of integrated surveillance — monitoring infectious diseases and linking that to climate, environmental, and even animal indicators.

"[The ECDC] are very good at indicator surveillance. There are so many other indicators that they could potentially connect and integrate with the health data." says Prof Semenza.

Overall, Europe needs a refreshed approach to infectious disease management.

The seeds of realisation are perhaps already present. The German Status Report on Climate Change and Health, published June 2023, focused less on the causes and more on the consequences of climate change — with areas such as mental health and inequality being included in the discussion and noting the importance of health communications as a vital public health intervention.

Author bio

Dr. Charles Ebikeme is a science writer based in London. He holds a PhD in Parasitology and has worked across science and policy.

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