In the last few years, there has been increasing attention to the links between climate change and health and calls to address the impact of climate change on health. This year’s global UN summit on climate change, known as COP28, will be the first of these event s to have a day dedicated to health. This week at the World Health Summit in Berlin, “the COP28 Presidency launched the ‘COP28 Declaration on Climate and Health’ as part of its commitment to make health a central element of the climate agenda,” according to a press release. COP28 President Dr. Sultan Al Jaber is quoted: “The link between climate change and health is becoming increasingly evident every day, with diseases like malaria surging as temperatures rise, and extreme weather events impacting people around the globe. The international community must act now to put health at the center of climate action before we see global health systems overwhelmed. Through the Declaration on Climate and Health we aim to help deliver public health systems that are climate-resilient, sustainable and equitable, and we urge all nations to endorse it.” 
 
This newsletter has often highlighted stories about the impact of climate change on health, from increasing cholera outbreaks to malaria and other infectious diseases moving back into regions where they had long been eliminated, fueled by a changing climate. Keep reading below for news on some of the latest disease outbreaks at least partially caused by climate disruptions.
 
If You Are in A Hurry

• Read The New York Times on the impact of lab leak fears on some US research into dangerous pathogens.
• Read Bhekesisa on the potential impact of climate change on the spread of TB.
• Read Axios on a potential use for artificial intelligence to help predict how SARS-CoV-2 and other viruses may mutate.
• Read The New York Times on new research that may shed light on causes of long COVID.
• Read a perspective in NEJM from Peter Hotez and Angelle Desiree LaBeaud who say yellow fever and other mosquito-borne diseases are likely to return to the Southern US.
• Read an analysis from Public Citizen and Health GAP on the huge shortfall of COVID-19 treatment doses in LMICs.
• Read The New York Times on a new study into what causes long COVID.

 
Climate Change and TB

Bhekesisa (South Africa) looks at the link between increasing rates of TB and climate change, reporting, “Changing weather patterns will cause TB to spread — not so much because places are getting hotter or drier, but because disruptive storms, heatwaves and droughts will become more common in the future. When people have to flee their homes because of climate disasters and seek refuge in crowded shelters, TB can spread easily. Disrupted health services for things like TB and HIV treatment and not having enough healthy food will make things worse.”
 
Neglected Tropical Diseases and Mental Health

Nature (UK) looks at the “psychological burden of disability and stigma” borne by many who are living with neglected tropical diseases. “These conditions are caused by a range of pathogens, including bacteria, viruses, fungi and toxins. They are united by the fact that they affect some of the poorest people on the planet and receive relatively little global attention. Most NTDs do not kill people, but many do cause severe scarring and disability, and numerous studies have demonstrated links between various NTDs and mental health. The full mental-health burden of NTDs, however, is unknown. ‘If you speak to any clinician, they’ll say this is a massive issue. We see it every time someone walks into our clinic and they’ve lost their job, or their husband, or had stones thrown at them by children,’ says Julian Eaton, a psychiatrist at the London School of Hygiene and Tropical Medicine. ‘But the research is really underinvested in at the moment.’”
 
Outbreaks Old and New

BNN (India) reports, “In a world still grappling with the fallout of a global pandemic, emerging health threats take on a renewed sense of urgency. For Indonesia, this urgency arrives in the form of monkeypox, a rare but severe viral disease, marking its second appearance in the country. In contrast, Vietnam grapples with a surge in dengue fever cases, a familiar adversary with a penchant for re-emergence. Both nations face the paradox of health crises, old and new, in a world where the battle lines of disease are constantly redrawn…. The juxtaposition of monkeypox in Indonesia and dengue fever in Vietnam underscores the complex and ever-evolving landscape of global health crises. As the world navigates the fallout of one pandemic, it’s a stark reminder of the constant vigilance required in the face of emerging and re-emerging diseases. The battle against health crises is a continuous one, with new challengers appearing even as old adversaries refuse to fade away.”
 
Huge Unmet Need for COVID-19 Treatment in LMICs

Public Citizen reports on a new analysis from Public Citizen and Health GAP which found, “that the number of people with high risk COVID-19 infections in low and middle income countries (LMICs) exceeded procured supply of the World Health Organization’s antiviral of choice – nirmatrelvir/ritonavir, marketed by Pfizer as Paxlovid – by at least eight million courses in 2022. This shortfall late in the COVID-19 emergency left unmet at least 90% of health need for the WHO-preferred treatment in developing countries…. The analysis suggests that supporting affordable, predictable and diverse sources of supply of future treatments can help spark country demand and meet treatment needs.” Read the report.
 
Fear of Lab Leaks Dampens Some Research

The New York Times (US) reports, “Questions about whether COVID-19 leaked from a Chinese laboratory have cast a chill over American virus research, drying up funding for scientists who collect or alter dangerous pathogens and intensifying a debate over those practices. The pullback has transformed one of the most highly charged fields of medical science. While some believe such experiments could fend off the next pandemic, others worry that they are more likely to start one.”
 
Malaria Cases Rise in Unlikely Parts of Kenya

The Standard (Kenya) reports, “Counties in the northern part of Kenya are recording a high prevalence of malaria, a trend that is worrying scientists, especially with the invasion of a new species of mosquito in the country….The malaria expert [Dr Donald Apat, Program Manager for Global Fund Malaria at Amref] said climate change may be the driver of the current surge. He observed that the northern part of the country has in the past been considered to be very hot, but with climate change, the areas are witnessing rainfall in abnormal proportions.”
 
Using AI to Forecast COVID-19 and Other Virus Strains

Axios (US) reports, “Harvard and University of Oxford researchers are harnessing AI to predict threatening new strains of COVID-19 and other viruses…. The approach could prove more efficient than lab-based testing, because it doesn't rely on people becoming infected or getting vaccinated to develop antibodies. This could lead to better and quicker vaccines, including in the next pandemic.”
 
Looking For Ways to Treat Long COVID

BBC (UK) reports, “A team of experts have started a new trial to test if an anti-viral drug could cure people with ‘long COVID’…. The study… involves about 100 people who have lived with the condition for more than two years. Dr Mark Faghy said the nine-month project would test remdesivir, which had been used to treat acute COVID.”
 
The The New York Times (US) reports, “A team of scientists is proposing a new explanation for some cases of long COVID, based on their findings that serotonin levels were lower in people with the complex condition. In their study, published on Monday in the journal Cell, researchers at the University of Pennsylvania suggest that serotonin reduction is triggered by remnants of the virus lingering in the gut. Depleted serotonin could especially explain memory problems and some neurological and cognitive symptoms of long COVID, they say.” Read the study.
 
Paxlovid Helps Prevent Long COVID in Some Populations

MedPage Today (US) reports, “Use of nirmatrelvir-ritonavir (Paxlovid) during the acute phase of COVID-19 appeared to significantly reduce the risk of post-COVID conditions (PCCs) in older adults at high risk for severe disease, but may have increased the risk in adolescents, according to a large case-control study from the CDC. In adults ages 50 and up, the risk of PCCs was lower among those who received nirmatrelvir-ritonavir…. However, in adolescents ages 12 to 17, the overall risk of PCCs in those who received the antiviral was significant for one or more PCCs, including hypertension, asthma, and type 2 diabetes, but not significant for two or more PCCs…. For adults ages 18 to 49, the use of nirmatrelvir-ritonavir appeared neutral with regard to PCC risks, with some variation. Dalton pointed to a slightly increased risk of asthma, but a decreased risk of thromboembolic events.”
 
Pandemic Early Warning System Needed

FT (US) reports, “A ‘global early warning system’ for dangerous viruses is essential to head off future pandemics and speed up vaccine development, says the head of an organisation charged with preventing such health crises. Greater surveillance and co-operation are needed to flag what health experts call ‘disease X’, an infectious disease yet to emerge that has the potential to cause a pandemic, said Richard Hatchett” of CEPI. 
 
Confronting the Ongoing Mpox Crisis in Africa

The Nation (Nigeria) reports, “The Nigeria Centre for Disease Control and Prevention (NCDC) and its partners have completed a strategy to strengthen mpox outbreak prevention, response and control in Nigeria…. Since the virus re-emerged in Nigeria in 2017, reported cases have continued to increase annually.” In a statement NCDC director Dr. Ifedayo Adetifa said “there are important gaps in clinical and epidemiological knowledge of mpox in Nigeria that are not limited to the hypothesised loss of protection from historical smallpox vaccination, lack of clarity about the actual animal reservoir, and emerging genomics data suggesting transmission may now be entirely human to human.” NCDC is sponsoring a research project: “Epidemiological and Clinical Investigation of mpox in Nigeria: A Multi-Disciplinary Research Project To Inform Case Management and Outbreak Prevention and Control” to help develop better mpox controls.
 
The Telegraph (UK) reports on the ongoing burden of mpox in countries like DRC. “Last week, reports emerged that 60 people had died of Mpox as part of an outbreak that infected 1,100 people in the Democratic Republic of Congo (DRC). Dr Francis Baelongadi, the head doctor of the local health department, says that such numbers aren’t out of the ordinary. ‘We are in an area where every month, every week we have new cases of Monkeypox,’ he said. ‘Some months the cases are very high.’…. During the 2022 Mpox outbreak, high-income countries were able to quickly secure large vaccine supplies to offer to their at-risk populations…. Africa, in contrast, has not received a single dose of the vaccine.”
 
Infection Induced Immunity to Mpox in the Netherlands

CIDRAP (US) reports on a new study that has yet to be per reviewed: “An analysis of the Netherlands’ mpox outbreak and measures to battle the disease suggest that infection-induced immunity, rather than vaccination, may have been the biggest contributor to a sharp decline in cases in summer 2022. Researchers from the country reported their findings this week on the medRxiv preprint server…. The group said it’s not likely that the vaccine triggered the outbreak decline, given that cases started falling before the mpox vaccine program began.”

Yellow Fever and other Mosquito-Borne Diseases Could Return to the US

Peter Hotez and Angelle Desiree LaBeaud write in a perspective in NEJM (US) that the spread of mosquito-borne diseases “has begun accelerating in the American South. Over the past decade, both Florida and Texas have experienced autochthonous outbreaks of dengue, chikungunya, and Zika virus infections, each transmitted by aedes mosquitoes… Data generated from epidemiologic, mapping, and modeling analyses reveal a new confluence of climate change, urbanization, and shifting patterns of human migrations that predicts significant upticks in infections with viruses transmitted by aedes mosquitoes…. Some forecasts are therefore bleak, suggesting that much of the southeastern United States will become widely suitable for dengue or other arbovirus infections. An added critical factor is extreme poverty throughout Texas and the Gulf Coast states, where inadequate or low-quality housing, absent or broken window screens, and a pervasive dumping of tires in poor neighborhoods (inviting breeding by Ae. aegypti) represent key risk factors. These conditions may ultimately permit sharp increases in the incidence of serious arbovirus infections in the southern United States.”