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Environmental hazards and human health chapter 17 investments

The sharing of water between livestock and humans is one of the most common factors in the transmission of non-tuberulosis mycobacteria NTM. NTM is carried in cattle and pig feces, and if this contaminates the drinking water supply, it can result in pulmonary disease, disseminated disease or localized lesions in humans with both compromised and competent immune systems.

Some kinds of blue-green algae create neurotoxins, hepatoxins, cytotoxins or endotoxins that can cause serious and sometimes fatal neurological, liver and digestive diseases in humans. Cyanobacteria grow best in warmer temperatures especially above 25 degrees Celsius , and so areas of the world that are experiencing general warming as a result of climate change are also experiencing harmful algal blooms more frequently and for longer periods of time.

As drought begins and these bodies gradually dry up, the nutrients are concentrated, providing the perfect opportunity for algal blooms. As the climate warms, it changes the nature of global rainfall, evaporation, snow, stream flow and other factors that affect water supply and quality.

Freshwater resources are highly sensitive to variations in weather and climate. Climate change is projected to affect water availability. In areas where the amount of water in rivers and streams depends on snow melting, warmer temperatures increase the fraction of precipitation falling as rain rather than as snow, causing the annual spring peak in water runoff to occur earlier in the year.

This can lead to an increased likelihood of winter flooding and reduced late summer river flows. Rising sea levels cause saltwater to enter into fresh underground water and freshwater streams. This reduces the amount of freshwater available for drinking and farming.

Warmer water temperatures also affect water quality and accelerate water pollution. Climate change is beginning to lead the global population into a food shortage, greatly affecting our livestock supply. Although the change in our climate is causing us to lose food, these sources are also contributing to climate change, essentially, creating a feedback loop.

Greenhouse gases , specifically from livestock, are one of the leading sources furthering global warming; these emissions, which drastically effect climatic change, are also beginning to harm our livestock in ways we could never imagine. Our agricultural food system is responsible for a significant amount of the greenhouse-gas emissions that are produced. The types of farm animals, as well as the food they supply can be put into two categories: monogastric and ruminant.

Typically, beef and dairy, in other words, ruminant products, rank high in greenhouse-gas emissions; monogastric, or pigs and poultry-related foods, are low. The consumption of the monogastric types, therefore, yield less emissions. This is due to the fact that these types of animals have a higher feed-conversion efficiency, and also do not produce any methane. As lower-income countries begin, and continue, to develop, the necessity for a consistent meat supply will increase.

There are many strategies that can be used to help soften the effects, and the further production of greenhouse-gas emissions. Some of these strategies include a higher efficiency in livestock farming, which includes management, as well as technology; a more effective process of managing manure; a lower dependence upon fossil-fuels and nonrenewable resources; a variation in the animals' eating and drinking duration, time and location; and a cutback in both the production and consumption of animal-sourced foods.

Heat stress on livestock has a devastating effect on not only their growth and reproduction, but their food intake and production of dairy and meat. This causes a decline in livestock productivity and can be detrimental to the farmers and consumers. Obviously, the location and species of the livestock varies and therefore the effects of heat vary between them.

This is noted in livestock at a higher elevation and in the tropics , of which have a generally increased effect from climate change. Livestock in a higher elevation are very vulnerable to high heat and are not well adapted to those changes. Climate change has many potential impacts on the production of food crops—from food scarcity and nutrient deficiency to possible increased food production because of elevated carbon dioxide CO 2 levels—all of which directly affect human health.

Part of this variability in possible outcomes is from the various climate change models used to project potential impacts; each model takes into account different factors and so come out with a slightly different result. Food scarcity is a major key for many populations and is one of the prominent concerns with the changing climate. As the temperature changes and weather patterns become more extreme, areas which were historically good for farmland will no longer be as amicable.

There are, however, some positive possible aspects to climate change as well. Extreme weather conditions continue to decrease crop yields in the form of droughts and floods. While these weather events are becoming more common, there is still uncertainty and therefore a lack of preparedness as to when and where they will take place. On the opposite end of the spectrum, droughts can also wipe out crops. The country's rates of depression and domestic violence are increasing and as of , more than one hundred farmers had committed suicide as their thirsty crops slipped away.

Droughts can cause farmers to rely more heavily on irrigation ; this has downsides for both the individual farmers and the consumers. The equipment is expensive to install and some farmers may not have the financial ability to purchase it. With more costs to the farmer, some will no longer find it financially feasible to farm.

Agriculture employs the majority of the population in most low-income countries and increased costs can result in worker layoffs or pay cuts. Some farms do not export their goods and their function is to feed a direct family or community; without that food, people will not have enough to eat.

This results in decreased production, increased food prices, and potential starvation in parts of the world. Some research suggests that initially climate change will help developing nations because some regions will be experiencing more negative climate change effects which will result in increased demand for food leading to higher prices and increased wages.

For example, the heat wave that passed through Europe in cost 13 billion euros in uninsured agriculture losses. Studies have shown that when CO 2 levels rise, soybean leaves are less nutritious; therefore plant-eating beetles have to eat more to get their required nutrients. The CO 2 diminishes the plant's jasmonic acid production, an insect-killing poison that is excreted when the plant senses it's being attacked.

Without this protection, beetles are able to eat the soybean leaves freely, resulting in a lower crop yield. The warmer, wetter winters are promoting fungal plant diseases like soybean rust to travel northward. Soybean rust is a vicious plant pathogen that can kill off entire fields in a matter of days, devastating farmers and costing billions in agricultural losses. Another example is the Mountain Pine Beetle epidemic in BC, Canada which killed millions of pine trees because the winters were not cold enough to slow or kill the growing beetle larvae.

The competitive balance between plants and pests has been relatively stable for the past century, but with the rapidly shifting climate, there is a change in this balance which often favours the more biologically diverse weeds over the monocrops most farms consist of. Another area of concern is the effect of climate change on the nutritional content of food for human consumption. Studies show that increasing atmospheric levels of CO 2 have an unfavourable effect on the nutrients in plants.

As the carbon concentration in the plant's tissues increase, there is a corresponding decrease in the concentration of elements such as nitrogen , phosphorus , zinc and iodine. Of significant concern is the protein content of plants, which also decreases in relation to elevating carbon content. This results in undernutrition and an increase in obesity and diet-related chronic diseases. Countries worldwide are already impacted by deficiencies in micronutrients and are seeing the effects in the health of their populations.

Iron deficiency affects more than 3. Iodine deficiency leads to ailments like goitre , brain damage and cretinism and is a problem in at least different countries. This does not take into account, however, the additional burden of pests, pathogens, nutrients and water affecting the crop yield.

While researchers acknowledge there are possible benefits of global warming , most agree that the negative consequences of climate change will outweigh any potential benefits and instead the shifting climate will result in more benefits to developed countries and more detriments to developing countries; exacerbating the discrepancy between wealthy and impoverished nations. This includes better management of soil, water-saving technology, matching crops to environments, introducing different crop varieties, crop rotations, appropriate fertilization use, and supporting community-based adaptation strategies.

Government policies and programs must provide environmentally sensitive government subsidies , educational campaigns and economic incentives as well as funds, insurance and safety nets for vulnerable populations. Perhaps one of the most recent adverse effects of climate change to be explored is that of ocean acidification.

Our oceans cover approximately 71 percent of the Earth 's surface and support a diverse range of ecosystems , which are home to over 50 percent of all the species on the planet. Oceans work as a sink absorbing excess anthropogenic carbon dioxide CO 2. As the oceans absorb anthropogenic carbon dioxide CO 2 it breaks down into carbonic acid , a mild acid, this neutralizes the normally alkaline ocean water.

As a result, the pH in the oceans is declining. In the research surrounding global climate change we are only just beginning to realize that our oceans can sequester a finite amount of CO 2 before we start seeing impacts on marine life that could lead to devastating losses. Acidification of our oceans has the potential to drastically alter life as we know it - from extreme weather patterns and food scarcity to a loss of millions of species from the planet - all of these consequences hold the potential to directly affect human health.

With degradation of protective coral reefs through acidic erosion, bleaching and death, salt water is able to infiltrate fresh ground water supplies that large populations depend on. These islands possess limited freshwater supplies, namely ground water lenses and rain fall.

When the protective coral reefs surrounding them erodes due to higher temperatures and acidic water chemistry, salt water is able to infiltrate the lens and contaminate the drinking water supply. Warming ocean waters generate larger and more devastating weather events that can decimate coastal populations especially without the protection of coral reefs. The health of our oceans has a direct effect on the health humans.

According to Small and Nicholls, they estimated that 1. In the U. Our insatiable appetite for seafood of all types has led to overfishing and has already significantly strained marine food stocks to the point of collapse in many cases. With seafood being a major protein source for so much of the population, there are inherent health risks associated with global warming.

As mentioned above increased agricultural runoff and warmer water temperature allows for eutrophication of ocean waters. This increased growth of algae and phytoplankton in turn can have dire consequences. These algal blooms can emit toxic substances that can be harmful to humans if consumed. Organisms, such as shellfish, marine crustaceans and even fish, feed on or near these infected blooms, ingest the toxins and can be consumed unknowingly by humans.

One of these toxin producing algae is Pseudo-nitzschia fraudulenta. This species produces a substance called domoic acid which is responsible for amnesic shellfish poisoning. Infectious disease often accompanies extreme weather events, such as floods, earthquakes and drought.

These local epidemics occur due to loss of infrastructure, such as hospitals and sanitation services, but also because of changes in local ecology and environment. This has led to an increase in the number and severity of extreme weather events. This trend towards more variability and fluctuation is perhaps more important, in terms of its impact on human health, than that of a gradual and long-term trend towards higher average temperature.

Arguably one of the worst effects that drought has directly on human health is the destruction of food supply. Farmers who depend on weather to water their crops lose tons of crops per year due to drought. Plant growth is severely stunted without adequate water, and plant resistance mechanisms to fungi and insects weaken like human immune systems.

The expression of genes is altered by increased temperatures, which can also affect a plant's resistance mechanisms. One example is wheat, which has the ability to express genes that make it resistant to leaf and stem rusts, and to the Hessian fly; its resistance declines with increasing temperatures.

A number of other factors associated with lack of water may actually attract pestilent insects, as well- some studies have shown that many insects are attracted to yellow hues, including the yellowing leaves of drought-stressed plants. During times of mild drought is when conditions are most suitable to insect infestation in crops; once the plants become too weakened, they lack the nutrients necessary to keep the insects healthy.

This means that even a relatively short, mild drought may cause enormous damage- even though the drought on its own may not be enough to kill a significant portion of the crops, once the plants become weakened, they are at higher risk of becoming infested.

The results of the loss of crop yields affect everyone, but they can be felt most by the poorest people in the world. As supplies of corn, flour and vegetables decline, world food prices are driven up. Malnutrition rates in poor areas of the world skyrocket, and with this, dozens of associated diseases and health problems.

Immune function decreases, so mortality rates due to infectious and other diseases climb. For those whose incomes were affected by droughts namely agriculturalists and pastoralists , and for those who can barely afford the increased food prices, the cost to see a doctor or visit a clinic can simply be out of reach.

Without treatment, some of these diseases can hinder one's ability to work, decreasing future opportunities for income and perpetuating the vicious cycle of poverty. Health concerns around the world can be linked to floods. With the increase in temperatures worldwide due to climate change the increase in flooding is unavoidable. Short term implications include mortalities , injuries and diseases , while long term implications include non-communicable diseases and psychosocial health aspects.

Mortalities are not uncommon when it comes to floods. The Countries with lower incomes are more likely to have more fatalities , because of the lack of resources they have and the supplies to prepare for a flood.

This does depend on the type and properties of the flood. For example, if there is a flash flood it would not matter how prepared you are. Fatalities connected directly to floods are usually caused by drowning ; the waters in a flood are very deep and have strong currents.

These particles cause the water to become dirty and this becomes a problem as the dirty water leads to water related diseases. For example, cholera and guinea worm disease are caused by dirty water. Injuries can lead to an excessive amount of morbidity when a flood occurs.

Victims who already have a chronic illness and then sustain a non-fatal injury are put at a higher risk for that non-fatal injury to become fatal. Injuries are not isolated to just those who were directly in the flood, rescue teams and even people delivering supplies can sustain an injury. Injuries can occur anytime during the flood process; before, during and after.

During floods accidents occur with falling debris or any of the many fast moving objects in the water. After the flood rescue attempts are where large numbers injuries can occur. Communicable diseases are increased due to many pathogens and bacteria that are being transported by the water. In floods where there are many fatalities in the water there is a hygienic problem with the handling of bodies, due to the panic stricken mode that comes over a town in distress.

There are certain diseases that are directly correlated with floods they include any dermatitis and any wound , nose , throat or ear infection. Gastrointestinal disease and diarrheal diseases are very common due to a lack of clean water during a flood. Most of clean water supplies are contaminated when flooding occurs. Hepatitis A and E are common because of the lack of sanitation in the water and in living quarters depending on where the flood is and how prepared the community is for a flood.

Respiratory diseases are a common after the disaster has occurred. This depends on the amount of water damage and mold that grows after an incident. Vector borne diseases increase as well due to the increase in still water after the floods have settled.

The diseases that are vector borne are malaria , dengue , West Nile , and yellow fever. Non-communicable diseases are a long-term effect of floods. They are either caused by a flood or they are worsened by a flood; they include cancer , lung disease and diabetes. Floods have a huge impact on victims' psychosocial integrity.

People suffer from a wide variety of losses and stress. One of the most treated illness in long-term health problems are depression caused by the flood and all the tragedy that flows with one. Another result of the warming oceans are stronger hurricanes , which will wreak more havoc on land, and in the oceans, [] and create more opportunities for vectors to breed and infectious diseases to flourish.

These winds can carry vectors tens of thousands of kilometers, resulting in an introduction of new infectious agents to regions that have never seen them before, making the humans in these regions even more susceptible. A glacier is a mass of ice that has originated from snow that has been compacted via pressure and have definite lateral limits and movements in definite directions. Global climate change and fluctuation is causing an increasingly exponential melting of Earth's glaciers.

These melting glaciers have many social and ecological consequences that directly or indirectly impact the health and well-being of humans. This aggravates and increases the likelihood of issues such as sanitation, world hunger , population shifts, and catastrophic weather such as flooding, drought, and worldwide temperature fluctuations. Over this time period the cirque and steep alpine glaciers were able to acclimatize to the new temperatures posed by climate change; large valley glaciers have not yet made this adjustment.

This means the large valley glaciers are rapidly retreating, as their mass is attempting to achieve equilibrium with the current climate. If regional snow lines stay constant, then the glaciers remain constant. More than two-thirds of its glaciers have disappeared and it is expected for them to be nonexistent in the park by the year Glacial melt will affect low-lying coastal wetlands via sea level rise , change key drivers of fresh-water ecosystems , shift the timing of snow packs, and alter the unique character of associated fresh water streams off of snow pack.

Fifty percent of the world's fresh water consumption is dependent glacial runoff. Environmental changes such as deforestation could increase local temperatures in the highlands thus could enhance the vectorial capacity of the anopheles.

Environmental changes, climate variability , and climate change are such factors that could affect biology and ecology of Anophelse vectors and their disease transmission potential. Anopheles mosquitoes in highland areas are to experience a larger shift in their metabolic rate due to the climate change.

This climate change is due to the deforestation in the highland areas where these mosquitoes dwell. When temperature rises, the larvae take a shorter time to mature [] and, consequently, there is a greater capacity to produce more offspring. In turn this could potentially lead to an increase in malaria transmission when infected humans are available.

Deforestation is directly linked with a decrease in plant biodiversity. One such implication is the loss of medicinal plants. However, it is important that medicinal resources are managed appropriately as they become globally traded in order to prevent species endangerment.

Climate change and the associated changing weather patterns occurring worldwide have a direct effect on biology, population ecology, and the population of eruptive insects, such as the mountain pine beetle MPB. This is because temperature is a factor which determines insect development and population success.

Climate change has led to a threatening pine beetle pandemic , causing them to spread far beyond their native habitat. This leads to ecosystem changes, forest fires , floods and hazards to human health. The whitebark pine ecosystem in these high elevations plays many essential roles, providing support to plant and animal life.

As the Rockies have not adapted to deal with pine beetle infestations , they lack the defenses to fight the beetles. As a consequence, the host forest becomes more vulnerable to the disease-causing agent the beetle. The whitebark forests of the Rockies are not the only forests that have been affected by the mountain pine beetle.

But as the forests become infested and die, carbon dioxide is released into the environment, and contributes even more to a warming climate. Ecosystems and humans rely on the supply of oxygen in the environment, and threats to this boreal forest results in severe consequences to our planet and human health. Forest fires present dangers to the environment, human health and the economy. The infestations and resulting diseases can indirectly, but seriously, effect human health.

As droughts and temperature increases continue, so does the frequency of devastating forest fires, insect infestations, forest diebacks, acid rain , habitat loss, animal endangerment and threats to safe drinking water.

Climate change increases wildfire potential and activity. Warming spring and summer temperatures increase flammability of materials that make up the forest floors. Furthermore, pollution from wildfires can exacerbate climate change by releasing atmospheric aerosols , which modify cloud and precipitation patterns. Wood smoke from wildfires produces particulate matter that has damaging effects to human health. The health effects of wildfire smoke exposure include exacerbation and development of respiratory illness such as asthma and chronic obstructive pulmonary disorder ; increased risk of lung cancer , mesothelioma and tuberculosis ; increased airway hyper-responsiveness; changes in levels of inflammatory mediators and coafulation factors; and respiratory tract infection.

Climate change causes displacement of people in several ways, the most obvious—and dramatic—being through the increased number and severity of weather-related disasters which destroy homes and habitats causing people to seek shelter or livelihoods elsewhere. Slow onset phenomena, including effects of climate change such as desertification and rising sea levels gradually erode livelihoods and force communities to abandon traditional homelands for more accommodating environments. This is currently happening in areas of Africa's Sahel , the semi-arid belt that spans the continent just below its northern deserts.

Deteriorating environments triggered by climate change can also lead to increased conflict over resources which in turn can displace people. Extreme environmental events are increasingly recognized as a key driver of migration across the world. According to the Internal Displacement Monitoring Centre, more than 42 million people were displaced in Asia and the Pacific during and , more than twice the population of Sri Lanka.

This figure includes those displaced by storms, floods, and heat and cold waves. Still others were displaced drought and sea-level rise. Most of those compelled to leave their homes eventually returned when conditions improved, but an undetermined number became migrants, usually within their country, but also across national borders.

Asia and the Pacific is the global area most prone to natural disasters, both in terms of the absolute number of disasters and of populations affected. It is highly exposed to climate impacts, and is home to highly vulnerable population groups, who are disproportionately poor and marginalized.

To reduce migration compelled by worsening environmental conditions, and to strengthen resilience of at-risk communities, governments should adopt policies and commit financing to social protection, livelihoods development, basic urban infrastructure development, and disaster risk management.

Though every effort should be made to ensure that people can stay where they live, it is also important to recognize that migration can also be a way for people to cope with environmental changes. If properly managed, and efforts made to protect the rights of migrants, migration can provide substantial benefits to both origin and destination areas, as well as to the migrants themselves.

The links between the gradual environmental degradation of climate change and displacement are complex: as the decision to migrate is taken at the household level, it is difficult to measure the respective influence of climate change in these decisions with regard to other influencing factors, such as poverty , population growth or employment options. From Wikipedia, the free encyclopedia. This article's lead section does not adequately summarize key points of its contents.

Please consider expanding the lead to provide an accessible overview of all important aspects of the article. June Climate change is the greatest threat to global health in the 21st century. Further information: Planetary health. Further information: Climate change and infectious diseases.

Further information: Coronavirus disease Further information: Solastalgia. See also: Environmental migrant. World Health Organization. Retrieved The Guardian. The New York Times. Retrieved 20 March — via Scientific American. Media Matters for America. April Washington, DC: U. Global Change Research Program. Bibcode : PNAS.. Proceedings of the National Academy of Sciences. University of California Press. Microbes and Infection. In Solomon, S. Nairoby: United Nations Environment Programme.

Retrieved 1 May Environmental Health Perspectives. Archived from the original on 24 August Journal of Applied Microbiology. The Lancet. Climate Change, Ticks, and". The Journal of Travel Medicine. American Journal of Epidemiology. Clin J Am Soc Nephrol. Clinical Microbiology and Infection. A Blanket Around the Earth. Bibcode : NatCC Indian Journal of Occupational and Environmental Medicine. Louis, Michael E. American Journal of Preventive Medicine. Medical Press. Retrieved 13 July Retrieved 2 December Zainal; Pereira, Joy J.

American Journal of Environmental Sciences. Malaria and climate change PDF. Archived from the original PDF on 26 September Retrieved 14 February Annual Review of Entomology. The New England Journal of Medicine. Science Submitted manuscript.

Media Centre. In Mahy, Brian W. Desk Encyclopedia of Human and Medical Virology. Academic Press. National Institutes of Health. Retrieved 24 November February Climatic Change. Journal of Travel Medicine. Retrieved 29 October Archives of Insect Biochemistry and Physiology. Ticks and Tick-borne Diseases. May The American Journal of Medicine. New England Journal of Medicine.

Center for Public Integrity. Natural Resources Council of Maine. Remote Sensing. Bibcode : RemS United Nations Environmental Programm. United Nations. Retrieved 2 June United Nations Environment Programme. World Banks Blogs. The World Bank. Retrieved 12 June Indeed, despite the unavailability of antivirals or vaccines, efforts to engage communities with added medical supplies and trained clinicians decreased the case-fatality ratio moderately as more patients trusted, sought, and received clinical care Aylward and others Medical supplies that may be needed for supportive care during a pandemic include hospital beds, disinfectants, ICU supplies such as ventilators , and personal protective equipment WHO b.

Medical interventions for pandemic influenza include antiviral drugs and antibiotics to treat bacterial coinfections. However, because of delays in case identification and antiviral deployment as discussed in box The term scaling up refers to the expansion of health intervention coverage Mangham and Hanson In the context of pandemic preparedness, successfully scaling up requires health systems to expand services to accommodate rapid increases in the number of suspected cases. Scaling up is facilitated by surge capacity the ability to draw on additional clinical personnel, logisticians, and financial and other resources as well as preexisting operational relationships and plans linking government, nongovernmental organizations, and the private sector.

Ultimately, scaling up consists of having both local surge capacity and the absorptive capacity to accept outside assistance. Local capacity building is vital, and some capacities may have particularly important positive externalities during outbreaks. During the Ebola importation into Nigeria, surge capacity that existed because of polio eradication efforts contributed to a more successful outbreak response Yehualashet and others Key elements included national experience running an emergency operations center and the use of global positioning systems to support contact tracing Shuaib and others ; WHO a.

Stockpiling of vaccines, medicines including antibiotics and antivirals , and equipment such as masks, gowns, and ventilators also can be useful for building local surge capacity Dimitrov and others ; Jennings and others ; Morens, Taubenberger, and Fauci ; Radonovich and others During a pandemic, health systems can tap into stockpiles more quickly than they can procure supplies from external sources or boost production. However, there are five important considerations for keeping stockpiles:.

Boosting local production capacity for necessary supplies may be a viable strategy for pandemic preparedness and may circumvent some of the challenges associated with amassing stockpiles. The influenza pandemic demonstrated how scaling up can affect the success rate of a mass vaccination campaign table Vaccination rates increased according to country income level, suggesting that vaccination campaigns were most successful in HICs, likely because of the size of their stockpiles, increased manufacturing capacity for vaccines, increased availability of vaccines, and more streamlined logistics in vaccine deployment.

Building local capacity to scale up is challenging, especially in LMICs. The biggest challenges include infrastructural gaps such as weak road, transportation, and communications networks and shortfalls in human resources such as logisticians, epidemiologists, and clinical staff. Bilateral and multilateral aid organizations have channeled substantial funding into building and sustaining local technical capacities in LMICs.

This type of investment is critically important. But, particularly in LMICs with weak health system capacity, progress in expanding local surge capacity likely will be slow. Another key component of scaling up, especially in LMICs, is the ability to use external assistance effectively.

During the West Africa Ebola epidemic, a surge of foreign clinicians, mobile medical units, and epidemiologists and other public health personnel was required to bolster limited local resources. LMICs can improve systems to facilitate and coordinate surges of foreign support in the following ways:. Even so, local absorptive capacity that is, the ability to channel and use foreign assistance effectively has its limits.

Constraints in bureaucratic capacity, financial controls, logistics, and infrastructure all are likely to be most severe in the countries that most need foreign assistance to manage infectious disease crises. Furthermore, although external assistance is a viable strategy during localized epidemics, it has limitations that are likely to arise during large-scale pandemics.

First, supply constraints exist, including limits to the number of medical personnel especially those with crisis response and infectious disease competencies and the number of specialized resources such as integrated mobile medical clinics available for deployment. Second, during a severe pandemic, countries are likely to use such resources locally before providing medical assistance abroad. The global humanitarian system provides a critical reservoir of crisis response capacity and shock absorption.

However, the humanitarian system currently is straining under the pressure of other crises, including upsurges in violent conflict Stoddard and others A severe epidemic or pandemic can quickly outstrip international resources. As with any other type of natural disaster, the risk from pandemics cannot be eliminated. Despite prevention efforts, pandemics will continue to occur and will at times overwhelm the systems that have been put in place to mitigate their health, societal, and economic effects.

The residual risk may be significant, particularly for LMICs that lack the resilience or resources to absorb shocks to public health and public finances. Risk transfer mechanisms such as specialized insurance facilities offer an additional tool to manage this risk. Risk-based insurance products are increasingly deployed in LMICs to pay for remediation and reconstruction costs following natural catastrophes such as hurricanes, floods, and droughts ARC ; IFRC Insurance products for epidemics and pandemics require specific characteristics.

First, insurance policies should be designed to release discretionary funds early in the course of an outbreak. In situations where financing poses a constraint to mobilizing personnel, drugs, or other supplies, payouts can be used to mobilize a public health response and mitigate further spread of disease, reducing the potential health and economic impacts of the pandemic. Third, risk transfer systems require the availability of rigorously and transparently compiled data to trigger a payout. In the context of pandemic insurance, the development of risk transfer systems requires countries to build the following capacities, among others:.

Insurance facilities can create positive incentives for LMICs to invest in planning and capacity building. Insurance mechanisms may have other positive externalities: most notably, the potential release of funds may provide a strong incentive for the timely reporting of surveillance data.

However, insurance facilities also may introduce perverse incentives including incentives to distort surveillance data and potential moral hazards such as permitting riskier activities. These incentive problems may be mitigated in the design of the risk transfer mechanism, such as by providing coverage only when minimum requirements for surveillance accuracy are met, by having preset phased triggers for payouts, and by including incentive payouts for successfully containing an outbreak.

Relative to investments in basic health provision, building capacity in infectious disease surveillance systems and other dimensions of pandemic preparedness has uncertain and potentially distant benefits. In LICs where near-term health needs are acute, this can complicate the political and economic logic for investing in pandemic preparedness Buckley and Pittluck The use of catastrophe modeling tools such as EP curves can clarify the benefit-cost rationale and the relevant time horizon for investments in preparedness, and it can inform the design and financial structure of pandemic insurance policies.

Figure On the basis of its risk tolerance, the country makes a decision to manage its risk at the 3 percent annual probability point on its EP curve. Some or all of this shortfall could be offloaded to another entity, such as a catastrophe risk insurance pool, which would give the country access to a payout during a pandemic. Because the PEF is designed to trigger early in an outbreak, the anticipated funding is less than would be required for a full-fledged response once a widespread pandemic is under way.

Risk transfer mechanisms such as insurance offer an injection of financial resources to help insured parties rapidly scale up disease response activities. As such, the utility of risk transfer mechanisms depends, in large part, on the absorptive capacity of the insured party. A country must have the ability to use insurance payouts effectively to access additional human resources clinicians, community health workers , personal protective equipment and other medical equipment consumables, and vaccines and therapeutics, from either domestic or international resources.

Much of the available data regarding pandemics including the morbidity and mortality impacts of historical pandemics and the effectiveness of different preparedness efforts and interventions come from HICs and upper-middle-income countries. Understanding of the prevalence of risk drivers, especially regarding spark risk, has improved markedly in both high- and low-income contexts. However, gaps in surveillance and reporting infrastructure in LMICs mean that, during a pandemic, many cases may never be detected or reported to the appropriate authorities Katz and others Particularly in LICs, empirical data on outbreak occurrences may be biased downward systematically.

Additionally, the means to disseminate collected data rapidly may not exist. For example, data may be kept in paper archives, so resource-intensive digitization may be required to analyze and report data to a wider audience. Data dissemination challenges are further compounded by a publication bias that results in overrepresentation of HICs in the scientific literature Jones and others Few data are available regarding costs and cost-effectiveness of pandemic preparedness and response measures, and they focus almost exclusively on HICs.

The available data suggest that the greatest cost-related benefits in pandemic preparedness and response are realized from early recognition and mitigation of disease—that is, catching and stopping sparks before they spread. Costs can be reduced if action is taken before an outbreak becomes a pandemic. Similarly, once a pandemic has begun, preventing illness generally is more cost-effective than treating illness, especially because hospitalizations typically have the highest direct cost per person.

High costs also may occur as a result of interventions such as quarantines and school closures that lead to economic disruption. These interventions may be more cost-effective during a severe pandemic. No systematic time-series data exist on global spending on pandemic preparedness, and arriving at an exact figure is complicated by the fact that many investments in building basic health system capacity also support core dimensions of pandemic preparedness.

Other, non-ODA spending on pandemic preparedness is similarly difficult to measure but likely to be significant; in , the U. Globally, the current funding for pandemic preparedness and response falls short of what is needed.

Costs for efforts associated with prepandemic preparedness activities also are not well quantified, although investment in One Health activities is likely to be cost-effective World Bank Instituting response measures after a pandemic has begun can be expensive, with most of the direct cost borne by the health care sector, although response costs typically are not reported in a cohesive manner.

When total costs for response are not available, unit costs for response activities provide valuable insights. Vaccinations and medicines have the lowest unit costs; in LMICs, large-scale purchasing and subsidies could push drug costs down even more. Conversely, hospital care has the highest unit costs.

Costs per day of hospitalization especially those with ICU involvement can add up quickly when aggregated at the national level. However, these medical care costs are potentially bounded by capacity limits such as a finite number of hospital beds , especially during more severe pandemics.

Pandemic severity itself can play a role in the drivers of cost and the effects of mitigation efforts. One study based on modeling simulations in an Australian population found that, in low-severity pandemics, most costs borne by the larger economy not just the health care system come from productivity losses related to illness and social distancing.

In higher-severity pandemics, the largest drivers of costs are hospitalization costs and productivity loss because of deaths Milne, Halder, and Kelso The lowest costs per deaths prevented were found for contact tracing, face masks, and surveillance. Pharmaceutical interventions such as vaccines and antiviral therapies were in the midrange. Measures that decreased person-to-person contact, including social distancing, quarantine, and school closures, had the greatest cost per death prevented, most likely because of the amount of economic disruption caused by those measures.

Social distancing includes avoidance of large gatherings and public places where economic activities occur. School closures often lead to lost productivity because they cause workplace absenteeism among caretakers of school-age children. Macroeconomic model simulations also have identified school closures as a potential source of GDP loss during a moderately severe pandemic Smith and others The information shown in figure Data on antiviral stockpiles provide some insight into how the cost utility of pandemic preparedness efforts may vary by country income level.

Although based only on a handful of countries, the results suggest that antiviral stockpiling in LICs has an extremely high cost per death prevented, whereas countries at other income levels are clustered within much lower ranges. Antiviral stockpiling is not cost-effective or feasible for LICs, primarily because of the high cost of antiviral agents.

For stockpiling to be a cost-effective strategy for LICs, almost all of the costs would have to be subsidized. The associated costs also may be reduced by the increased availability of generic antiviral drugs. Additionally, the efficacy of antivirals is not assured, particularly for LICs, which may not be able to identify cases early enough to administer antivirals efficaciously. In their analysis, the following interventions among the general population had the potential to provide cost savings: vaccines, antiviral treatment, social distancing, antiviral prophylaxis plus antiviral treatment, and vaccines plus antiviral treatment.

The cost savings from antiviral drugs found in this study are likely to be diminished in LMICs, as inability to deploy antivirals in a timely manner poses a serious challenge to their efficacious use. Depending on the characteristics of a pandemic and how mitigation efforts are implemented, some mitigation strategies could become highly cost- ineffective. For example, a costly vaccination campaign that is carried out in an area well after a pandemic peaks is not nearly as effective in reducing transmission as having vaccines available and distributed earlier in the pandemic.

Allocation of limited resources by creating priority groups for vaccines and antivirals is an important consideration during a pandemic. Modeling studies from the influenza pandemic investigated the most cost-effective strategies for allocating vaccines. Those studies found that vaccinating high-risk individuals was more cost-effective than prioritizing children.

Favoring children decreased the overall infection rate, but high-risk individuals were the predominant drivers of direct costs during the pandemic, because they were more likely to be hospitalized Lee and others However, these studies did not account for the indirect costs of school closures and absenteeism. Consideration of these factors could reveal increased cost savings from vaccinating children.

Another key question for benefit-cost analyses related to pandemics is the extent to which stockpiles of vaccines, antiviral drugs, and protective equipment should be assembled in advance of a pandemic. Vaccines for a novel influenza virus can take several months to develop, and vaccines for other pathogens for example, Ebola and Zika can take even longer to develop.

Studies have examined the cost-effectiveness of stockpiling prepandemic vaccines that have lower efficacy than reactive vaccines but can be deployed more quickly. One study found that cost savings can be obtained as long as prepandemic vaccines have at least 30 percent efficacy. However, cost-effectiveness differs by pandemic severity and the percentage of the population that receives the vaccine during the vaccination campaign Halder, Kelso, and Milne Antiviral drugs to fight pandemic influenza also can be stockpiled ahead of time.

However, the optimal number of doses to stockpile depends on factors including the effectiveness of concurrent interventions and the likelihood of antiviral wastage on noninfluenza respiratory infections Greer and Schanzer Most pandemic-related benefit-cost studies focus on pharmaceutical interventions for high-income and upper-middle-income countries.

The studies have largely neglected the question of how to allocate strained resources in low- and lower-middle-income countries. Furthermore, few evaluations have been conducted of the cost-effectiveness of general investment in health systems, infrastructure, and capacity building as a means to achieve pandemic preparedness Drake, Chalabi, and Coker Preparing for a pandemic is challenging because of a multitude of factors, many of which are unique among natural disasters.

Pandemics are rare events, and the risk of occurrence is influenced by anthropogenic changes in the natural environment. In addition, accountability for preparedness is diffuse, and many of the countries at greatest risk have the most limited capacity to manage and mitigate pandemic risk. Unlike most other natural disasters, pandemics do not remain geographically contained, and damages can be mitigated significantly through prompt intervention. As a result, there are strong ethical and global health imperatives for building capacity to detect and respond to pandemic threats, particularly in countries with weak preparedness and high spark and spread risk.

Investments to improve pandemic preparedness may have fewer immediate benefits, particularly relative to other pressing health needs in countries with heavy burdens of endemic disease. Therefore, characterizing pandemic risk and identifying gaps in pandemic preparedness are essential for prioritizing and targeting capacity-building efforts. Thinking about risks in terms of frequency and severity, notably using probabilistic modeling and EP curves, can quantify the potential pandemic risks facing each country and clarify the benefit-cost case for investing in pandemic preparedness.

No single, optimal response to a public health emergency exists; strategies must be tailored to the local context and to the severity and type of pandemic. However, overarching lessons emerge after multiple regional epidemics and global pandemics. For example, because of their high spark and spread risks, many LMICs would benefit most from building situational awareness and health care coordination capacity; public health response measures are far more cost-effective if they are initiated quickly and if scarce resources are targeted appropriately.

Building pandemic situational awareness is complex, requiring coordination across bureaucracies, across the public and private sectors, and across disciplines with different training and different norms including epidemiology, clinical medicine, logistics, and disaster response. However, an appropriately sized and trained health workforce encompassing doctors, nurses, epidemiologists, veterinarians, laboratorians, and others that is supported by adequate coordination systems is a fundamental need—the World Health Organization has recommended a basic threshold of 23 skilled health professionals per 10, people WHO a.

Increasing the trained health workforce also will increase the capacity to detect whether any particular population for example, human, farm animal, or wildlife is suffering from a pathogen with high pandemic risk. Increasing the health workforce also will improve the overall resiliency of the health system, an improvement that can be applied to any emergency that results in morbidity and mortality shocks.

Additionally, building situational awareness will require sustained investment in infectious disease surveillance, crisis management, and risk communications systems. Investments in these capacities are likely to surge after pandemic or epidemic events and then abate as other priorities emerge.

Hence, stable investment to build sustained capacity is critical. Risk transfer mechanisms such as catastrophe risk pools offer a viable strategy for countries to manage pandemic risk. Further developing these mechanisms will allow countries to offload portions of pandemic risk and response that are beyond their immediate budgetary capacity. For this reason, risk transfer solutions should be designed with the needs and constraints of LMICs in mind.

However, countries must have predefined contingency and response plans as well as the absorptive capacity to use the emergency financing offered by such solutions. Broad and effective use of pandemic insurance will require parallel investments in capacity building and emergency response planning.

Improving the tracking of spending and aid flows specifically tied to pandemic prevention and preparedness is vital to tracking gaps and calibrating aid flows for maximum efficiency. Systematic data on response costs in low-income settings are scarce, including data regarding spending on clinical facilities, supplies, human resources, and response activities such as quarantines.

Bridging these data gaps can improve pandemic preparedness planning and response through evidence-based decision making and support efforts to prevent and mitigate epidemics and pandemics. This chapter uses World Bank Income Classifications for as follows, based on estimates of gross national income GNI per capita for One Health considers individual, community, and animal health as interconnected and requires the collaboration of human, animal, and environmental health professionals to recognize and alleviate the problems on one level to reduce the downstream health effects on another level for example, rabies in animals and humans.

For more information, see the U. Working with partners in 31 countries, PREDICT is building platforms for conducting disease surveillance and for identifying and monitoring pathogens that can be shared between animals and people. Using the One Health approach, the project is investigating the behaviors, practices, and ecological and biological factors driving the emergence, transmission, and spread of disease.

This work is available under the Creative Commons Attribution 3. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions:. Attribution —Please cite the work as follows: Patel, V. Dua, R. Laxminarayan, and M. Medina-Mora, editors. Mental, Neurological, and Substance Use Disorders.

Disease Control Priorities, third edition, volume 4. Washington, DC: World Bank. Translations —If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation. The World Bank shall not be liable for any content or error in this translation. Third-party content —The World Bank does not necessarily own each component of the content contained within the work.

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Turn recording back on. National Center for Biotechnology Information , U. Search term. This chapter covers the following findings concerning the risks, impacts, and mitigation of pandemics as well as knowledge gaps: Risks Pandemics have occurred throughout history and appear to be increasing in frequency, particularly because of the increasing emergence of viral disease from animals. Pandemic risk is driven by the combined effects of spark risk where a pandemic is likely to arise and spread risk how likely it is to diffuse broadly through human populations.

Some geographic regions with high spark risk, including Central and West Africa, lag behind the rest of the globe in pandemic preparedness. Probabilistic modeling and analytical tools such as exceedance probability EP curves are valuable for assessing pandemic risk and estimating the potential burden of pandemics. Influenza is the most likely pathogen to cause a severe pandemic. EP analysis indicates that in any given year, a 1 percent probability exists of an influenza pandemic that causes nearly 6 million pneumonia and influenza deaths or more globally.

Impacts Pandemics can cause significant, widespread increases in morbidity and mortality and have disproportionately higher mortality impacts on LMICs. Pandemics can cause economic damage through multiple channels, including short-term fiscal shocks and longer-term negative shocks to economic growth. Individual behavioral changes, such as fear-induced aversion to workplaces and other public gathering places, are a primary cause of negative shocks to economic growth during pandemics.

In countries with weak institutions and legacies of political instability, pandemics can increase political stresses and tensions. In these contexts, outbreak response measures such as quarantines have sparked violence and tension between states and citizens. Mitigation Pathogens with pandemic potential vary widely in the resources, capacities, and strategies required for mitigation. However, there are also common prerequisites for effective preparedness and response.

The most cost-effective strategies for increasing pandemic preparedness, especially in resource-constrained settings, consist of investing to strengthen core public health infrastructure, including water and sanitation systems; increasing situational awareness; and rapidly extinguishing sparks that could lead to pandemics.

Once a pandemic has started, a coordinated response should be implemented focusing on maintenance of situational awareness, public health messaging, reduction of transmission, and care for and treatment of the ill. Successful contingency planning and response require surge capacity—the ability to scale up the delivery of health interventions proportionately for the severity of the event, the pathogen, and the population at risk.

For many poorly prepared countries, surge capacity likely will be delivered by foreign aid providers. This is a tenable strategy during localized outbreaks, but global surge capacity has limits that likely will be reached during a full-scale global pandemic as higher-capacity states focus on their own populations. Risk transfer mechanisms, such as risk pooling and sovereign-level catastrophe insurance, provide a viable option for managing pandemic risk.

Knowledge Gaps Spending and costs specifically associated with pandemic preparedness and response efforts are poorly tracked. There is no widely accepted, consistent methodology for estimating the economic impacts of pandemics.

Most data regarding the impacts of pandemics and the benefits and costs of mitigation measures come from high-income countries HICs , leading to biases and potential blind spots regarding the risks, consequences, and optimal interventions specific to LMICs. Pandemic Risk Factors Pandemic risk, as noted, is driven by the combined effects of spark risk and spread risk.

Spark Risk A zoonotic spark could arise from the introduction of a pathogen from either domesticated animals or wildlife. Spread Risk After a spark or importation, the risk that a pathogen will spread within a population is influenced by pathogen-specific factors including genetic adaptation and mode of transmission and human population-level factors such as the density of the population and the susceptibility to infection; patterns of movement driven by travel, trade, and migration; and speed and effectiveness of public health surveillance and response measures Sands and others However, it diverges from the IHR metrics in its breadth and focus on measuring underlying and enabling institutional, infrastructural, and financial capacities such as the following Oppenheim and others : Public health infrastructure capable of identifying, tracing, managing, and treating cases.

Capacity to mobilize financial resources to pay for disease response and weather the economic shock of the outbreak. Burden of Pandemics Quantifying the morbidity and mortality burden from pandemics poses a significant challenge. An influenza pandemic having the global mortality rate observed during the Swine flu pandemic 0.

In any given year, the probability of an influenza pandemic causing nearly 6 million pneumonia and influenza deaths 8 deaths per 10, persons or more globally is 1 percent. As indicated by the heavy tail of the EP curve, most of the potential burden from influenza pandemics comes from the most severe pandemics.

Consequences of Pandemics Health Impacts The direct health impacts of pandemics can be catastrophic. Viral hemorrhagic fevers such as Ebola take an especially severe toll on health care workers, who face significant exposure to infectious material: During the first Ebola outbreak in the Democratic Republic of Congo in then called Zaire , the Yambuku Mission Hospital—at the epicenter of the outbreak—was closed because 11 out of the 17 staff members had died of the disease WHO During the Kikwit Ebola outbreak in in the same country, 24 percent of cases occurred among known or possible health care workers Rosello and others During the West Africa Ebola epidemic , health care workers experienced high mortality rates: 8 percent of doctors, nurses, and midwives succumbed to Ebola in Liberia, 7 percent in Sierra Leone, and 1 percent in Guinea Evans, Goldstein, and Popova Economic Impacts Pandemics can cause acute, short-term fiscal shocks as well as longer-term damage to economic growth.

Social and Political Impacts Evidence suggests that epidemics and pandemics can have significant social and political consequences, creating clashes between states and citizens, eroding state capacity, driving population displacement, and heightening social tension and discrimination Price-Smith Trends Affecting Pandemic Risk In recent decades, several trends have affected pandemic probability, preparedness, and mitigation capacity.

Box Situational Awareness Situational awareness—in the context of pandemic preparedness—can be defined as having an accurate, up-to-date view of potential or ongoing infectious disease threats including through traditional surveillance in humans and animals and the resources human, financial, informational, and institutional available to manage those threats ASPR Preventing and Extinguishing Pandemic Sparks Although most pandemic preparedness activities focus on reducing morbidity and mortality after a pandemic has spread widely, certain activities may prevent and contain pandemic sparks before they become a wider threat.

Risk Communications Risk communications can play a significant role in the control of an emerging epidemic or pandemic by providing information that people can use to take protective and preventive action WHO c. Reducing Pandemic Spread Once a pandemic has begun in earnest, public health efforts often focus on minimizing its spread.

Strategies to minimize pandemic spread include the following Ferguson and others : Curtailing interactions between infected and uninfected populations: for example, through patient isolation, quarantine, social distancing practices, and school closures. Reducing infectiousness of symptomatic patients: for example, through antiviral and antibiotic treatment and infection control practices. Curtailing Interactions between Infected and Uninfected Populations The methods for curtailing interactions between infected and uninfected populations include patient isolation, quarantine, social distancing practices, school closures, use of personal protective equipment, and travel restrictions.

Reducing Infectiousness and Susceptibility Vaccines, antibiotics, and antiviral drugs can play a critical role in mitigating a pandemic by reducing the infectiousness of symptomatic patients and the susceptibility of uninfected individuals. Care and Treatment to Reduce the Severity of Pandemic Illness During a pandemic, health authorities work to reduce the severity of illness through patient care and treatment, which can help decrease the likelihood of severe outcomes such as hospitalizations and deaths.

Potential for Scaling Up The term scaling up refers to the expansion of health intervention coverage Mangham and Hanson However, there are five important considerations for keeping stockpiles: Building a stockpile requires significant up-front costs, which can be especially prohibitive for LICs Oshitani, Kamigaki, and Suzuki Stockpiles need to be refreshed regularly, because pharmaceuticals and equipment can reach expiration dates.

Build mechanisms to coordinate between military and humanitarian units involved in crisis response. Risk Transfer Mechanisms As with any other type of natural disaster, the risk from pandemics cannot be eliminated. In the context of pandemic insurance, the development of risk transfer systems requires countries to build the following capacities, among others: Robust surveillance data to identify when an outbreak has reached sufficient scale to require the release of funds. Adequacy of Evidence on Pandemics in LMICs Much of the available data regarding pandemics including the morbidity and mortality impacts of historical pandemics and the effectiveness of different preparedness efforts and interventions come from HICs and upper-middle-income countries.

Program and Health System Costs No systematic time-series data exist on global spending on pandemic preparedness, and arriving at an exact figure is complicated by the fact that many investments in building basic health system capacity also support core dimensions of pandemic preparedness.

Costs per Death Prevented Figure Cost-utility analyses of pandemic preparedness and response for LMICs are rare. Because the underlying data for these studies were drawn primarily from HICs, the estimates may not accurately represent the relative benefit-cost of interventions in LMICs. For example, in countries with high unemployment and underemployment, school closures may not lead to increased workforce absenteeism and thus might have a lower cost per death prevented.

The influenza pandemic is considered a relatively mild pandemic. In a more severe influenza pandemic, the cost per death prevented could decrease for some interventions, such as school closures. Results are sensitive to assumptions about the value of a prevented death and estimated costs of different interventions.

The data cover only pandemics caused by influenza. For pandemics caused by other types of pathogens, the cost-utility values may be different, and not all intervention measures may be available. Arimah B C. Oxford: Oxford University Press. Barrett R, Brown P J. Brattberg E, Rhinard M. Chisholm H. Cohn S K. DeWitte S N. Diamond J. New York: Norton. Elbe S. Epstein H. Falcone R E, Detty A.

Fan V Y, Jamison D. T, Summers L S. Farmer P. Fischer J E, Katz R. Flahault A, Valleron A J. Frieden N M. Fullam J D, Madhav N. Greenhill K, Oppenheim B. Greer A L, Schanzer D. Hooghe L, Marks G. Types of Multi-Level Governance. The Politics behind the Ebola Crisis. Geneva: IFRC. Jonas O B. Jones D S. Jun K. Katz R. Katz R, Seifman R. Kavet J. KFF Henry J. Kaiser Family Foundation. Mangham L J, Hanson K. McCoy T. Ten Essential Reforms before the Next Pandemic. Morse S S.

Report, MSF, London. Mullard A. Murphy F A. Pandemic: A Quantitative Analysis. Neiderud C J. Osterholm M T. Park J, Kim J. Platt C. Oxon U. Porta M. A Dictionary of Epidemiology. Price-Smith A T. Reperant L A, Rimmelzwaan G. Smolinsky M S, Hamburg M. A, Lederberg J.

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This results in decreased production, increased food prices, and potential starvation in parts of the world. Some research suggests that initially climate change will help developing nations because some regions will be experiencing more negative climate change effects which will result in increased demand for food leading to higher prices and increased wages. For example, the heat wave that passed through Europe in cost 13 billion euros in uninsured agriculture losses. Studies have shown that when CO 2 levels rise, soybean leaves are less nutritious; therefore plant-eating beetles have to eat more to get their required nutrients.

The CO 2 diminishes the plant's jasmonic acid production, an insect-killing poison that is excreted when the plant senses it's being attacked. Without this protection, beetles are able to eat the soybean leaves freely, resulting in a lower crop yield. The warmer, wetter winters are promoting fungal plant diseases like soybean rust to travel northward. Soybean rust is a vicious plant pathogen that can kill off entire fields in a matter of days, devastating farmers and costing billions in agricultural losses.

Another example is the Mountain Pine Beetle epidemic in BC, Canada which killed millions of pine trees because the winters were not cold enough to slow or kill the growing beetle larvae. The competitive balance between plants and pests has been relatively stable for the past century, but with the rapidly shifting climate, there is a change in this balance which often favours the more biologically diverse weeds over the monocrops most farms consist of.

Another area of concern is the effect of climate change on the nutritional content of food for human consumption. Studies show that increasing atmospheric levels of CO 2 have an unfavourable effect on the nutrients in plants. As the carbon concentration in the plant's tissues increase, there is a corresponding decrease in the concentration of elements such as nitrogen , phosphorus , zinc and iodine.

Of significant concern is the protein content of plants, which also decreases in relation to elevating carbon content. This results in undernutrition and an increase in obesity and diet-related chronic diseases. Countries worldwide are already impacted by deficiencies in micronutrients and are seeing the effects in the health of their populations.

Iron deficiency affects more than 3. Iodine deficiency leads to ailments like goitre , brain damage and cretinism and is a problem in at least different countries. This does not take into account, however, the additional burden of pests, pathogens, nutrients and water affecting the crop yield. While researchers acknowledge there are possible benefits of global warming , most agree that the negative consequences of climate change will outweigh any potential benefits and instead the shifting climate will result in more benefits to developed countries and more detriments to developing countries; exacerbating the discrepancy between wealthy and impoverished nations.

This includes better management of soil, water-saving technology, matching crops to environments, introducing different crop varieties, crop rotations, appropriate fertilization use, and supporting community-based adaptation strategies. Government policies and programs must provide environmentally sensitive government subsidies , educational campaigns and economic incentives as well as funds, insurance and safety nets for vulnerable populations.

Perhaps one of the most recent adverse effects of climate change to be explored is that of ocean acidification. Our oceans cover approximately 71 percent of the Earth 's surface and support a diverse range of ecosystems , which are home to over 50 percent of all the species on the planet. Oceans work as a sink absorbing excess anthropogenic carbon dioxide CO 2. As the oceans absorb anthropogenic carbon dioxide CO 2 it breaks down into carbonic acid , a mild acid, this neutralizes the normally alkaline ocean water.

As a result, the pH in the oceans is declining. In the research surrounding global climate change we are only just beginning to realize that our oceans can sequester a finite amount of CO 2 before we start seeing impacts on marine life that could lead to devastating losses. Acidification of our oceans has the potential to drastically alter life as we know it - from extreme weather patterns and food scarcity to a loss of millions of species from the planet - all of these consequences hold the potential to directly affect human health.

With degradation of protective coral reefs through acidic erosion, bleaching and death, salt water is able to infiltrate fresh ground water supplies that large populations depend on. These islands possess limited freshwater supplies, namely ground water lenses and rain fall. When the protective coral reefs surrounding them erodes due to higher temperatures and acidic water chemistry, salt water is able to infiltrate the lens and contaminate the drinking water supply.

Warming ocean waters generate larger and more devastating weather events that can decimate coastal populations especially without the protection of coral reefs. The health of our oceans has a direct effect on the health humans. According to Small and Nicholls, they estimated that 1.

In the U. Our insatiable appetite for seafood of all types has led to overfishing and has already significantly strained marine food stocks to the point of collapse in many cases. With seafood being a major protein source for so much of the population, there are inherent health risks associated with global warming.

As mentioned above increased agricultural runoff and warmer water temperature allows for eutrophication of ocean waters. This increased growth of algae and phytoplankton in turn can have dire consequences. These algal blooms can emit toxic substances that can be harmful to humans if consumed.

Organisms, such as shellfish, marine crustaceans and even fish, feed on or near these infected blooms, ingest the toxins and can be consumed unknowingly by humans. One of these toxin producing algae is Pseudo-nitzschia fraudulenta. This species produces a substance called domoic acid which is responsible for amnesic shellfish poisoning. Infectious disease often accompanies extreme weather events, such as floods, earthquakes and drought.

These local epidemics occur due to loss of infrastructure, such as hospitals and sanitation services, but also because of changes in local ecology and environment. This has led to an increase in the number and severity of extreme weather events. This trend towards more variability and fluctuation is perhaps more important, in terms of its impact on human health, than that of a gradual and long-term trend towards higher average temperature.

Arguably one of the worst effects that drought has directly on human health is the destruction of food supply. Farmers who depend on weather to water their crops lose tons of crops per year due to drought. Plant growth is severely stunted without adequate water, and plant resistance mechanisms to fungi and insects weaken like human immune systems. The expression of genes is altered by increased temperatures, which can also affect a plant's resistance mechanisms.

One example is wheat, which has the ability to express genes that make it resistant to leaf and stem rusts, and to the Hessian fly; its resistance declines with increasing temperatures. A number of other factors associated with lack of water may actually attract pestilent insects, as well- some studies have shown that many insects are attracted to yellow hues, including the yellowing leaves of drought-stressed plants.

During times of mild drought is when conditions are most suitable to insect infestation in crops; once the plants become too weakened, they lack the nutrients necessary to keep the insects healthy. This means that even a relatively short, mild drought may cause enormous damage- even though the drought on its own may not be enough to kill a significant portion of the crops, once the plants become weakened, they are at higher risk of becoming infested.

The results of the loss of crop yields affect everyone, but they can be felt most by the poorest people in the world. As supplies of corn, flour and vegetables decline, world food prices are driven up. Malnutrition rates in poor areas of the world skyrocket, and with this, dozens of associated diseases and health problems.

Immune function decreases, so mortality rates due to infectious and other diseases climb. For those whose incomes were affected by droughts namely agriculturalists and pastoralists , and for those who can barely afford the increased food prices, the cost to see a doctor or visit a clinic can simply be out of reach.

Without treatment, some of these diseases can hinder one's ability to work, decreasing future opportunities for income and perpetuating the vicious cycle of poverty. Health concerns around the world can be linked to floods. With the increase in temperatures worldwide due to climate change the increase in flooding is unavoidable. Short term implications include mortalities , injuries and diseases , while long term implications include non-communicable diseases and psychosocial health aspects.

Mortalities are not uncommon when it comes to floods. The Countries with lower incomes are more likely to have more fatalities , because of the lack of resources they have and the supplies to prepare for a flood. This does depend on the type and properties of the flood. For example, if there is a flash flood it would not matter how prepared you are. Fatalities connected directly to floods are usually caused by drowning ; the waters in a flood are very deep and have strong currents.

These particles cause the water to become dirty and this becomes a problem as the dirty water leads to water related diseases. For example, cholera and guinea worm disease are caused by dirty water. Injuries can lead to an excessive amount of morbidity when a flood occurs. Victims who already have a chronic illness and then sustain a non-fatal injury are put at a higher risk for that non-fatal injury to become fatal. Injuries are not isolated to just those who were directly in the flood, rescue teams and even people delivering supplies can sustain an injury.

Injuries can occur anytime during the flood process; before, during and after. During floods accidents occur with falling debris or any of the many fast moving objects in the water. After the flood rescue attempts are where large numbers injuries can occur. Communicable diseases are increased due to many pathogens and bacteria that are being transported by the water. In floods where there are many fatalities in the water there is a hygienic problem with the handling of bodies, due to the panic stricken mode that comes over a town in distress.

There are certain diseases that are directly correlated with floods they include any dermatitis and any wound , nose , throat or ear infection. Gastrointestinal disease and diarrheal diseases are very common due to a lack of clean water during a flood.

Most of clean water supplies are contaminated when flooding occurs. Hepatitis A and E are common because of the lack of sanitation in the water and in living quarters depending on where the flood is and how prepared the community is for a flood. Respiratory diseases are a common after the disaster has occurred. This depends on the amount of water damage and mold that grows after an incident. Vector borne diseases increase as well due to the increase in still water after the floods have settled.

The diseases that are vector borne are malaria , dengue , West Nile , and yellow fever. Non-communicable diseases are a long-term effect of floods. They are either caused by a flood or they are worsened by a flood; they include cancer , lung disease and diabetes. Floods have a huge impact on victims' psychosocial integrity. People suffer from a wide variety of losses and stress.

One of the most treated illness in long-term health problems are depression caused by the flood and all the tragedy that flows with one. Another result of the warming oceans are stronger hurricanes , which will wreak more havoc on land, and in the oceans, [] and create more opportunities for vectors to breed and infectious diseases to flourish.

These winds can carry vectors tens of thousands of kilometers, resulting in an introduction of new infectious agents to regions that have never seen them before, making the humans in these regions even more susceptible. A glacier is a mass of ice that has originated from snow that has been compacted via pressure and have definite lateral limits and movements in definite directions. Global climate change and fluctuation is causing an increasingly exponential melting of Earth's glaciers.

These melting glaciers have many social and ecological consequences that directly or indirectly impact the health and well-being of humans. This aggravates and increases the likelihood of issues such as sanitation, world hunger , population shifts, and catastrophic weather such as flooding, drought, and worldwide temperature fluctuations.

Over this time period the cirque and steep alpine glaciers were able to acclimatize to the new temperatures posed by climate change; large valley glaciers have not yet made this adjustment. This means the large valley glaciers are rapidly retreating, as their mass is attempting to achieve equilibrium with the current climate.

If regional snow lines stay constant, then the glaciers remain constant. More than two-thirds of its glaciers have disappeared and it is expected for them to be nonexistent in the park by the year Glacial melt will affect low-lying coastal wetlands via sea level rise , change key drivers of fresh-water ecosystems , shift the timing of snow packs, and alter the unique character of associated fresh water streams off of snow pack.

Fifty percent of the world's fresh water consumption is dependent glacial runoff. Environmental changes such as deforestation could increase local temperatures in the highlands thus could enhance the vectorial capacity of the anopheles. Environmental changes, climate variability , and climate change are such factors that could affect biology and ecology of Anophelse vectors and their disease transmission potential. Anopheles mosquitoes in highland areas are to experience a larger shift in their metabolic rate due to the climate change.

This climate change is due to the deforestation in the highland areas where these mosquitoes dwell. When temperature rises, the larvae take a shorter time to mature [] and, consequently, there is a greater capacity to produce more offspring. In turn this could potentially lead to an increase in malaria transmission when infected humans are available.

Deforestation is directly linked with a decrease in plant biodiversity. One such implication is the loss of medicinal plants. However, it is important that medicinal resources are managed appropriately as they become globally traded in order to prevent species endangerment. Climate change and the associated changing weather patterns occurring worldwide have a direct effect on biology, population ecology, and the population of eruptive insects, such as the mountain pine beetle MPB.

This is because temperature is a factor which determines insect development and population success. Climate change has led to a threatening pine beetle pandemic , causing them to spread far beyond their native habitat. This leads to ecosystem changes, forest fires , floods and hazards to human health. The whitebark pine ecosystem in these high elevations plays many essential roles, providing support to plant and animal life.

As the Rockies have not adapted to deal with pine beetle infestations , they lack the defenses to fight the beetles. As a consequence, the host forest becomes more vulnerable to the disease-causing agent the beetle. The whitebark forests of the Rockies are not the only forests that have been affected by the mountain pine beetle. But as the forests become infested and die, carbon dioxide is released into the environment, and contributes even more to a warming climate.

Ecosystems and humans rely on the supply of oxygen in the environment, and threats to this boreal forest results in severe consequences to our planet and human health. Forest fires present dangers to the environment, human health and the economy. The infestations and resulting diseases can indirectly, but seriously, effect human health. As droughts and temperature increases continue, so does the frequency of devastating forest fires, insect infestations, forest diebacks, acid rain , habitat loss, animal endangerment and threats to safe drinking water.

Climate change increases wildfire potential and activity. Warming spring and summer temperatures increase flammability of materials that make up the forest floors. Furthermore, pollution from wildfires can exacerbate climate change by releasing atmospheric aerosols , which modify cloud and precipitation patterns. Wood smoke from wildfires produces particulate matter that has damaging effects to human health. The health effects of wildfire smoke exposure include exacerbation and development of respiratory illness such as asthma and chronic obstructive pulmonary disorder ; increased risk of lung cancer , mesothelioma and tuberculosis ; increased airway hyper-responsiveness; changes in levels of inflammatory mediators and coafulation factors; and respiratory tract infection.

Climate change causes displacement of people in several ways, the most obvious—and dramatic—being through the increased number and severity of weather-related disasters which destroy homes and habitats causing people to seek shelter or livelihoods elsewhere. Slow onset phenomena, including effects of climate change such as desertification and rising sea levels gradually erode livelihoods and force communities to abandon traditional homelands for more accommodating environments.

This is currently happening in areas of Africa's Sahel , the semi-arid belt that spans the continent just below its northern deserts. Deteriorating environments triggered by climate change can also lead to increased conflict over resources which in turn can displace people. Extreme environmental events are increasingly recognized as a key driver of migration across the world.

According to the Internal Displacement Monitoring Centre, more than 42 million people were displaced in Asia and the Pacific during and , more than twice the population of Sri Lanka. This figure includes those displaced by storms, floods, and heat and cold waves. Still others were displaced drought and sea-level rise.

Most of those compelled to leave their homes eventually returned when conditions improved, but an undetermined number became migrants, usually within their country, but also across national borders. Asia and the Pacific is the global area most prone to natural disasters, both in terms of the absolute number of disasters and of populations affected. It is highly exposed to climate impacts, and is home to highly vulnerable population groups, who are disproportionately poor and marginalized.

To reduce migration compelled by worsening environmental conditions, and to strengthen resilience of at-risk communities, governments should adopt policies and commit financing to social protection, livelihoods development, basic urban infrastructure development, and disaster risk management. Though every effort should be made to ensure that people can stay where they live, it is also important to recognize that migration can also be a way for people to cope with environmental changes.

If properly managed, and efforts made to protect the rights of migrants, migration can provide substantial benefits to both origin and destination areas, as well as to the migrants themselves. The links between the gradual environmental degradation of climate change and displacement are complex: as the decision to migrate is taken at the household level, it is difficult to measure the respective influence of climate change in these decisions with regard to other influencing factors, such as poverty , population growth or employment options.

From Wikipedia, the free encyclopedia. This article's lead section does not adequately summarize key points of its contents. Please consider expanding the lead to provide an accessible overview of all important aspects of the article. June Climate change is the greatest threat to global health in the 21st century. Further information: Planetary health. Further information: Climate change and infectious diseases.

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Circle of Blue. Climate Change and Water Research. Archived from the original on 31 October Retrieved 12 August Archived from the original PDF on 16 April Agricultural Systems. Because the event catalog includes scenarios incorporating spark probabilities and estimates of disease propagation, the EP curve includes the combined impacts of both spark risk and spread risk. Although a global curve is shown in figure The EP curve is a powerful tool that yields several key findings regarding the frequency and severity of potential pandemics.

Applied to influenza pandemics, we find the following:. For example, in any given year, all LICs combined have a 3 percent probability of experiencing at least , deaths attributable to an influenza pandemic and a 0. LICs bear a substantial burden of mortality risk from influenza pandemics.

Strikingly, LICs contain only about 9 percent of the global population, yet they would contribute nearly 25 percent of deaths during an influenza pandemic. Based on the event catalog, the average estimated global mortality from pneumonia and influenza during an influenza pandemic is more than 7.

However, because influenza pandemics occur on average once every 25—30 years, the average annual pneumonia and influenza mortality from influenza pandemics is a little more than , deaths. This is comparable to seasonal influenza, which worldwide causes at least , deaths annually WHO b. Although both numbers reflect an annual average, they differ in the combination of frequency and severity. Seasonal influenza deaths occur every year, but pandemic influenza deaths occur much less frequently, are concentrated in larger spikes, and affect a younger demographic.

When pandemics cause large morbidity and mortality spikes, they are much more likely to overwhelm health systems. Overwhelmed health systems and other indirect effects may contribute to a 2. If indirect deaths are taken into account, the average annual global deaths from influenza pandemics could be greater than ,, although there is a significant uncertainty in the estimate. Pandemics caused by pathogens other than influenza also must be considered.

Novel coronaviruses such as SARS-CoV , filoviruses such as Ebola virus , and flaviviruses such as Zika virus have caused large epidemics and pandemics. These viruses, like influenza, are ribonucleic acid viruses that have high mutation rates. Noninfluenza viruses typically cause more frequent, smaller epidemics but also an overall lower burden of morbidity and mortality than pandemic influenza.

For diseases caused by coronaviruses and filoviruses, the lower burden stems from the mode of transmission, which often requires closer and more sustained contact than influenza does to spread. The direct health impacts of pandemics can be catastrophic. Pandemics can disproportionately affect younger, more economically active segments of the population Charu and others During influenza pandemics as opposed to seasonal outbreaks of influenza , the morbidity and mortality age distributions shift to younger populations, because younger people have lower immunity than older people, which significantly increases the years of life lost Viboud and others Furthermore, many infectious diseases can have chronic effects, which can become more common or widespread in the case of a pandemic.

For example, Zika-associated microcephaly has lifelong impacts on health and well-being. The indirect health impacts of pandemics can increase morbidity and mortality further. Drivers of indirect health impacts include diversion or depletion of resources to provide routine care and decreased access to routine care resulting from an inability to travel, fear, or other factors.

This indirect death toll nearly equaled the 11, deaths directly caused by Ebola in those countries WHO a. Additionally, diversion of funds, medical resources, and personnel led to a 30 percent decrease in routine childhood immunization rates in affected countries UNDP During the influenza pandemic, a greater surge in hospital admissions for influenza and pneumonia was associated with statistically significant increases in deaths attributable to acute myocardial infarction and stroke Rubinson and others However, during a pandemic, distinguishing which deaths are attributable to the pandemic itself and which are merely coincidental may be impossible.

During the West Africa Ebola epidemic, facilities closures as a result of understaffing and fear of contracting the disease played a large role in lack of access to or avoidance of routine health care. Among children under age five years, hospitals witnessed a 60 percent decrease in visits for diarrhea and a 58 percent decrease in visits for acute respiratory illness ARI , while health centers saw a 25 percent decrease in visits for diarrhea and a 23 percent decrease in visits for ARI.

In Sierra Leone, visits to public facilities for reproductive health care fell by as much as 40 percent during the outbreak UNDP The availability of health care workers also decreases during a pandemic because of illness, deaths, and fear-driven absenteeism. Viral hemorrhagic fevers such as Ebola take an especially severe toll on health care workers, who face significant exposure to infectious material:.

Even if health care workers do not die, their ability to provide care may be reduced. At the peak of a severe influenza pandemic, up to 40 percent of health care workers might be unable to report for duty because they are ill themselves, need to care for ill family members, need to care for children because of school closures, or are afraid Falcone and Detty ; U.

Homeland Security Council Pandemics can cause acute, short-term fiscal shocks as well as longer-term damage to economic growth. Early-phase public health efforts to contain or limit outbreaks such as tracing contacts, implementing quarantines, and isolating infectious cases entail significant human resource and staffing costs Achonu, Laporte, and Gardam As an outbreak grows, new facilities may need to be constructed to manage additional infectious cases; this, along with increasing demand for consumables medical supplies, personal protective equipment, and drugs can greatly increase health system expenditures Herstein and others Diminished tax revenues may exacerbate fiscal stresses caused by increased expenditures, especially in LMICs, where tax systems are weaker and government fiscal constraints are more severe.

This dynamic was visible during the West Africa Ebola epidemic in Liberia: while response costs surged, economic activity slowed, and quarantines and curfews reduced government capacity to collect revenue World Bank During a mild or moderate pandemic, unaffected HICs can offset fiscal shocks by providing increased official development assistance ODA to affected countries, including direct budgetary support.

However, during a severe pandemic where HICs confront the same fiscal stresses and may be unable or unwilling to provide assistance, LMICs could face larger budget shortfalls, potentially leading to weakened public health response or cuts in other government spending. The direct fiscal impacts of pandemics generally are small, however, relative to the indirect damage to economic activity and growth. Negative economic growth shocks are driven directly by labor force reductions caused by sickness and mortality and indirectly by fear-induced behavioral changes.

Fear manifests itself through multiple behavioral changes. The indirect economic impact of pandemics has been quantified primarily through computable general equilibrium simulations; the empirical literature is less developed. World Bank economic simulations indicate that a severe pandemic could reduce world gross domestic product GDP by roughly 5 percent Burns, Van der Mensbrugghe, and Timmer The reduction in demand caused by aversive behavior such as the avoidance of travel, restaurants, and public spaces, as well as prophylactic workplace absenteeism exceeds the economic impact of direct morbidity- and mortality-associated absenteeism.

For example, the economic growth estimate for Liberia was 3 percent against a pre-Ebola estimate of 6. Finally, estimates of fiscal and growth shocks are significant but do not include the intrinsic value of lives lost. Fan, Jamison, and Summers consider this additional dimension of economic loss by estimating the value of excess deaths across varying levels of modeled pandemic severity, finding that the bulk of the expected annual loss from pandemics is driven by the direct cost of mortality, particularly in the case of low-probability, severe events.

During a severe pandemic, all sectors of the economy—agriculture, manufacturing, services—face disruption, potentially leading to shortages, rapid price increases for staple goods, and economic stresses for households, private firms, and governments. A sustained, severe pandemic on the scale of the influenza pandemic could cause significant and lasting economic damage.

Evidence suggests that epidemics and pandemics can have significant social and political consequences, creating clashes between states and citizens, eroding state capacity, driving population displacement, and heightening social tension and discrimination Price-Smith Severe premodern pandemics have been associated with significant social and political upheaval, driven by large mortality shocks and the resulting demographic shifts.

Subsequent pandemics have not had such dramatic effects on political and social stability, primarily because the potential mortality shock has been attenuated by improvements in prevention and care. Evidence does suggest that epidemics and pandemics can amplify existing political tensions and spark unrest, particularly in fragile states with legacies of violence and weak institutions.

During the West Africa Ebola epidemic, steps taken to mitigate disease transmission, such as the imposition of quarantines and curfews by security forces, were viewed with suspicion by segments of the public and opposition political leaders. This led directly to riots and violent clashes with security forces McCoy Latent political tensions from previously warring factions in Liberia also reemerged early in the epidemic and were linked with threats to health care workers as well as attacks on public health personnel and facilities.

The Ebola epidemic also greatly amplified political tensions in Guinea, Liberia, and Sierra Leone, with incumbent politicians accused of leveraging the crisis and disease control measures to cement political control and opposition figures accused of hampering disease response efforts ICG Whereas growing tensions did not lead to large-scale political violence or instability, they did complicate public health response efforts.

In Sierra Leone, quarantine in opposition-dominated regions was delayed because of concerns that it would be seen as politically motivated ICG In countries with high levels of political polarization, recent civil war, or weak institutions, sustained outbreaks could lead to more sustained and challenging political tensions. Pandemics also can have longer-term impacts on state capacity Price-Smith Similar effects may occur during shorter, more acute pandemics, reducing state capacity to manage instability.

The weakening of security forces can, in turn, amplify the risk of civil war and other forms of violent conflict Fearon and Laitin Large-scale outbreaks of infectious disease have direct and consequential social impacts.

For example, widespread public panic during disease outbreaks can lead to rapid population migration. Sudden population movements can have destabilizing effects, and migrants face elevated health risks arising from poor sanitation, poor nutrition, and other stressors Toole and Waldman Migration also poses the risk of further spreading an outbreak.

Finally, outbreaks of infectious disease can cause already vulnerable social groups, such as ethnic minority populations, to be stigmatized and blamed for the disease and its consequences Person and others During the Black Death, Jewish communities in Europe faced discrimination, including expulsion and communal violence, because of stigma and blame for disease outbreaks Cohn Modern outbreaks have seen more subtle forms of discrimination, such as shunning and fear, directed at minority populations linked with disease foci.

For example, Africans in Hong Kong SAR, China, reported experiencing social isolation, anxiety, and economic hardship resulting from fears of their association with Ebola Siu In recent decades, several trends have affected pandemic probability, preparedness, and mitigation capacity. Various factors—population growth, increasing urbanization, greater demand for animal protein, greater travel and connectivity between population centers, habitat loss, climate change, and increased interactions at the human-animal interface—affect the likelihood of pandemic events by increasing either the probability of a spark event or the potential spread of a pathogen Tilman and Clark ; Tyler ; Zell With global population estimated to reach 9.

As for poverty, the trends are mixed. On the positive side, enormous gains in poverty reduction have decreased the number of people living in extreme poverty. This may attenuate the mortality shock of a mild pandemic somewhat.

On the negative side, extreme poverty is now concentrated in a small number of low-growth, high-poverty countries Chandy, Kato, and Kharas In such countries, progress in building health system capacity also has been far slower. Likewise, for a subset of countries with endemically weak institutions, building institutional capacity for complex tasks like pandemic mitigation and response is likely to be a slow process even under the most optimistic assumptions Pritchett, Woolcock, and Andrews Many of these countries are in areas with high spark risk, particularly in Central and West Africa, and thus may remain vulnerable and require significant international assistance during a pandemic.

Other environmental and population trends that could increase the severity of pandemics include the persistence of slums, unresponsive health systems, higher prevalence of comorbidities, weaker sanitation, and aging populations Arimah ; UNDESA The increasing threat posed by antibiotic resistance also could amplify mortality during pandemics of bacterial diseases such as tuberculosis and cholera and even viral diseases especially for influenza, in which a significant proportion of deaths is often the result of bacterial pneumonia coinfections Brundage and Shanks ; Van Boeckel and others Pandemic preparedness and response interventions can be classified by their timing with respect to pandemic occurrence: the prepandemic period, the spark period, and the spread period, as shown in box Whereas some interventions clearly fall under the purview of a single authority, responsibility for implementing and scaling up many critical aspects of preparedness and response is spread across multiple authorities, which play complementary, interlocking, and, in some cases, overlapping roles Brattberg and Rhinard The governance of pandemic preparedness and response is complex, with authority fragmented across international, national, and subnational institutions, as well as among multiple organizations with functional responsibility for specific tasks Hooghe and Marks Pandemic preparedness requires close coordination across public and private sector actors: vaccine development requires close coordination between government and vaccine producers; whereas critical response measures—such as managing quarantines—requires engagement between nonprofit organizations hospitals, clinics, and nongovernmental organizations , public health authorities, affected communities and civil society groups, and the security sector.

Historical pandemics offer only a partial view to guide preparedness and response activities. Many countries and organizations have used the historical influenza pandemics in , , and to estimate the potential morbidity and mortality burden during a future pandemic WHO c. However, using these moderate-to-severe events to plan for a mild pandemic for example, the influenza pandemic can lead to an overzealous response—such as widespread mandatory school closures—that may create unintended negative economic consequences Kelly and others Especially in LMICs, intensive care unit ICU beds and therapies for acute respiratory distress syndrome are in short supply, which could lead to many casualties Osterholm Situational awareness—in the context of pandemic preparedness—can be defined as having an accurate, up-to-date view of potential or ongoing infectious disease threats including through traditional surveillance in humans and animals and the resources human, financial, informational, and institutional available to manage those threats ASPR Situational awareness is a crucial activity at all stages of a pandemic, including prepandemic, spark, and spread periods.

It requires the support of health care resources such as hospitals, doctors, and nurses , diagnostic infrastructure, and communications systems. It also requires the population to have access to and trust in the health care system. Situational awareness supports policy decisions by tracking if and where disease transmission is occurring, detecting the most effective methods to reduce transmissibility, and deciding where to allocate resources.

During a pandemic, situational awareness allows for monitoring to understand the course a pandemic is taking and whether intervention measures are effective. The ability to detect the presence of a pandemic requires the health care workforce to recognize the illness and to have the technical and laboratory capacity to identify the pathogen or rule out known pathogens and respond to surges of clinical specimens in a timely manner.

Rapid identification reduces risk by enabling infected persons to be isolated and given appropriate clinical care. During the SARS pandemic, a one-week delay in applying control measures may have nearly tripled the size of the outbreak and increased its duration by four weeks Wallinga and Teunis Endemic infectious diseases can affect pandemic detection by complicating the differential diagnosis and rapid identification of pandemic cases. Overlapping symptoms between endemic and emerging pathogens—for instance, between dengue and Zika or between malaria and Ebola—have hampered the early identification of cases de Wit and others ; Waggoner and Pinsky This difficulty suggests a role for investment in the development and deployment of rapid diagnostic tests in regions with a high burden of endemic pathogens and high risk of disease emergence or importation Yamey and others Additional constraints affecting epidemic and pandemic situational awareness in LMICs are described in box Although most pandemic preparedness activities focus on reducing morbidity and mortality after a pandemic has spread widely, certain activities may prevent and contain pandemic sparks before they become a wider threat.

At the core of pandemic prevention is the concept of One Health, an approach that considers human health, animal health, and the environment to be fundamentally interconnected Zinsstag and others To understand the etiology of pandemics, important One Health activities include the surveillance of zoonotic pathogens of pandemic potential at the human-animal interface, the modeling of evolutionary dynamics, the risk assessments of zoonotic pathogens, and other methods of understanding the interplay between environmental changes and pathogen emergence Paez-Espino and others ; Wolfe and others Agency for International Development USAID has invested a significant amount of resources in understanding and characterizing zoonotic risk Anthony and others Countries can focus their spark mitigation efforts on policies designed to control animal reservoirs; monitor high-risk populations such as people working at the animal interface for example, those involved in animal husbandry, animal slaughter, and so on ; and maintain robust animal health infrastructure, biosecurity, and veterinary public health capacities Jonas ; Pike and others ; Watts ; Yu and others Risk communications can play a significant role in the control of an emerging epidemic or pandemic by providing information that people can use to take protective and preventive action WHO c.

The dissemination of basic information such as how the pathogen is transmitted, guidance on managing patient care, high-risk practices, and protective behavioral measures can rapidly and significantly reduce the transmission of disease.

The way in which risk communications are framed and transmitted matters a great deal; they must be clear, simple, timely, and delivered by credible messengers. Factors such as literacy rates, cultural sensitivities, familiarity with scientific principles such as the germ theory of disease , and reliance on oral versus written traditions all have implications for how messages should be designed and delivered Bedrosian and others Public health officials also need to identify and address misinformation, rumors, and anxieties.

This can be a significant challenge. During the West Africa Ebola epidemic, many communities reached for culturally familiar explanations of disease transmission and rejected disease control practices that clashed with their traditional healing and burial practices Roca and others Still other individuals spread rumors about the source of the infection; for example, in Liberia some community leaders claimed that the disease was created by the government Epstein Rumors can impede disease control and can be amplified by mistrust of government officials, which is a significant challenge in LMICs with high levels of corruption or legacies of violent conflict and social division.

Research has found that in unstable contexts, people tend to believe rumors that confirm their preexisting beliefs and anxieties Greenhill and Oppenheim This finding suggests that countering rumors with facts alone will not be sufficient. Risk communications need to be both factual and empathetic, addressing unfolding events and underlying fears through the lens of community experiences, histories, and perceptions.

The effectiveness of risk communications is difficult to measure. However, previous risk communication efforts have brought forth overarching themes that may be beneficial during the next epidemic or pandemic. One notable model comes from a Nipah virus outbreak in Bangladesh in In that outbreak, investigators found that messages about the sources of infection and potential strategies to reduce risk were more effective when conveyed by trusted local leaders and in terms that were relevant and grounded in the shared experiences of the affected community Parveen and others Once a pandemic has begun in earnest, public health efforts often focus on minimizing its spread.

Limiting the spread of a pandemic can help to reduce the number of total people who are infected and thus also mitigate some of the indirect health and economic effects. Strategies to minimize pandemic spread include the following Ferguson and others :. During the prepandemic period, plans for implementing those measures should be developed and tested through simulation exercises.

The methods for curtailing interactions between infected and uninfected populations include patient isolation, quarantine, social distancing practices, school closures, use of personal protective equipment, and travel restrictions. The practice of quarantine began in the fourteenth century in response to the Black Death and continues today Mackowiak and Sehdev Quarantine and social distancing such as the prohibition of mass gatherings during the influenza pandemic reduced spread and mortality rates, particularly when implemented in the early stages of the pandemic Bootsma and Ferguson ; Hollingsworth, Ferguson, and Anderson During SARS and Ebola outbreaks, health agencies and hospitals limited disease spread by isolating symptomatic patients, quarantining patient contacts, and improving hospital infection control practices Cohen and others ; Twu and others During the SARS pandemic, none of the health care workers in hospitals in Hong Kong SAR, China, who reported appropriate and consistent use of masks, gloves, gowns, and hand washing as recommended under droplet and contact precautions were infected Seto and others Travel restrictions are sometimes implemented by governments to curtail disease spread.

Fear and lack of scientific understanding may motivate the imposition of travel restrictions Flahault and Valleron As such, these measures are sometimes implemented for inappropriate pathogens or too late to contain an outbreak and can cause substantial economic damage and public anxiety. Travel restrictions are more beneficial for pathogens that do not have a significant asymptomatic carrier state and have a relatively long incubation period for example, SARS and Ebola.

However, such restrictions may be of limited efficacy for influenza pandemics unless initiated when there are fewer than 50 cases at the spark site Ferguson and others Vaccines, antibiotics, and antiviral drugs can play a critical role in mitigating a pandemic by reducing the infectiousness of symptomatic patients and the susceptibility of uninfected individuals.

Antivirals may reduce influenza transmission, although the extent of their effectiveness is unclear Ferguson and others ; Jefferson and others A systematic review of clinical trial data among treated adults showed that oseltamivir reduced the duration of influenza symptoms by 17 hours, but prophylaxis trials found no significant reduction of transmission Jefferson and others If available, vaccines can reduce susceptibility.

Significant efforts have focused on speeding up vaccine development and scaling up production. Vaccination strategies targeting younger populations may be especially beneficial, in part because influenza transmissibility is higher among younger populations during pandemics Miller and others The effectiveness of antivirals, antibiotics, and vaccines in reducing spread diminishes if the pandemic is already global, if LMICs cannot afford adequate vaccine stocks for their populations, or if specific populations for example, the poor or the socially vulnerable cannot access vaccines.

Additionally, pandemics may be caused by a pathogen without an available vaccine or efficacious biomedical therapy. Efforts to improve the vaccine development pipeline are underway box During a pandemic, health authorities work to reduce the severity of illness through patient care and treatment, which can help decrease the likelihood of severe outcomes such as hospitalizations and deaths.

Treatments may range from nonspecific, supportive care to disease-specific drugs. During the prepandemic period, plans to implement these measures should be developed and tested through simulation exercises. Maintaining supportive care during an epidemic or pandemic can improve mortality rates by alleviating the symptoms of disease.

During the West Africa Ebola epidemic, for example, evidence suggests that earlier case identification, supportive care, and rehydration therapy modestly reduced mortality Walker and Whitty Indeed, despite the unavailability of antivirals or vaccines, efforts to engage communities with added medical supplies and trained clinicians decreased the case-fatality ratio moderately as more patients trusted, sought, and received clinical care Aylward and others Medical supplies that may be needed for supportive care during a pandemic include hospital beds, disinfectants, ICU supplies such as ventilators , and personal protective equipment WHO b.

Medical interventions for pandemic influenza include antiviral drugs and antibiotics to treat bacterial coinfections. However, because of delays in case identification and antiviral deployment as discussed in box The term scaling up refers to the expansion of health intervention coverage Mangham and Hanson In the context of pandemic preparedness, successfully scaling up requires health systems to expand services to accommodate rapid increases in the number of suspected cases.

Scaling up is facilitated by surge capacity the ability to draw on additional clinical personnel, logisticians, and financial and other resources as well as preexisting operational relationships and plans linking government, nongovernmental organizations, and the private sector. Ultimately, scaling up consists of having both local surge capacity and the absorptive capacity to accept outside assistance.

Local capacity building is vital, and some capacities may have particularly important positive externalities during outbreaks. During the Ebola importation into Nigeria, surge capacity that existed because of polio eradication efforts contributed to a more successful outbreak response Yehualashet and others Key elements included national experience running an emergency operations center and the use of global positioning systems to support contact tracing Shuaib and others ; WHO a.

Stockpiling of vaccines, medicines including antibiotics and antivirals , and equipment such as masks, gowns, and ventilators also can be useful for building local surge capacity Dimitrov and others ; Jennings and others ; Morens, Taubenberger, and Fauci ; Radonovich and others During a pandemic, health systems can tap into stockpiles more quickly than they can procure supplies from external sources or boost production.

However, there are five important considerations for keeping stockpiles:. Boosting local production capacity for necessary supplies may be a viable strategy for pandemic preparedness and may circumvent some of the challenges associated with amassing stockpiles. The influenza pandemic demonstrated how scaling up can affect the success rate of a mass vaccination campaign table Vaccination rates increased according to country income level, suggesting that vaccination campaigns were most successful in HICs, likely because of the size of their stockpiles, increased manufacturing capacity for vaccines, increased availability of vaccines, and more streamlined logistics in vaccine deployment.

Building local capacity to scale up is challenging, especially in LMICs. The biggest challenges include infrastructural gaps such as weak road, transportation, and communications networks and shortfalls in human resources such as logisticians, epidemiologists, and clinical staff. Bilateral and multilateral aid organizations have channeled substantial funding into building and sustaining local technical capacities in LMICs.

This type of investment is critically important. But, particularly in LMICs with weak health system capacity, progress in expanding local surge capacity likely will be slow. Another key component of scaling up, especially in LMICs, is the ability to use external assistance effectively.

During the West Africa Ebola epidemic, a surge of foreign clinicians, mobile medical units, and epidemiologists and other public health personnel was required to bolster limited local resources. LMICs can improve systems to facilitate and coordinate surges of foreign support in the following ways:. Even so, local absorptive capacity that is, the ability to channel and use foreign assistance effectively has its limits.

Constraints in bureaucratic capacity, financial controls, logistics, and infrastructure all are likely to be most severe in the countries that most need foreign assistance to manage infectious disease crises. Furthermore, although external assistance is a viable strategy during localized epidemics, it has limitations that are likely to arise during large-scale pandemics.

First, supply constraints exist, including limits to the number of medical personnel especially those with crisis response and infectious disease competencies and the number of specialized resources such as integrated mobile medical clinics available for deployment. Second, during a severe pandemic, countries are likely to use such resources locally before providing medical assistance abroad.

The global humanitarian system provides a critical reservoir of crisis response capacity and shock absorption. However, the humanitarian system currently is straining under the pressure of other crises, including upsurges in violent conflict Stoddard and others A severe epidemic or pandemic can quickly outstrip international resources. As with any other type of natural disaster, the risk from pandemics cannot be eliminated. Despite prevention efforts, pandemics will continue to occur and will at times overwhelm the systems that have been put in place to mitigate their health, societal, and economic effects.

The residual risk may be significant, particularly for LMICs that lack the resilience or resources to absorb shocks to public health and public finances. Risk transfer mechanisms such as specialized insurance facilities offer an additional tool to manage this risk. Risk-based insurance products are increasingly deployed in LMICs to pay for remediation and reconstruction costs following natural catastrophes such as hurricanes, floods, and droughts ARC ; IFRC Insurance products for epidemics and pandemics require specific characteristics.

First, insurance policies should be designed to release discretionary funds early in the course of an outbreak. In situations where financing poses a constraint to mobilizing personnel, drugs, or other supplies, payouts can be used to mobilize a public health response and mitigate further spread of disease, reducing the potential health and economic impacts of the pandemic.

Third, risk transfer systems require the availability of rigorously and transparently compiled data to trigger a payout. In the context of pandemic insurance, the development of risk transfer systems requires countries to build the following capacities, among others:. Insurance facilities can create positive incentives for LMICs to invest in planning and capacity building.

Insurance mechanisms may have other positive externalities: most notably, the potential release of funds may provide a strong incentive for the timely reporting of surveillance data. However, insurance facilities also may introduce perverse incentives including incentives to distort surveillance data and potential moral hazards such as permitting riskier activities. These incentive problems may be mitigated in the design of the risk transfer mechanism, such as by providing coverage only when minimum requirements for surveillance accuracy are met, by having preset phased triggers for payouts, and by including incentive payouts for successfully containing an outbreak.

Relative to investments in basic health provision, building capacity in infectious disease surveillance systems and other dimensions of pandemic preparedness has uncertain and potentially distant benefits. In LICs where near-term health needs are acute, this can complicate the political and economic logic for investing in pandemic preparedness Buckley and Pittluck The use of catastrophe modeling tools such as EP curves can clarify the benefit-cost rationale and the relevant time horizon for investments in preparedness, and it can inform the design and financial structure of pandemic insurance policies.

Figure On the basis of its risk tolerance, the country makes a decision to manage its risk at the 3 percent annual probability point on its EP curve. Some or all of this shortfall could be offloaded to another entity, such as a catastrophe risk insurance pool, which would give the country access to a payout during a pandemic.

Because the PEF is designed to trigger early in an outbreak, the anticipated funding is less than would be required for a full-fledged response once a widespread pandemic is under way. Risk transfer mechanisms such as insurance offer an injection of financial resources to help insured parties rapidly scale up disease response activities.

As such, the utility of risk transfer mechanisms depends, in large part, on the absorptive capacity of the insured party. A country must have the ability to use insurance payouts effectively to access additional human resources clinicians, community health workers , personal protective equipment and other medical equipment consumables, and vaccines and therapeutics, from either domestic or international resources. Much of the available data regarding pandemics including the morbidity and mortality impacts of historical pandemics and the effectiveness of different preparedness efforts and interventions come from HICs and upper-middle-income countries.

Understanding of the prevalence of risk drivers, especially regarding spark risk, has improved markedly in both high- and low-income contexts. However, gaps in surveillance and reporting infrastructure in LMICs mean that, during a pandemic, many cases may never be detected or reported to the appropriate authorities Katz and others Particularly in LICs, empirical data on outbreak occurrences may be biased downward systematically.

Additionally, the means to disseminate collected data rapidly may not exist. For example, data may be kept in paper archives, so resource-intensive digitization may be required to analyze and report data to a wider audience. Data dissemination challenges are further compounded by a publication bias that results in overrepresentation of HICs in the scientific literature Jones and others Few data are available regarding costs and cost-effectiveness of pandemic preparedness and response measures, and they focus almost exclusively on HICs.

The available data suggest that the greatest cost-related benefits in pandemic preparedness and response are realized from early recognition and mitigation of disease—that is, catching and stopping sparks before they spread. Costs can be reduced if action is taken before an outbreak becomes a pandemic.

Similarly, once a pandemic has begun, preventing illness generally is more cost-effective than treating illness, especially because hospitalizations typically have the highest direct cost per person. High costs also may occur as a result of interventions such as quarantines and school closures that lead to economic disruption.

These interventions may be more cost-effective during a severe pandemic. No systematic time-series data exist on global spending on pandemic preparedness, and arriving at an exact figure is complicated by the fact that many investments in building basic health system capacity also support core dimensions of pandemic preparedness. Other, non-ODA spending on pandemic preparedness is similarly difficult to measure but likely to be significant; in , the U.

Globally, the current funding for pandemic preparedness and response falls short of what is needed. Costs for efforts associated with prepandemic preparedness activities also are not well quantified, although investment in One Health activities is likely to be cost-effective World Bank Instituting response measures after a pandemic has begun can be expensive, with most of the direct cost borne by the health care sector, although response costs typically are not reported in a cohesive manner.

When total costs for response are not available, unit costs for response activities provide valuable insights. Vaccinations and medicines have the lowest unit costs; in LMICs, large-scale purchasing and subsidies could push drug costs down even more. Conversely, hospital care has the highest unit costs. Costs per day of hospitalization especially those with ICU involvement can add up quickly when aggregated at the national level. However, these medical care costs are potentially bounded by capacity limits such as a finite number of hospital beds , especially during more severe pandemics.

Pandemic severity itself can play a role in the drivers of cost and the effects of mitigation efforts. One study based on modeling simulations in an Australian population found that, in low-severity pandemics, most costs borne by the larger economy not just the health care system come from productivity losses related to illness and social distancing.

In higher-severity pandemics, the largest drivers of costs are hospitalization costs and productivity loss because of deaths Milne, Halder, and Kelso The lowest costs per deaths prevented were found for contact tracing, face masks, and surveillance. Pharmaceutical interventions such as vaccines and antiviral therapies were in the midrange. Measures that decreased person-to-person contact, including social distancing, quarantine, and school closures, had the greatest cost per death prevented, most likely because of the amount of economic disruption caused by those measures.

Social distancing includes avoidance of large gatherings and public places where economic activities occur. School closures often lead to lost productivity because they cause workplace absenteeism among caretakers of school-age children.

Macroeconomic model simulations also have identified school closures as a potential source of GDP loss during a moderately severe pandemic Smith and others The information shown in figure Data on antiviral stockpiles provide some insight into how the cost utility of pandemic preparedness efforts may vary by country income level.

Although based only on a handful of countries, the results suggest that antiviral stockpiling in LICs has an extremely high cost per death prevented, whereas countries at other income levels are clustered within much lower ranges. Antiviral stockpiling is not cost-effective or feasible for LICs, primarily because of the high cost of antiviral agents.

For stockpiling to be a cost-effective strategy for LICs, almost all of the costs would have to be subsidized. The associated costs also may be reduced by the increased availability of generic antiviral drugs. Additionally, the efficacy of antivirals is not assured, particularly for LICs, which may not be able to identify cases early enough to administer antivirals efficaciously. In their analysis, the following interventions among the general population had the potential to provide cost savings: vaccines, antiviral treatment, social distancing, antiviral prophylaxis plus antiviral treatment, and vaccines plus antiviral treatment.

The cost savings from antiviral drugs found in this study are likely to be diminished in LMICs, as inability to deploy antivirals in a timely manner poses a serious challenge to their efficacious use. Depending on the characteristics of a pandemic and how mitigation efforts are implemented, some mitigation strategies could become highly cost- ineffective.

For example, a costly vaccination campaign that is carried out in an area well after a pandemic peaks is not nearly as effective in reducing transmission as having vaccines available and distributed earlier in the pandemic. Allocation of limited resources by creating priority groups for vaccines and antivirals is an important consideration during a pandemic.

Modeling studies from the influenza pandemic investigated the most cost-effective strategies for allocating vaccines. Those studies found that vaccinating high-risk individuals was more cost-effective than prioritizing children. Favoring children decreased the overall infection rate, but high-risk individuals were the predominant drivers of direct costs during the pandemic, because they were more likely to be hospitalized Lee and others However, these studies did not account for the indirect costs of school closures and absenteeism.

Consideration of these factors could reveal increased cost savings from vaccinating children. Another key question for benefit-cost analyses related to pandemics is the extent to which stockpiles of vaccines, antiviral drugs, and protective equipment should be assembled in advance of a pandemic.

Vaccines for a novel influenza virus can take several months to develop, and vaccines for other pathogens for example, Ebola and Zika can take even longer to develop. Studies have examined the cost-effectiveness of stockpiling prepandemic vaccines that have lower efficacy than reactive vaccines but can be deployed more quickly.

One study found that cost savings can be obtained as long as prepandemic vaccines have at least 30 percent efficacy. However, cost-effectiveness differs by pandemic severity and the percentage of the population that receives the vaccine during the vaccination campaign Halder, Kelso, and Milne Antiviral drugs to fight pandemic influenza also can be stockpiled ahead of time.

However, the optimal number of doses to stockpile depends on factors including the effectiveness of concurrent interventions and the likelihood of antiviral wastage on noninfluenza respiratory infections Greer and Schanzer Most pandemic-related benefit-cost studies focus on pharmaceutical interventions for high-income and upper-middle-income countries. The studies have largely neglected the question of how to allocate strained resources in low- and lower-middle-income countries.

Furthermore, few evaluations have been conducted of the cost-effectiveness of general investment in health systems, infrastructure, and capacity building as a means to achieve pandemic preparedness Drake, Chalabi, and Coker Preparing for a pandemic is challenging because of a multitude of factors, many of which are unique among natural disasters.

Pandemics are rare events, and the risk of occurrence is influenced by anthropogenic changes in the natural environment. In addition, accountability for preparedness is diffuse, and many of the countries at greatest risk have the most limited capacity to manage and mitigate pandemic risk.

Unlike most other natural disasters, pandemics do not remain geographically contained, and damages can be mitigated significantly through prompt intervention. As a result, there are strong ethical and global health imperatives for building capacity to detect and respond to pandemic threats, particularly in countries with weak preparedness and high spark and spread risk.

Investments to improve pandemic preparedness may have fewer immediate benefits, particularly relative to other pressing health needs in countries with heavy burdens of endemic disease.

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