Editing IPCC:AR6/WGII/Chapter-7 (section)

==== 7.2.2.5 Other Water Shortage and Drought-Associated Diseases and Health Outcomes ====

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Water shortage and drought are associated with skin diseases ( [[#Schachtel--2021|Schachtel et al., 2021]] ; [[#Lundgren--2018|Lundgren, 2018]] ; [[#Andersen--2017|Andersen and Davis, 2017]] ; [[#Kaffenberger--2017|Kaffenberger et al., 2017]] ; [[#Andersen--2017|Andersen and Davis, 2017]] ), trachoma ( [[#Ramesh--2016|Ramesh et al., 2016]] ) and violence ( [[#Epstein--2020a|Epstein et al., 2020a]] ); more research is warranted in these areas for future assessment.

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'''Box 7.3 | Cascading Risk Pathways Linking Waterborne Disease to Climate Hazards'''
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The causal linkages between climate variability and change and incidence of WBDs follow multiple direct and indirect pathways, often as part of a cascading series of risks ( [[#Semenza--2020|Semenza, 2020]] ). For example, extreme precipitation can result in a cascading hazard or disease event with implications of greater magnitude than the initial hazard, especially if there are pre-existing vulnerabilities in critical infrastructure and human populations ( [[#Semenza--2021|Semenza and Paz, 2021]] ). Intense or prolonged precipitation can flush pathogens in the environment from pastures and fields to groundwater, rivers and lakes, consequently infiltrating water treatment and distribution systems ( [[#Howard--2016|Howard et al., 2016]] ; [[#Khan--2015|Khan et al., 2015]] ; [[#Sherpa--2014|Sherpa et al., 2014]] ; [[#Cissé--2016|Cissé et al., 2016]] ; [[#Kostyla--2015|Kostyla et al., 2015]] ; Chapter 4). Table Box 7.3.1 shows the variety and complexity of pathways between climate hazard and WBD outcomes ( [[#Semenza--2020|Semenza, 2020]] ).

'''Table Box 7.3.1 |''' Pathways between climate hazard and waterborne disease (WBD) outcomes. Source: [[#Semenza--2020|Semenza (2020)]] .

{| class="wikitable"
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| Cascading risk pathways from heavy rain and flooding

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| Storm runoff yields water turbidity, which compromises water treatment efficiency

Storm runoff and floods mobilise and transport pathogens

Overwhelmed or damaged infrastructure compromises water treatment efficiency

Floods overwhelm containment system and discharge untreated wastewater

Floods damage critical water supply and sanitation infrastructure

Floods displace populations towards inadequate sanitation infrastructure

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| Cascading risk pathways from drought

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| Low water availability augments travel distance to alternate (contaminated) sources

Intensified demand for and sharing (e.g., with livestock) of limited water resources decreases water availability and quality

Intermittent drinking water supply results in cross-connections with sewer lines and water contamination

Uncovered household water containers are a source of vector breeding

Poor hygiene due to decreased volume of source water and increased concentration of pathogens

Exposure to accumulated human excrements and animal manure

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| Cascading risk pathways from increasing temperature

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| Extended transmission season for opportunistic pathogens

Permissive temperature for the replication of marine bacteria

Enhanced pathogen load in animal reservoirs (e.g., chicken)

Pathogen survival and proliferation outside of host

Wildfires during heatwaves degrade water quality

Exposure to contaminated water due to higher water consumption

Behaviour change due to extended season (e.g., food spoilage during barbeque)

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| Cascading risk pathways from sea level rise

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| Population displacement due to powerful storm surges

Disruption of drinking water supply and sanitation infrastructure due to inundation

Decline in soil and water quality due to saline intrusion into coastal aquifers

Seawater infiltration into drinking water distribution and sewage lines

|}

Notes:

Examples are purposely not exhaustive and should be considered illustrative.

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'''Cross-Chapter Box COVID | COVID-19'''
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Authors: Maarten van Aalst (Netherlands, Chapter 16), Guéladio Cissé (Mauritania/Switzerland/France, Chapter 7), Ayansina Ayanlade (Nigeria, Chapter 9), Lea Berrang-Ford (United Kingdom/Canada, Chapter 16), Rachel Bezner Kerr (Canada/USA, Chapter 5), Robbert Biesbroek (Netherlands, Chapter 13), Kathryn Bowen (Australia, Chapter 7), Martina Angela Caretta (Sweden, Chapter 4), So-Min Cheong (Republic of Korea, Chapter 17), Winston Chow (Singapore, Chapter 6), Mark John Costello (New Zealand/Norway/Ireland, Chapter 11, CCP1), Kristie Ebi (USA, Chapter 7), Elisabeth Gilmore (USA/Canada, Chapter 14), Bruce Glavovic (South Africa/New Zealand, Chapter 18, CCP2), Walter Leal (Germany, Chapter 8), Stefanie Langsdorf (Germany, TSU), Elena Lopez-Gunn (Spain/United Kingdom, Chapter 4), Ruth Morgan (Australia, Chapter 4), Aditi Mukherji (India, Chapter 4), Camille Parmesan (France/ United Kingdom /USA, 2), Mark Pelling (United Kingdom, Chapter 6), Elvira Poloczanska (United Kingdom, TSU), Marie-Fanny Racault (United Kingdom/France, Chapter 3), Diana Reckien (Germany/Netherlands, Chapter 17), Jan C. Semenza (Sweden, Chapter 7), Pramod Kumar Singh (India, Chapter 18), Stavana E. Strutz (USA), Maria Cristina Tirado von der Pahlen (Spain/USA, Chapter 7), Corinne Schuster-Wallace (Canada), Alistair Woodward (New Zealand, Chapter 11), Zinta Zommers (Latvia, Chapter 17)

'''Introduction'''
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COVID-19, emerged in late 2019, halfway through the preparation of the IPCC WGII Sixth Assessment Report. This Cross-Chapter Box assesses how the massive shock of the pandemic and response measures interact with climate-related impacts and risks as well as its significant implications for risk management and climate resilient development.

'''COVID-19 and environmental connections'''
''Infectious diseases may emerge and spread through multiple climate-related avenues, including direct effects of climatic conditions on disease reproduction and transmission and various indirect effects, often interlinked with ecosystem degradation (high confidence)'' . Climate change is affecting the risk of emerging infectious diseases by contributing to factors that drive the movements of species, including vectors and reservoirs of diseases, into novel human populations and vice versa ( ''high confidence'' ) (Sections 2.4.2.7, 5.2.2.3; Cross-Chapter Box Illness in Chapter 2; [[#IPCC--2019b|IPCC, 2019b]] ; IPBES 2020). The spillover of some emerging infectious diseases from wildlife into humans is associated with live animal–human markets, intensified livestock production and climate-related movements of humans and wild animals into new areas that alter human–animal interactions ( [[IPCC:Wg2:Chapter:Chapter-2#2.4.2.7|Section 2.4.2.7]] ; Chapter 3; Sections 5.2.2.3, 7.2; Cross-Chapter Box ILLNESS in Chapter 2; Cross-Chapter Box MOVING PLATE in Chapter 5).

''Human-to-human transmission is the prominent driver in the spread of the COVID-19 pandemic, rather than climatic drivers (high confidence)'' . There is emerging literature on the environmental determinants of COVID-19 transmission, incidence and mortality rates, with initial evidence suggesting that temperature, humidity and air pollution contribute to these patterns ( [[#Brunekreef--2021|Brunekreef et al., 2021]] ; [[#Xiong--2020|Xiong et al., 2020]] ; [[#Zhang--2020b|Zhang et al., 2020b]] ; AR6 WGI CCB 6.1: Implications of COVID-19 restrictions for emissions, air quality and climate). Climate change is altering environmental factors like temperature and seasonality that affect COVID-19 transmission ( [[#Choi--2021|Choi et al., 2021]] ).

The impact of COVID-19 containment measures resulted in a temporary reduction in greenhouse gas (GHG) emissions and reduced air pollution ''(high confidence)'' (IPCC WGI TS; [[#Arias--2021|Arias et al., 2021]] ; AR6 WGI CCB 6.1: Implications of COVID-19 restrictions for emissions, air quality and climate). However, global and regional climate responses to the radiative effect were undetectable above internal climate variability due to the temporary nature of emission reductions. They therefore do not result in detectable changes in impacts or risks due to changes in climate hazards (Arias et al 2021; AR6 WGI CCB 6.1: Implications of COVID-19 restrictions for emissions, air quality and climate; [[#Naik--2021|Naik et al., 2021]] ).

'''Cascading and compounding risks and impacts'''
''The COVID-19 pandemic posed a severe shock to many socioeconomic systems, resulting in substantial changes in vulnerability and exposure of people to climate risks'' ( ''high confidence'' ). The disease and response measures significantly affected human health, economic activity, food production and availability, health services, poverty, social and gender inequality, education, supply chains, infrastructure maintenance and the environment. These COVID-19 impacts interact with many risks associated with climate change ( [[#IMF--2020|IMF, 2020]] ), often through a cascade of impacts across numerous sectors ( [[#van%20den%20Hurk--2020|van den Hurk et al., 2020]] ). Beyond COVID-19-related mortality and long-term COVID, mortality from other diseases (some of which may also have a climate-related component), as well as maternal and neonatal mortality, increased because of disruption in health services ( [[#Barach--2020|Barach et al., 2020]] ; [[#Maringe--2020|Maringe et al., 2020]] ; [[#Zadnik--2020|Zadnik et al., 2020]] ; [[#Goyal--2021|Goyal et al., 2021]] ). In addition, a rapid rise in poverty has disproportionately affected poorer countries and people ( [[#Ferreira--2021|Ferreira et al., 2021]] ), and thus increased their vulnerability. After many years of steady declines, extreme poverty increased by about 100 million people in 2020 (World Bank, 2021). The effects of the pandemic increased food insecurity and malnourishment, which increased by 1.5 percentage points to around 9.9% in 2020 after being virtually unchanged for the previous five years ( [[#FAO--2021|FAO et al., 2021]] ).

''During the pandemic, extreme weather and climate events such as droughts, storms, floods, wildfires and heatwaves continued, resulting in disastrous compounding impacts'' ( ''high confidence'' ). Between March and September 2020, 92 extreme weather events coincided with the COVID-19 pandemic, affecting an estimated 51.6 million people; additionally, 431.7 million people were exposed to extreme heat, and 2.3 million people were affected by wildfires ( [[#Walton--2020|Walton and van Aalst, 2020]] ). The COVID-19 pandemic, in combination with extreme events, affected disaster preparedness, disaster response and safe evacuations, while physical distancing regulations reduced the capacity of temporary shelters (UN DRR Asia-Pacific, 2020; [[#Tozier%20de%20la%20Poterie--2020|Tozier de la Poterie et al., 2020]] ; Shumake-Guillemot, J, et al, 2020; [[#Bose-O’Reilly--2021|Bose-O’Reilly et al., 2021]] ). Complex humanitarian emergencies were aggravated, with vulnerable populations facing the combined risks of conflict, displacement, COVID-19 and climate impacts ( [[#FSIN--2020|FSIN, 2020]] ). Compounding events are not only found in low-income countries but also in medium- and high-income countries, for instance in the case of COVID-19 and heatwaves ( [[#Shumake-Guillemot--2020|Shumake-Guillemot et al., 2020]] ; [[#Bose-O’Reilly--2021|Bose-O’Reilly et al., 2021]] ).

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Cross-Chapter Box COVID

'''Responses and implications for adaptation and climate resilient development'''
''The pandemic emphasises the inter-connected and compound nature of risks, vulnerabilities and responses to emergencies that are simultaneously local and global (high confidence)'' . COVID-19 is often considered a more ‘explosive’ risk than the more gradual anthropogenic climate change. However, many climate-related risks do already appear as severe shocks at smaller scales, and infrequent or unprecedented extreme weather-related events often warrant similar rapid responses ( [[#Dodds--2020|Dodds et al., 2020]] ; [[#Gebreslassie--2020|Gebreslassie, 2020]] ; [[#Hynes--2020|Hynes et al., 2020]] ; [[#Phillips--2020|Phillips et al., 2020]] ; [[#Schipper--2020|Schipper, 2020]] ; [[#Semenza--2021|Semenza et al., 2021]] ; illustrated in Figure COVID.1). Individuals, households, sub-national and national entities, and international organisations had generally delayed responses or denied the pandemic’s severity before responding at the scale and urgency required, a pattern that resembles the international action required on climate change ( [[#Polyakova--2020|Polyakova et al., 2020]] ; [[#Shrestha--2020|Shrestha et al., 2020]] ).

Improved contingency and recovery planning, including disease mitigation measures, were crucial in responding to the pandemic in similar ways to those seen in the aftermath of climate-related disasters ( [[#Guo--2020|Guo et al., 2020]] ; [[#Ebrahim--2020|Ebrahim et al., 2020]] ; [[#Baidya--2020|Baidya et al., 2020]] ; [[#Shultz--2020|Shultz et al., 2020]] ; [[#Mukherjee--2020|Mukherjee et al., 2020]] ). The pandemic highlighted the lack of global and country-specific capacity to respond to an unexpected and unplanned event and the need to implement more flexible detection and response systems ( [[#Ebi--2021b|Ebi et al., 2021b]] ).

It also exposed underlying vulnerabilities, such as the lack of water access and healthcare in select low- and middle-income countries and among indigenous and marginalised groups in high-income countries ( [[IPCC:Wg2:Chapter:Chapter-4#4.4.3|Section 4.4.3]] ; Box 4.3; 5.12.1). Increased risks of COVID-19 transmission emerged in crowded areas such as urban settings, refugee camps, detention centres and some workplaces, including in rural settings ( [[#Brauer--2020|Brauer et al., 2020]] ; [[#Ramos--2020|Ramos et al., 2020]] ; [[#Staddon--2020|Staddon et al., 2020]] ; [[#Haddout--2020|Haddout et al., 2020]] ). Public health responses to the COVID-19 pandemic, such as mandates for social distancing and advice for frequent handwashing, underlined the need for access to water and sanitation facilities and wastewater management. However, they also sometimes interfered with access, for example, in evacuation and shelter infrastructure during climate-related disasters ( [[#Armitage--2020|Armitage and Nellums, 2020]] ; [[#Adelodun--2020|Adelodun et al., 2020]] ; [[#Poch--2020|Poch et al., 2020]] ; [[#Hallema--2020|Hallema et al., 2020]] ; [[#Patel--2020|Patel et al., 2020]] ; [[#Espejo--2020|Espejo et al., 2020]] ).

The experience of COVID-19 demonstrates that many warnings about the risks of the emergence of zoonotic transmission (‘delay is costly’, ‘adapt early’ and ‘prevention pays’) did not result in sufficient political attention, funding and pandemic prevention. In some countries, there has been an increased awareness of the risks and the real or perceived trade-offs associated with risk management (e.g., economy compared with health and impacts compared with adaptation). Building trust and participatory processes and establishing stronger relationships with communities and other civic institutions may enable a recalibration of how the government responds to crises and society–government relationships more generally ( [[#Amat--2020|Amat et al., 2020]] ; [[#Deslatte--2020|Deslatte, 2020]] ).

''The management of the COVID-19 pandemic has highlighted the value of scientific (including medical and epidemiological) expertise and the importance of fast, accurate and comprehensive data to inform policy decisions and to anticipate and manage risk (high confidence)'' . It emphasises the importance of effective communication of scientific knowledge ( [[#Semenza--2021|Semenza et al., 2021]] ), decision-making under uncertainty and decision frameworks that navigate different values and priorities. Successful policy responses were based on the emerging data, medical advice and collaboration with a wider set of societal stakeholders beyond public health experts. For instance, experience in Aotearoa, New Zealand, highlights the importance of pandemic responses attuned to the needs of different sociocultural groups and Indigenous Peoples in particular. Their strengths-based COVID-19 response goes beyond identifying vulnerabilities to unlocking the resources, capabilities and potential that might otherwise be latent in communities ( [[#McMeeking--2020|McMeeking and Savage, 2020]] ). As far as the value of information for risk management is concerned, compared to the initial uncertainties regarding COVID-19, data about near- and longer-term climate-related hazards is generally very good; however, high-quality and dense meteorological data are often still lacking in lower income countries ( [[#Otto--2020|Otto et al., 2020]] ). Health data are particularly difficult to obtain in real time, as is the case for biodiversity data, which has a time lag of years before being made available and for which there is no coordinated monitoring, hampering effective risk management ( [[#Navarro--2017|Navarro et al., 2017]] ). Therefore, both epidemiological and meteorological forecasts would benefit from more focus on (a) decision support, (b) conveying uncertainty and (c) capturing vulnerability ( [[#Coughlan%20de%20Perez--2021|Coughlan de Perez et al., 2021]] ).

''There is a considerable evidence base of specific actions that have co-benefits for reducing pandemic and climate change risks while enhancing social justice and biodiversity conservation (high confidence)'' . The pandemic highlighted aspects of risk management that have long been recognised but are often not reflected in national and international climate policy: the value of addressing structural vulnerability rather than taking specific measures to control single hazards and drivers of risk and the importance of decision-making capacities and transparency, the rule of law, accountability and addressing inequities (or social exclusion) (reviewed by [[#Pelling--2021|Pelling et al. (2021)]] ; see also Figure COVID.1).

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Cross-Chapter Box COVID

Comprehensive and integrated risk management strategies can enable countries to address both the current pandemic and increase resilience against climate change and other risks ( [[#Reckien--2021|Reckien, 2021]] ; [[#Semenza--2021|Semenza et al., 2021]] ; [[#Ebi--2021b|Ebi et al., 2021b]] ). In particular, given their immense scale, COVID-19 recovery investments may offer an opportunity to contribute to climate resilient development pathways (CRDPs) through a green, resilient, healthy and inclusive recovery ( ''high confidence'' ) ( [[#Sovacool--2020|Sovacool et al., 2020]] ; [[#Rosenbloom--2020|Rosenbloom and Markard, 2020]] ; [[#Lambert--2020|Lambert et al., 2020]] ; [[#Boyle--2020|Boyle et al., 2020]] ; [[#Bouman--2020|Bouman et al., 2020]] ; UN DRR Asia-Pacific, 2020; [[#Brosemer--2020|Brosemer et al., 2020]] ; [[#Dodds--2020|Dodds et al., 2020]] ; [[#Hynes--2020|Hynes et al., 2020]] ; [[#Markard--2020|Markard and Rosenbloom, 2020]] ; [[#Phillips--2020|Phillips et al., 2020]] ; [[#Schipper--2020|Schipper, 2020]] ; [[#Willi--2020|Willi et al., 2020]] ; [[#Semenza--2021|Semenza et al., 2021]] ; [[#Pasini--2020|Pasini and Mazzocchi, 2020]] ; [[#Meige--2020|Meige et al., 2020]] ; [[#Pelling--2021|Pelling et al., 2021]] ). However, windows of opportunity to enable such transitions are only open for a limited period and need to be swiftly acted upon to effect change ( ''high confidence'' ) (Chapter 18; [[#Weible--2020|Weible et al., 2020]] ; [[#Reckien--2021|Reckien, 2021]] ). Initial indications suggest that only USD 1.8 trillion of the greater than USD 17 trillion COVID-19-related stimulus financing by G20 countries and other major economies that was committed up until mid-2021 contributed to climate action and biodiversity objectives, with significant differences between countries and sectors (Vivideconomics, 2021). Moreover, responses to previous crises (e.g., the 2008–2011 global financial crisis) demonstrate that despite high ambitions during the response phase, opportunities for reform do not necessarily materialise ( [[#Bol--2020|Bol et al., 2020]] ; [[#Boin--2005|Boin et al., 2005]] ). In addition, heightened societal and political attention to one crisis often comes at the cost of other policy priorities ( ''high confidence'' ) ( [[#Maor--2018|Maor, 2018]] ; [[#Tosun--2017|Tosun et al., 2017]] ), which could affect investments for climate resilient development ( [[#Hepburn--2020|Hepburn et al., 2020]] ; [[#WHO--2020a|WHO, 2020a]] ; [[#Bateman--2020|Bateman et al., 2020]] ; [[#Meige--2020|Meige et al., 2020]] ; [[#Semenza--2021|Semenza et al., 2021]] ).

In summary, the emerging literature suggests that the COVID-19 pandemic has aggravated climate-related health risks, demonstrated the global and local vulnerability to cascading shocks and illustrated the importance of integrated solutions that tackle ecosystem degradation and structural vulnerabilities in human societies. This highlights the potential and urgency of interventions that reduce pandemic and climate change risks while enhancing compound resilience, social justice and biodiversity conservation (see Figure COVID.1).

[[File:a7970ececffaaf5ea5301b8da3688bca IPCC_AR6_WGII_Figure_7_Covid_1.png]]

'''Figure COVID.1 |''' '''Compound risk and compound resilience to pandemic and climate change.''' Source: [[#Pelling--2021|Pelling et al. (2021)]] .

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