WMO Forum Geneva 8-11 April, 2013 Michel Jancloes MD, MPH, PHD

1. Climate Services for Health WMO Forum Geneva 8-11 April, 2013 Michel Jancloes MD, MPH, PHD Health and Climate Foundation

2. 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

3. An Impact-oriented Strategy Health deliverables ? Operational Strategies ? Knowledge building M. Jancloes. WMO Forum Geneva 2013

4. Malaria and Climate changes Information 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 M. Jancloes. WMO Forum Geneva 2013

5. 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 M. Jancloes. WMO Forum Geneva 2013

6. Case story 1: MERIT MeningitisEnvironmentRiskInformationTechnologies M. Jancloes. WMO Forum Geneva 2013

7. The Meningitis Belt in Sub Sahara Africa( Lapeyssonie and all, 1968) What shape today? tomorrow? M. Jancloes. WMO Forum Geneva 2013

8. 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. M. Jancloes. WMO Forum Geneva 2013

9. 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 M. Jancloes. WMO Forum Geneva 2013

10. Meningitis A. epidemiological risks factors:A changing pattern Climate factors: Humidity, dust, winds, temperature Season: Dry season December to June Social & behavioural factors Crowded housing Displacements Social gathering Biological factors: Damaged mucosa Co-infections Causal pathogen Carriers Person to person transmission Preventive vaccine Reactive vaccination Seasonal annual epidemic pattern Major cyclic outbreaks every 5-12 Y Dr Michel JANCLOES HCF M. Jancloes. WMO Forum Geneva 2013

11. 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. MERITImplementation: 2007-2013 Dr Michel JANCLOES HCF M. Jancloes. WMO Forum Geneva 2013

12. 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 M. Jancloes. WMO Forum Geneva 2013

13. Current challenges for MERIT There 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 Dr Michel JANCLOES HCF M. Jancloes. WMO Forum Geneva 2013

14. MERIT Références: MERIT Web site: http:// www.merit.hc-foundation.org With: • WHO perspectives on MERIT research and modelling activities. July 2011 • MERIT Strategic Review Report . Nov. 2011MERIT Strategic Review Meeting – WMOwww.wmo.int/pages/prog/.../3_9_2_MERIT_Strategic_Review.pdf • M. Thomson: Climate and Public Health - The MERIT Initiativeconference2011. 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 M. Jancloes. WMO Forum Geneva 2013

15. Case story 2: GLEAN Global Leptospirosis Environmental Action Network M. Jancloes. WMO Forum Geneva 2013

16. M. Jancloes. WMO Forum Geneva 2013

17. 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 to potential underreporting to cause annually >1,500,000 cases, >100,000 deaths • A serious global zoonosis • http://www.who.int/zoonoses/diseases/lerg/en/ M. Jancloes. WMO Forum Geneva 2013

18. 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 M. Jancloes. WMO Forum Geneva 2013

19. Challenges (GLEAN working groups) • PREDICT • Baseline Incidence? • Main drivers and predictive value?*** • Climate, • Environment • Vector demography • Predictive models and risk stratification*** • (to be validated at risk sites.) DETECT Case definition? Outbreak threshold? Early diagnosis tests and case confirmation (specificity-sensitivity) Algorithms for outbreak detection ? ** PREVENT Evaluation of -Rodent controls? ** -Chemoprophylaxis In humans? * -Impact of animal vaccination ? INTERVENE Informing public *** health decision Outbreak investigation guidelines. ** Operational Guidance for outbreak control. * M. Jancloes. WMO Forum Geneva 2013

20. Future challenges New partnerships: new working areas • Public Health-Veterinarians-Biotechnology Industry • Economic analysis of outbreaks • Detection strategies • Vaccine development • Public health and Research Institutions • Early case detectionsurveillance and public health intelligence • Improved coordination with climate services *** • GLEAN and countries • Method comparison and knowledge sharing • Testing and experiment strategies • Public information M. Jancloes. WMO Forum Geneva 2013

21. 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 M. Jancloes. WMO Forum Geneva 2013

22. The HCF Mission to 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. M. Jancloes. WMO Forum Geneva 2013

23. Thanks! Health and Climate Foundation M. Jancloes. WMO Forum Geneva 2013