1. WORLD WEATHER OPEN SCIENCE CLIMATE CONFERENCE 2014 MONTRÉAL USERS, APPLICATION, & SOCIAL SCIENCE Joint Plenary Session 21 August 2014

2. RESEARCH NEEDS for BETTER HEALTH RESILIENCE to WEATHER HAZARDS MICHEL JANCLOES MD, MPH, DPH Assisted by: NICHOLAS CHONG Joint Plenary: User, Applications, and Science Program WWOSC Montreal 21 August 2014

3. A Story: Malaria in Pikine Early acute malaria cases Longitudinal prospective study Findings: Humidity changes = transmission shift New warning messages and interventions against malaria M. Jancloes WWOSC Montreal 21 August 2014

4. A new health proverb “When baobabs blossom, use your mosquito bed nets” M. Jancloes WWOSC Montreal 21 August 2014 Science is beautiful when open to community knowledge and action

5. Our agenda today This plenary: Health Issues and Research Perspectives Later, a special panel! Climatic information data to improve public health M. Jancloes WWOSC Montreal 21 August 2014

6. Plenary presentation outline 1. Need for Operational Research 2. Experience sharing 3. Current trends 4. Strategic Research tracks M. Jancloes WWOSC Montreal 21 August 2014

7. Plenary presentation outline 1.Need for Operational Research 2.Experience sharing 3.Current trends 4.Strategic Research tracks M. Jancloes WWOSC Montreal 21 August 2014

8. Need for Operational Research In the future: more frequent, longer and more severe weather hazards. Predicted health impact due to: Water/food/shelter conditions Spread of diseases Access to Health infrastructure and services M. Jancloes WWOSC Montreal 21 August 2014

9. Potential use of new Climate IC Technologies Demand for informed decision making on: Response preparedness Early warning Alert Request of scientific evidence for investment pre appraisal and capacity building Need for Operational Research M. Jancloes WWOSC Montreal 21 August 2014

10. Plenary presentation outline 1.Need for Operational Research 2.Experience sharing 3.Current trends 4.Strategic Research tracks M. Jancloes WWOSC Montreal 21 August 2014

11. Experience 1: MERIT Meningitis Environment Risk Information Technologies M. Jancloes WWOSC Montreal 21 August 2014

12. Meningitis belt What shape today? Tomorrow? Thomson et al., 2013 M. Jancloes WWOSC Montreal 21 August 2014

13. MERIT purposes A network of public health and climate/environment scientists to: Improve response timeliness to meningococcal meningitis outbreaks AND Influence decisions related the introduction a new preventive vaccine. M. Jancloes WWOSC Montreal 21 August 2014

14. Cyclic outbreaks due to conjunction of risks factors: Root cause still not fully understood Meningitis belt in Africa is extending Urgent need to better capture the influence of environmental factors on epidemics Attention is given to Climate changes New climate technologies Services are available Rationale for a Research Network M. Jancloes WWOSC Montreal 21 August 2014

15. Epidemiological pattern Season: Dry season December to June Biological factors: Damaged mucosa Co-infections Climate factors: Humidity, dust, winds, temperature Person to person transmission Carriers Social & behavioural factors Crowded housing Displacements Social gathering Seasonal annual epidemic pattern Major cyclic outbreaks every 5-12 Y Causal pathogen Preventive vaccine Reactive vaccination

16. Thresholds for saving lives Alert threshold (5/100 000/wk) Alinical samples + lab confirmation Epidemic threshold (10/100 000/wk) Immediate mass vaccination Strengthen case management M. Jancloes WWOSC Montreal 21 August 2014

17. From coordinated research works ( more than 30 institutions): Retrospective review of existing data (epidemiological, environmental and climatic) Several models developed and validated during two years in five countries. Predictive value of models in countries with and without vaccines. M. Jancloes WWOSC Montreal 21 August 2014 MERIT 7 years work

18. MERIT’s merits M. Jancloes WWOSC Montreal 21 August 2014 Working with a Network of research institutions and country officers. Strengthening epidemiological surveillance. Validating strategies between several countries.

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20. Plenary presentation outline 1.Need for Operational Research 2.Experience sharing 3.Current trends 4.Strategic Research tracks M. Jancloes WWOSC Montreal 21 August 2014

21. Experience 2: GLEAN Global Leptospirosis Environmental Action Network M. Jancloes WWOSC Montreal 21 August 2014

22. GLEAN Participants M. Jancloes WWOSC Montreal 21 August 2014

23. Leptospirosis: a neglected disease Endemic & epidemic disease Increasing severity post-disaster Adjusted due to potential underreporting: >1,500,000 cases >100,000 deaths A serious global zoonosis M. Jancloes WWOSC Montreal 21 August 2014

24. Rationale for a Research network Major human and animal disease YET neglected, non-detected, and under-reported Absence of control strategy due to Non-specific symptoms Complex transmission Complex pathogen agent with multiple variants >250 sero-variants Economic impact Probable impact of climate change Increasing concerns at country level and request for technical support M. Jancloes WWOSC Montreal 21 August 2014

25. M. Jancloes WWOSC Montreal 21 August 2014 A complex epidemiology

26. GLEAN network components PREDICT Baseline Incidence? Main drivers and predictive value? Climate Environment Vector demography Predictive models and risk stratification (to be validated at risk sites) INTERVENE Informing public health decision Outbreak investigation guidelines Operational Guidance for outbreak control PREVENT Evaluation of: Rodent controls? Chemoprophylaxi s in humans? Impact of animal vaccination ? DETECT Case definition? Outbreak threshold? Early diagnosis tests and case confirmation (specificity-sensitivity) Algorithms for outbreak detection ? M. Jancloes WWOSC Montreal 21 August 2014

27. Linking extreme events and outbreaks M. Jancloes WWOSC Montreal 21 August 2014 Compounding impacts of floods (AR4, IPCC): Proving more than just a correlation to increase and/or shifts in disease epidemiology. Identifying the specific link will be crucial for targeting the most appropriate health determinant: Role of animal hosts (esp. rodents) in disease spread. Need for understanding different patterns of outbreaks: Local transmission dynamics Important for intervention program focused on control Especially since post-outbreak management is costly

28. M. Jancloes WWOSC Montreal 21 August 2014 Linking extreme events and outbreaks 680 cases of leptospirosis /yr with seasonal peak during the rainy season Typhoon Pepeng: 3 October Typhoon Ondoy: 26 September Thousands of people displaced and housed in emergency evacuation centers In the 2 following weeks, 505 suspect cases and 15 deaths in Manila alone ! Philippines, 2009

29. GLEAN: Way forward New partnerships and new working areas Public Health-Veterinarians-Biotechnology Industry Economic analysis of outbreaks Detection strategies Vaccine development Public health and Research Institutions Prediction and Early case detection surveillance and public health intelligence Improved coordination with meteo/climate services M. Jancloes WWOSC Montreal 21 August 2014

30. Lessons learnt 1. Prerequisite: Understand the knowledge and capacity gaps 2. Move from impact assessment towards risk management with a focus on vulnerability understanding. 3. Time and space downscale for developing adaptation strategies and involve the local communities 4. Enhance quality of data sets, in particular epidemiological surveillance. 5. Develop interaction between Health and MET/Climate services on a need based approach 6. Validate the relevance of new knowledge and identify backup required for implementation M. Jancloes WWOSC Montreal 21 August 2014

31. Still some Research traps a) Weather/Climate kills? b) Impact assessment leads to risk management? c) Research meets user needs when findings are shared? M. Jancloes WWOSC Montreal 21 August 2014

32. Plenary presentation outline 1.Need for Operational Research 2.Experience sharing 3.Current trends 4.Strategic Research tracks M. Jancloes WWOSC Montreal 21 August 2014

33. Current Research trends Policy background and recommendations from the international community: WMO/GFCS, WHO, the UN Summit, Several world conferences such as ICCS, One Health… Advocacy for health at the center of adaptation strategies. Research needs for backing up short and long term policy decisions. M. Jancloes WWOSC Montreal 21 August 2014

34. Current Research trends Using new technologies, in particular tele-information and communication. Scaling down to local contexts with participative process. Integrating research into Resilience development including awareness on solution gaps, vulnerability risk analysis and incremental capacity building towards anticipative interventions awareness. M. Jancloes WWOSC Montreal 21 August 2014

35. Plenary presentation outline 1.Need for Operational Research 2.Experience sharing 3.Current trends 4.Strategic Research tracks M. Jancloes WWOSC Montreal 21 August 2014

36. Strategic Research tracks  Patterns of health resilience challenges due to extreme events ( as amplified by climate change and vulnerability shift)  Synergy of observations, experiments and modeling for policy guidance  Water Safety, Food security Risks linked with extreme events and vulnerability predictions  Specificity and sensitivity Early Warning, Alert thresholds linked with vulnerability  Space Downscaling (new modeling methods) M. Jancloes WWOSC Montreal 21 August 2014

37. Some institutional issues Considering other determinants of health, should it be a priority to link meteorology and climatology for better health resilience against future weather hazards? Who should be involved in the design of research proposals? Who should be the key actors? How can we develop a sustained cooperation between met/climate offices, research institutes and public health related services? M. Jancloes WWOSC Montreal 21 August 2014

38. Conclusion M. Jancloes WWOSC Montreal 21 August 2014 Science is beautiful when open to community knowledge and action A political MUST An Applied Research Opportunity

39. FIND OUT MORE: WWW.HC-FOUNDATION.ORG

40. References M. Jancloes WWOSC Montreal 21 August 2014 Bertherat E. 2007. Meningococcal Meningitis in Africa Overview: Response Strategies and Current Challenges. WHO Global Frame Work for Climate Services. Available online: http://www.gfcs-climate.org (accessed on 31 July 2014)http://www.gfcs-climate.org Jancloes M, et al. 2014. Climate services to improve public health. Int. J. Environ. Res. Public Health. 11, p. 4555-4559. Jancloes M. 2013. Climate Services for Health (Presentation). WMO GFCS MERIT Report of the 4th MERIT technical meeting (2010). Rogers, D.P.; Tsirkunov, V. 2013. Weather and Climate Resilience Effective Preparedness through National Meteorological and Hydrological Services; The World Bank: Washington, DC, USA. Thomson MC, et al. 2013. A climate and health partnership to inform the prevention and control of meningoccocal meningitis in sub-Saharan Africa: the MERIT initiative. Climate Science for Serving Society: Research, Modeling and Prediction Priorities. Geneva (Switzerland): World Health Organization; p.459–484. 3rd Global Leptospirosis Environmental Action Network (GLEAN) Meeting (2013). One Health Summit. Available online: http://glean-lepto.org/component/k2/item/95-one-health-summit-17-20- november-2013-in-davos-switzerland (accessed on 31 July 2014). Committee on Climate, Ecosystems, Infectious Diseases, and Human Health. Under the Weather: Climate, Ecosystems, and Infectious Disease. 2001:National Academies Press.