What we learned from “Catching What’s Shifting,” our first webinar with Columbia Global Centers

On October 26, CSIDNet and Columbia Global Centers co-hosted “Catching What’s Shifting: Climate-Sensitive Infectious Diseases from Nairobi, Mumbai, and Rio.” It was our first event with Columbia, and it brought members of both communities together (virtually) around a practical question: when a forecast says the risk of a climate-sensitive infectious disease is rising, what has to happen next?

Wafaa El-Sadr, Executive Vice President for Columbia Global, opened the session, and Abdulmumuni Samuel Aliyu, a member of CSIDNet’s Events and Gatherings Committee, moderated a conversation with Jeffrey Shaman, Professor at the Columbia Climate School,  and Margareth Dalcolmo, a senior researcher at the Oswaldo Cruz Foundation. Our Nairobi panelist was unable to join on the day, so the discussion leaned on Brazil and on Jeffrey’s work on forecasting more broadly and preparedness work in Brazil.

Here are a few lessons we are taking away:

1. A forecast is only useful if someone is ready to act on it. Samuel pushed the panel to make this concrete: a health system learns that malaria risk is rising over the next four weeks. Jeffrey’s answer started with the hospital. Do we have enough clinicians and beds? What is our supply status, from malaria treatments to gloves? How do we set up triage, and do we need temporary space? And how do we manage this not for one day but across weeks, through the peak and after it?

2. Consistent data matters more than lots of data. A participant, dialing in from Tanzania, asked what information should be collected to inform national responses. Jeffrey said “the backbone of it has to be regular collection of health outcome data, gathered at the same frequency and with the same diagnostic procedures across facilities, over a long enough period to build and test a prediction model.” Climate data matters too, as does information on interventions like bed net campaigns, but health outcome data is usually what is missing.

3. Climate is one driver among many. “It’s important that we not declare that climate is the sole driver of infectious disease because it most certainly isn’t,” Jeffrey said. His example was cholera and other diarrheal disease outbreaks in refugee camps: people may have fled drought, which is a climate signal, or conflict, which may have nothing to do with climate, and conditions in the camp look the same either way. Understanding the pathway matters before building a warning system around it.

4. Start local, with the diseases that actually burden a place. “We don’t need a malaria warning system in areas that don’t have malaria,” Jeffrey noted, and a system built in Rwanda should look different from one built in Brazil. The starting point is the local disease burden, then the question of which of those diseases are climate sensitive and can be forecast. Margareth described how this plays out across Brazil, where dense urban areas and forest regions in the north need different strategies. After a severe dengue epidemic two years ago, with about a million cases in the Rio de Janeiro area alone and high mortality among adolescents, Brazil is prioritizing older people and adolescents for vaccination with the Takeda vaccine (also produced at the Butantan Institute), alongside Wolbachia mosquito releases and public awareness work.

5. Communication is part of the response. Margareth, who served on the Ministry of Health’s expert group from the start of COVID-19, talked about learning to translate. For example, she does not tell the public about how vaccines stimulate T lymphocytes; she tells them vaccines help the body defend itself against hospitalization and death. Scientists, in her view, should never hold back from giving people information.

6. Health systems will have to handle infectious and noncommunicable disease at the same time. Wafaa pointed out that many health systems in countries around the world have been shifting toward addressing noncommunicable diseases and aging populations just as climate change brings infectious threats back. Jeffrey reminded us that in the 1950s and 60s the WHO thought infectious diseases were close to eradication, and that only two diseases have ever been eradicated, one of which (rinderpest) does not even affect humans. The two kinds of disease types are intertwined, and neither is going away.

In his closing, Samuel reminded us that “recognizing a changing risk is not the same as being prepared for it.” He also raised a question there was no time to take up: how do we make sure the communities most exposed to these risks are not the ones least able to benefit from early warning and preparedness? We want to come back to it in a future session in the series.

We were glad to bring CSIDNet’s and Columbia’s communities into the same conversation for our first co-hosted event, and to hear questions from members joining from Tanzania, Uganda, Ethiopia and beyond. Thank you to Wafaa, Jeffrey and Margareth, to Samuel for his moderation, and to the teams who made it happen: Sandra Mikal Masira, Puja Pednekar and Maria Luiza Paranhos at Columbia Global Centers, and Livini Perera and Ragıp Zık at CSIDNet.