wmo forum geneva 8-11 april, 2013 michel jancloes md, mph, phd health and climate foundation climate...

WMO ForumGeneva 8-11 April, 2013

Michel Jancloes MD, MPH, PHD

Health and Climate Foundation

Climate Services for Health

Climate Services for Health?

Interest and challenge

•Increasing health risks linked to climate•Improved climate information •Better knowledge on Health an Climate interface (including predictive modeling)

However

•Little is known on the possible impact of climate services on Health risks reduction•There is need for an impact-oriented strategy

M. Jancloes. WMO Forum Geneva 2013

An Impact-oriented Strategy


Health deliverables

OperationalStrategies

Knowledge building

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Malaria and Climate changesInformation based approach: warning of risk transmission: planning and management adaptation

Climate changes and their impact on– the Anopheles (vector)– the plasmodium(s)– the population immunity


Malaria and Climate changes: can forecasting make a difference?

Defining an alert threshold: based on weather indexed indicators to anticipate malaria outbreaks and support decision making on operational issues such as:

– Improving treatment algorithms on fever (including weather /climate criteria)

– When and where to use mosquito bed nets ? (social marketing) – How to include these data into costs/risks sharing to ensure

affordable access to health care (climate sensitive insurance scheme?)


Defining the criteria for risk reduction

Case story 1: MERIT


MeningitisEnvironmentRiskInformationTechnologies

The Meningitis Belt in Sub The Meningitis Belt in Sub Sahara AfricaSahara Africa( Lapeyssonie and all, 1968( Lapeyssonie and all, 1968))

The Meningitis Belt in Sub The Meningitis Belt in Sub Sahara AfricaSahara Africa( Lapeyssonie and all, 1968( Lapeyssonie and all, 1968))

What shape today? tomorrow?


MERIT• The MERIT initiative is a multi- sectoral partnership of health experts

(public health specialists, epidemiologists, immunologists, microbiologists, demographers, etc.) and climate and environment scientists.

• The main objective of the initiative was to address meningococcal meningitis epidemics in Africa and its influent environmental, biological, economic and demographic determinants.

• The effort was designed to create new knowledge that can be used to improve the current, (reactive) and future (proactive) vaccination strategies.


Initiative background and rationale

The cyclic meningitis outbreaks are due to a conjunction of risks factors, poorly understood•The meningitis belt in Africa is extending•There is an urgent need to better capture the influence of environmental factors on epidemics•Attention is given to

– climate changes– New climate technologies

•Services are available


Meningitis A. epidemiological risks factors:A changing pattern

Season: Dry season

December to June


Biological factors: Damaged mucosaCo-infections

Climate factors:

Humidity, dust, winds, temperature

Person to person transmissionCarriers

Social & behavioural factorsCrowded housingDisplacementsSocial gathering

Seasonal annual epidemic pattern Major cyclic outbreaks every 5-12 Y

Causal pathogen

Preventive vaccine Reactive vaccination

Dr Michel JANCLOESHCF

MERIT Implementation: 2007-2013


– Health- Climate alliance: WHO initiative, established at a GEO hosted meeting in 2007 Geneva,

– A Global Steering Committee chaired by WHO

– A Scientific platform • 6 Global annual technical meetings. • Operational research: monitoring in near real time environmental conditions

and epidemics, modelling and forecast testing• Research subgroups.• Country and regional settings • Global partnerships, joined by 35 partners

– Information and knowledge dissemination; database development: web site– Training; Institutional development.


MERIT merits

After 5 years of existence MERIT has

shown to bring added value for

• Case detection, surveillance and Alert preparedness • Multi-disciplinary operational research • Setting methods for measuring and forecasting outbreaks

risks• Health (MOH) & Meteorologist specialists institutional

cooperation• Relevance, quality and availability of climate data • In service training


Current challenges for MERITThere is need to:• Improving response timeliness to epidemic outbreaks (refining the

decision tree)with an early warning system• Guiding the introduction of the new Vaccine

– Integrating environmental/climate factors in the design of impact evaluation studies for the conjugate A vaccine

– With attention to possible variations in meningitis strains biology.• Re-defining the Meningitis belt and its extension based on:

– A retrospective review of existing data, projected changes of climatic demographic epidemiological and environmental data

– The mapping of populations at higher risk– The predictive value of models on different epidemic scenarios, in

countries and at fringes of the belt, with and without vaccines



MERITRéférences: MERIT Web site: http:// www.merit.hc-foundation.orgWith:

• WHO perspectives on MERIT research and modelling activities. July 2011• MERIT Strategic Review Report . Nov. 2011MERIT Strategic Review Meeting – WMO

www.wmo.int/pages/prog/.../3_9_2_MERIT_Strategic_Review.pdf• M. Thomson: Climate and Public Health - The MERIT Initiative conference2011. wcrp-climate.org/abstracts/thomson_A6.pdf• MERIT Initiative: A climate and health partnership to inform decision makers April 2012

http://conference2011.wcrp-climate.org• MERIT case study for Climate Services Partnership Sept.2012 http://climate-services.org


GlobalLeptospirosisEnvironmentalAction Network

Case story 2: GLEAN


Leptospirosis: Magnitude

• A global endemic +epidemic disease

• Of increasing magnitude through severe post-disaster , floods outbreaks .

• Counting annually worldwide, >500,000 cases >50,000 deaths

• Estimated, when adjusted due topotential underreporting to cause annually

>1,500,000 cases, >100,000 deaths

• A serious global zoonosis

• http://www.who.int/zoonoses/diseases/lerg/en/


A Public Health Threat

• A Major human and animal disease– yet neglected, – non-detected, – under-reported

• Absence of control strategy due to– Non- specific symptoms– Complex transmission– Complex pathogen agent with multiple

variants (>250 sero-variants)

• Economic Impact: a serious zoonosis

• Probable impact of climate change, in urban slums, subsistence farmers

• Increasing concerns at country level and request for technical support


Challenges (GLEAN working groups)

PREDICTPREDICT

Baseline Incidence?

Main drivers and predictive value?***• Climate,

• Environment• Vector

demography

Predictive models and risk stratification***

(to be validated at risk sites.)

INTERVENEINTERVENE

Informing public ***

health decision

Outbreak investigation guidelines. **

Operational Guidance for outbreak control. *

PREVENTPREVENT

Evaluation of

-Rodent controls? **

-Chemoprophylaxis

In humans? *

-Impact of animal vaccination ?

DETECTDETECT

Case definition?

Outbreak threshold?

Early diagnosis tests and case confirmation

(specificity-sensitivity)

Algorithms for outbreak detection ? **


Future challengesNew partnerships: new working areas

– Public Health-Veterinarians-Biotechnology Industry Economic analysis of outbreaks Detection strategies Vaccine development

– Public health and Research Institutions Early case detection

surveillance and public health intelligence Improved coordination with climate services ***

– GLEAN and countries Method comparison and knowledge sharing Testing and experiment strategies Public information


What are the lessons for an impact oriented strategy?

• There is need to:– Understand the operational issues for prevention

and control– Identify the specific climate indicators which are

critical for decision making (i.e: defining an alert threshold) in public health : they may vary with the disease and socio economic conditions)

– Validate climate information tools and algorithms at risk sites


The HCF Missionto reduce the health risks due to the impact of climate and inequities in mitigation and adaptation strategies,

by facilitating and convening the dialogue and interaction between the health sector, the climate services, research and development institutions, decision makers and community groups.


Thanks!


Health and Climate Foundation

wmo forum geneva 8-11 april, 2013 michel jancloes md, mph, phd health and climate foundation climate...

Documents

wmo forum geneva

health slide

health climate alliance

climate interface

climate changes information

availability of climate

weather climate criteria

michel jancloes md