First Annual National Health And Climate Change Science And Policy Research Consensus Conference - How Will Climate Change Affect Priorities For Your Health Science And Policy Research?

Health Issue Topic: Vector-borne infectious diseases

Summary of Discussion

This breakout group considered how climate change and climate variability might affect the health threats posed by vector-borne and rodent-borne diseases in Canada. The conclusions and recommendations are in the form provided by the group. The strategic research questions provided by the group were in part rearranged or combined into larger themes for greater clarity, consistency or coherence. The section on research tasks, outputs, and uses or linkages of the research results is based on the questions which the group provided, but was drafted by the Climate Change and Health Office and was reviewed by members of the breakout group.

The group identified as research priorities the need for baseline data and for other information which is needed to track disease trends; the need for better methods to address issues related to the identification and control of vector-borne diseases; and the need to consider the interactions between vectors and their environment.

The group elaborated on its choice of strategic questions by identifying key needs for enhancing current research areas and creating new ones. The group recommended that the baseline data being collected on vector-borne diseases be improved, because valuable information may be lost if reporting is not accurate, immediate and complete. This requires not only collecting data from areas where the incidents are occurring, but also using an integrated approach by including biological and other factors involved in vector-borne diseases in the context of climate change. This is best done by using a multi-disciplinary approach with international collaboration

Effective prevention of vector-borne infectious diseases must focus on two aspects: public health measures, and combined conventional and holistic health care. The first involves identification of vector-borne diseases, and effective measures for vector and disease surveillance and control. The second involves comprehensive care of the health and well-being of infected and at-risk population groups or individuals, including traditional and multicultural health care methods, and social supporting mechanisms.

Vector-borne infectious diseases

Knowledge
Strengths

• Meteorological variables and disease requirements are known.
• Good understanding of life cycle of vectors and pathogens.
• Good international relationships.
• Good infrastructure to cope with and respond to issues.
• Good understanding of how diseases are transmitted.
• Good response time in monitoring pathogens over time and space.
• Capacity to develop strong GIS skills.
• Good baseline knowledge about potential vectors in Canada.

Limitations

• Limited awareness of the full gamut of ecological influences on vector-borne diseases.
• Limited awareness of current abundance and distribution of vectors and pathogens.
• Inadequate understanding of full impacts of climate change on vector-borne diseases in the short, medium and long term.
• Insufficient modelling ability, and insufficient number of modeling studies.
• Shortage of fully trained professionals.
• Significant uncertainties in current monitoring methods.
• Insufficiently detailed travel case histories of infected travellers returning to Canada.
• Insufficient sharing of information and knowledge on the health effects of climate change among primary health care providers.
• Insufficient dissemination of information among countries.
• Insufficient ability to anticipate new means of transmission and the introduction of new and re-emerging diseases and vectors.
• Insufficient understanding of the interactions among vectors, pathogens and all environmental changes, including new environmental contaminants.
• Failure to facilitate capacity building in other countries.
• Limited indicators for environmental health.
• Failure to consider traditional and Indigenous health care and methods for preventing and dealing with disease.
• Potential publication biases in favor of sensational research findings.
• Absence of a vested long-term interest in climate change, as demonstrated by a tendency to focus on short-term approaches. A short-term focus on present positive effects of global warming in a cold climate such as is being experienced on the Prairies, fails to consider the consequences of such warming for the medium-to-longer term either locally (e.g., drought) or in other regions (e.g., flooding coastlines).
• Inadequate recognition of varying levels of population vulnerability.
• Failure of economic models to weigh the full costs associated with the medium and long-term effects of climate change (a need for macro-economic modeling).

Data Sources
Strengths

• Sufficient research literature.
• Availability of free or inexpensive data sources on the Internet.
• Established confidentiality guidelines for sharing and gaining access to data.
• Existence of standards for data collection, which contributes to data accuracy.

Limitations

• Limited access to and linkages between certain types of data.
• Limited awareness of existing data.
• Various data gaps, including data collection that is not comprehensive or that focuses on irrelevant issues.
• Under-reporting from remote or under-serviced communities.

Methods
Strengths

• Well-developed epidemiological methods.
• Global Public Health Intelligence Network (GPHIN) housed at Health Canada.
• Good examples of effective public education (e.g. on UV radiation and skin cancer).

Limitations

• Political boundaries vs. natural eco-regions or climate-based regions as demarcated areas for assessing and comparing regional climate related effects.
• Reliance on reductionist rather than systemic approaches.
• Insufficient attention to multi-disciplinary or transdisciplinary approaches.
• Limited experience with foreign vector-borne diseases in Canada.
• Insufficient knowledge of why certain vector-borne diseases are self-limiting.
• Failure to factor in social and ecological determinants.

Capacity
Strengths

• The National Microbiology Laboratory in Winnipeg.
• The Prairie Adaptation Research Collaborative (PARC).
• The Canadian Climate Impact and Adaptation Research Network (C-CIARN).
• Good expertise in tropical diseases and climatology.
• The Global Public Health Intelligence Network (GPHIN).

Limitations

• Inadequate explanations of the science of climate change.
• Shortage of trained experts in insect- and rodent-borne diseases.
• Uncertainty over the use of the precautionary principle.
• Limited federal funding for surveilla nce, resulting in insufficient surveillance capacity.
• Inadequate collaboration among professionals.
• Insufficiently advanced information technology systems.
• Inadequate inspection methods.
• Absence of scenario-based risk assessment and integrated assessment frameworks.
• Positive and negative aspects of the relationship between climate change and human health.
• Inadequate inter- and trans-disciplinary approaches to studying vector-borne diseases (see also methods limitations).
• Inadequate rapid response systems. Absence of adequate scenarios for managing possible extreme weather disasters (e.g. flooding) resulting from climate change.

Comments on the Location of the Health Node of the Climate Impact and Adaptation Research Network , C-CIARN :

The group stated that Health Canada should continue to play an organizational role in relation to C-CIARN and to the Network Health Node. However, since other possibilities had not yet been put forward, it might be desirable to see if any Canadian university might wish to be involved.

Strategic Questions (arranged by Research Sub-Topic)

The research agenda should reflect the following strategic questions, tasks, and outputs/deliverables:

Knowledge Acquisition, Distribution, and Use

• 1. Question:
  What are the current and past incidences of vector-borne diseases in Canada , the USA and northern Europe, and how is the experience gained in coping with these outbreaks relevant to Canada under the conditions of Climate Change?
  

• Task:
  Establish a complete inventory of the distributions and abundance of vector-borne diseases and pathogens in Canada since 1950; map the number of annual cases of vector-borne diseases by ecozones and jurisdictional regions.
  
  
• Output:
  A national inventory of trends in the occurrence and distribution of vector-borne diseases and pathogens in Canada; data bases, maps, charts and tables, statistics, trend analyses.
  
  
• Uses / Linkages
  Recommendations for improved health risk assessment and health risk management policies and strategies through improved monitoring and surveillance of vector-borne diseases, and through a better understanding of key ecologic and jurisdictional factors which influence the occurrence and prevention of vector-borne diseases. More accurate and more useful information being communicated to health professionals, news media, and the public.
  
  
• Order on Critical Path, or Priority:
  Medium to High

• 2. Question:
  Are there publication biases in the literature regarding vector-borne diseases ?

• Task:
  Review published studies on vector-borne diseases, and assess whether editorial policies or practices of scientific journals may lead to biased reporting of scientific findings with special attention to reports which had no explicitly positive or negative outcomes (including the gray literature).
  
  
• Output:
  An assessment of actual or possible biases or gaps in the published scientific literature on vector-borne diseases, and of resulting information gaps or biases which might influence the setting of research and disease prevention priorities. Recommendations to establish and implement editorial and publication policies which would provide an unbiased reporting of scientific information, and to ensure that all relevant information is made available to interested users, even if it fails to meet some criteria for scientific publications.
  
  
• Uses / Linkages:
  More accurate information for setting research priorities, and for formulating health risk assessment and management policies and practices. Better use of resources.
  
  
• Order on Critical Path, or Priority:
  Medium to low

• 3. Question:
  What can be done to establish more complete and transparent reporting processes and more open information exchange for vector-borne diseases ?

• Task:
  Assess the extent to which the reporting and information exchange processes for vector-borne diseases in Canada and elsewhere can be improved.
  
  
• Output:
  Recommendations for improvements in reporting and information exchange processes to allow faster and more accurate use of scientific data and other information for the control and prevention of vector-borne diseases in Canada.
  
  
• Uses / Linkages:
  Faster and more effective health risk recognition and management through improved communication and action by public health authorities. Better use of resources. Improved risk communication to health professionals, news media, and the public.
  
  
• Order on Critical Path, or Priority:
  Medium to low

• 4. Question:
  How can current research and surveillance capacities and practices for vector-borne diseases in Canada and elsewhere be strengthened to improve their performance in the future ?

• Task:
  Establish criteria and indicators for desired performance levels, assess current performances, and identify means for improvement.
  
  
• Output:
  Recommendations for strengthening research and surveillance capacities for vector-borne diseases in Canada and in other countries relevant to Canada.
  
  
• Uses / Linkages:
  Improved recognition of present and imported or emerging vector-borne diseases and pathogens. Improved health risk assessment and management.
  
  
• Order on Critical Path, or Priority:
  High

• 5. Question:
  How can ecologically based health risk indicators improve early warning monitoring and surveillance of vector-borne diseases ?

• Task:
  Define appropriate indicators of environmental conditions that favour or impede the population growth, and dispersion of vectors and the virulence of pathogens and the transmission of pathogens to animals and humans, and implement their use. Include a consideration of ecological and climatic regions or zones, and their possible future geographic shifts in response to Climate Change. Establish sentinel reporting centres and provide guidelines for effective use of indicators of vector-borne disease risks by these centres.
  
  
• Output:
  Improved knowledge of the relationships between environmental factors and health risks due to vector-borne diseases which are, or may become, established in Canada, e.g. through importation or trans-border migration, or by other means. Assessments of the suitability of various candidate indicators, selection of preferred indicators , and guidelines for their appropriate use. Workshops and demonstration or pilot projects to promote the use of preferred indicators.
  
  
• Uses / Linkages:
  Improved health risk monitoring, surveillance, assessment and management, by taking into account the effects of Climate Change on present ecosystems and ecozones and their influence on health risk factors related to vector-borne diseases.
  
  
• Order on Critical Path, or Priority:
  High

• 6. Question:
  Ho w can Canadian public health officials and health professionals become better informed about the nature and health risks of vector-borne diseases which occur in Canada or which may reach Canada from other regions ?

• Task:
  In collaboration with Provincial and Territorial Chief Medial Officers of Health and public health representatives, assess the relevant knowledge among Canadian public health officials and health professionals, and identify common knowledge gaps and desired information. Compile and distribute desired information: hold information sessions, workshops; list or set up and publicize appropriate World Wide Web sites with relevant information, including names and location or institutional association of experts; reinforce and supplement existing appropriate information networks and electronic news letters. Establish partnerships for knowledge gathering and distribution. Periodically solicit feedback from health professionals to further improve the information transfer.
  
  
• Output:
  Assessments of information gaps and information needs; inventories of desired information and of appropriate means of information transfer; information dissemination initiatives, periodic assessments of the usefulness and effectiveness of the information content, and of the information transfer methods. Partnerships for knowledge gathering and distribution.
  
  
• Uses / Linkages:
  Better informed health officials and health professionals due to improved information needs assessment and information transfer. Improved health risk assessment and management. Better client-oriented continued education programs for public health officials, health professionals, and other interested persons. Partnership building.
  
  
• Order on Critical Path, or Priority:
  High

• 7. Question:
  How can one develop an integrated and effective framework for data collection, data access, data sharing, and research collaboration and partnerships in the area of vector-borne diseases?

• Task:
  Create an inventory of Canadian agencies, institutions, and experts and of their present information holdings, information dissemination and sharing, and research initiatives and partnerships related to vector-borne diseases. Assess their involvement in existing research networks and partnerships. Identify barriers and impediments to information sharing and research partnerships and means of removing or alleviating these obstacles. Identify incentives and possible means for increased collaboration.
  
  
• Output:
  Inventory of agencies, institutions, experts, and research networks which might be induced to increase their information sharing and collaborative research efforts on vector-borne diseases. Recommendations for achieving greater collaboration and partnerships.
  
  
• Uses / Linkages:
  Improved information acquisition and transfer, and greater collaborative research efforts; more effective use of resources. Augmentation and facilitation of C-CIARN and of public health initiatives to assess and manage public health risks of vector-borne diseases. Research policy development.
  
  
• Order on Critical Path, or Priority:
  High

• 8. Question:
  How will Climate Change affect environmental conditions, social and economic circumstances, the public health infrastructure, and population groups at risk from vector-borne diseases ?

• Task:
  Assess and categorize how the changing climatic factors might influence the present environmental, social, and economic conditions; the nature and adequacy of the public health infrastructure, the growth and distribution of human and vector populations, and vulnerable population groups at risk from vector-borne diseases. Involve mathematical modelers, climatologists, ecologists, epidemiologists, sociologists, economists, public health officials.
  
  
• Outputs:
  Data, scenarios and multi-disciplinary methods for coupling outputs from models for assessing climate change to models for assessing short, medium, and long-term climate influences on: - ecosystems and on the vector and pathogen populations in these; - on human population growth and human population movements; - on socio-economic circumstances; - human population groups at risk from vector-borne diseases.
  
  
• Uses / Linkages:
  Health risk assessments for vector-borne diseases under various future climate conditions. Control and prevention strategies for coping with the threat of vector-borne diseases under a variety of possible future climatic conditions. Improved health risk management.
  
  
• Order on Critical Path, or Priority:
  Medium

Public Health: a) Capacity Building

• 1. Question
  How can one improve the capacity of public health officials and health care providers to survey, identify, treat, control, and prevent vector-borne diseases, including through strategies and approaches which incorporate conventional, holistic, and traditional practices and approaches ?

• Task:
  In collaboration with Provincial and Territorial Chief Medial Officers of Health and, public health and health care representatives, assess current capacities and identify shortcomings or gaps. Assess costs, benefits and potential effectiveness of possible capacity building measures. Establish rationales and recommendations for capacity improvements.
  
  
• Uses / Linkages:
  Improved capacity to survey, identify, treat, control, and prevent vector-borne diseases. Improved health risk monitoring, surveillance, assessment and management. Improved knowledge basis for planning and building an adequate public health capacity for coping with vector-borne diseases.
  
  
• Order on Critical Path, or Priority:
  High

• 2. Question
  How can Geographic Information Systems (GIS) be used in assessing health risks from vector-borne diseases?

• Tasks:
  Using data available through the National Atlas of Canada and from other sources, map macro-, meso-, and micro-environmental spatial factors in conjunction with data on the distribution and population density of vectors, pathogens, potential host animals and humans to identify high-risk areas for vector-borne disease outbreaks (early warning systems).
  
  
• Output:
  Data collections, maps, graphs, charts, and other visual aids for showing potential high-risk areas for vector-borne disease outbreaks.
  
  
• Uses / Linkages:
  Improved health risk assessment and management for vector-borne diseases; development of policies and strategies for more effective use of public health resources based on GIS analyses. Outreach and education initiatives aimed at health professionals and the public.
  
  
• Order on Critical Path, or Priority:
  High

b) Health Risk Management

• 1. Question:
  How can one best inform Canadians about the dangers of assuming a 'business-as-usual' approach to vector-borne diseases when the health risks related to these diseases may be altered by Climate Change?

• Task:
  Identify knowledge, knowledge sources, health concerns and attitudes of Canadians in regard to vector-bo rne diseases and the relationship of these diseases to weather and climate. Assess knowledge gaps, misconceptions, and willingness to accept and act upon information from various sources. Develop case studies of vector-borne disease outbreaks to educate and sensitize target audiences to the challenge that vector-borne outbreaks represent. Recommend appropriate information initiatives.
  
  
• Output:
  Assessments of knowledge gaps and misconceptions and of their causes, and of appropriate means and methods, including identification of critical factors and components, for effective public information initiatives. Case studies showing how adequate public knowledge of the effects of weather and climate on vector-borne diseases can help people to better protect themselves. Recommendations for appropriate outreach and information dissemination initiatives.
  
  
• Uses / Linkages:
  Formulation of effective public information policies and strategies. Improved public knowledge of links between climate change and vector-borne diseases. Improved health risk management through changed public perceptions and attitudes.
  
  
• Order on Critical Path, or Priority:
  High

• 2. Question:
  How can ethical principles and values contribute to a more effective policy development for health risk management ?

• Task:
  Demonstrate the necessity of including ethical principles and values in health risk management of vector-borne diseases, e.g. through analogous case studies of recent failures of Canadian drinking water safety measures and their immediate and underlying causes, and of ethical strengths and weaknesses of recent US initiatives to contain the spread of West Nile virus.
  
  
• Output:
  Case studies and recommendations regarding the necessity of basing health risk management policies on ethical principles and values.
  
  
• Uses / Linkages:
  Development of policies and guidelines for health risk management of vector-borne diseases.
  
  
• Order on Critical Path, or Priority:
  Medium