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

==== 7.4.2.3 Adaptation Options for Vector-borne, Water-borne and Food-Borne Diseases ====

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''Integrated vector control approaches are crucial to effectively manage the geographic spread, distribution and transmission of VBDs associated with climate change'' ( ''high confidence'' ) ''.'' Some of the projected risks of climate change on VBDs can be offset through enhanced commitment to existing approaches to integrated case management and integrated vector control management ( [[#Cissé--2018|Cissé et al., 2018]] ; [[#Confalonieri--2017|Confalonieri et al., 2017]] ; [[#Semenza--2021|Semenza and Paz, 2021]] ). Important components include enhanced disease surveillance and early warning and response systems that can identify potential outbreaks at sub-seasonal to decadal time scales ( [[#Rocklöv--2020|Rocklöv and Dubrow, 2020]] ; [[#Semenza--2014|Semenza and Zeller, 2014]] ; Table 7.3). In many cases, the exposure dynamics of VBDs are strongly influenced by socioeconomic dynamics that should be considered when developing and deploying adaptation options ( [[#UNEP--2018|UNEP, 2018]] ). This is especially the case in low-income countries. For example, insufficient access to sanitation and the presence of standing water are important determinants of the presence of ''Aedes aegypti'' populations and the pathogens that cause visceral leishmaniasis ( ''L. donovani'' and ''L. infantum'' ) in urban and peri-urban areas. Low housing quality and lack of refuse management are associated with higher rodent infestation. Strategies expected to have important health co-benefits include those that support health systems strengthening and ecosystem health, improve access to health coverage, increase awareness and education and address the underlying conditions of uneven development and a lack of adequate housing and access to water and sanitation systems in areas endemic to mosquito-borne diseases ( [[#Semenza--2021|Semenza and Paz, 2021]] ; Cross-Chapter Box ILLNESS in Chapter 2).

'''Table 7.3 |''' Summary of adaptation options for key risks associated with climate-sensitive vector-, water- and food-borne diseases (VBDs, WBDs, FBDs).

{| class="wikitable"
|-
! '''Key risk'''

! '''Geographic region(s) at higher risk'''

! '''Consequence that would be considered severe and to whom'''

! '''Hazard conditions that would contribute to this risk being severe'''

! '''Exposure conditions that would contribute to this risk being severe'''

! '''Vulnerability conditions that would contribute to this risk being severe'''

! '''Adaptation options with high potential for reducing risk'''

! '''Selected key references'''

|-
| '''VBDs'''

| Global

| Increase in the incidence of some VBDs, such as malaria, dengue and other mosquito-borne diseases, in endemic areas and in new risk areas (e.g., cities, mountains and Northern Hemisphere)

| Increased climatic suitability for transmission (e.g., enhanced vectorial capacity through a temperature shift)

| Large increases in human exposure to vectors driven by growth in human and vector populations, globalisation, population mobility and urbanisation

| Few effective vaccines, weak health systems, ineffective personal and household protections, susceptibility to disease, poverty, poor hygiene conditions, insecticide resistance and behavioural factors

| Improved housing, better sanitation conditions and self-protection awareness; insecticide-treated bed nets and indoor spraying of insecticide; broader access to healthcare for the most vulnerable; establishment of disease surveillance and early warning systems for VBDs; cross-border joint control of outbreaks; effective vector control; targeted efforts to develop vaccines

| Cissé et al. (2018); [[#Semenza--2021|Semenza (2021)]] ; Rocklöv and Dubrow. (2020)

|-
| '''WBDs'''

| Mostly low- and middle-income countries (Africa and Asia); small islands; global for ''Vibrios''

| Increase in the occurrence and intensity of WBDs such as ''Vibrios'' (particularly ''V. cholerae'' ), diarrhoeal diseases and other waterborne GI illnesses

| Substantial changes in temperature and precipitation patterns, increased frequency and intensity of extreme weather events (e.g., droughts, storms and floods), ocean warming and acidification

| Large increases in exposure, particularly in flood-prone areas with poor sanitation and favourable ecological environments for WBD pathogens

| Poor hygiene conditions, lack of clean drinking water and safe food, flood- and drought-prone areas and vulnerable water and sanitation systems

| Improved WASH conditions and surveillance systems; improved personal drinking and eating habits; behaviour change

| [[#Brubacher--2020|Brubacher et al. (2020)]] ; [[#Ford--2018|Ford and Hamner (2018)]] ; [[#Lake--2018|Lake (2018)]] ; Levy et al. (2018); Nichols et al. (2018); [[#Rocklöv--2021|Rocklöv et al. (2021)]]

|-
| '''FBDs'''

| Global

| Increase in the occurrence and intensity of FBDs such as ''Salmonella'' and ''Campylobacter,'' including in high-income countries

| Substantial changes in temperature and precipitation patterns, increased frequency and intensity of extreme weather events (e.g., droughts, storms and floods), ocean warming and acidification

| Large increases in exposure, particularly in flood-prone areas with poor sanitation and favourable ecological environments for FBD pathogens

| Poor hygiene conditions; lack of clean drinking water and safe food; flood- and drought-prone areas; vulnerable water and sanitation systems, food storage systems, food processes, food preservation and cold chain/storage

| Improved WASH conditions and surveillance systems; improved personal drinking and eating habits; behaviour change; improved food storage, food processing, food preservation and cold chain/storage

| [[#Brubacher--2020|Brubacher et al. (2020)]] ; [[#Ford--2018|Ford and Hamner (2018)]] ; [[#Lake--2018|Lake (2018)]] ; Levy et al. (2018); Nichols et al. (2018); [[#Rocklöv--2021|Rocklöv et al. (2021)]]

|}

''Adaptation options for climate-related risks for WBDs and FBDs are strongly associated with wider, multi-sectoral initiatives to improve sustainable development in low-income communities'' ( ''high confidence'' ) ''.'' Effective measures include improving access to potable water and reducing exposure of water and sanitation systems to flooding and extreme weather events ( [[#Brubacher--2020|Brubacher et al., 2020]] ; [[#Cisse--2019|Cisse, 2019]] ; Table 7.3). This requires focusing on farm-level interventions that limit the spread of pathogens into adjacent waterways, preventing the ongoing contamination of water and sanitation systems and the promotion of food-safe human behaviours ( [[#Levy--2018|Levy et al., 2018]] ; [[#Nichols--2018|Nichols et al., 2018]] ). It is also important to implement well-targeted and integrated WASH interventions, including at schools and ensuring proper disposal of excreta and wastewater. Cities can integrate regional climate projections into their engineering models to produce lower-risk source waters and increase the resilience of water and sanitation technologies and management systems under a range of climate scenarios. Technologies can help abstract source waters from depth, introduce or increase secondary booster disinfection, design or modify systems to reduce residence times within pipes and/or coat exposed pipes ( [[#Levy--2018|Levy et al., 2018]] ). Other efficient interventions include source water protection, promoting water filtration, testing the presence of waterborne pathogens in shellfish, imposing trade restrictions where necessary and improving hygiene at all levels ( [[#Semenza--2021|Semenza and Paz, 2021]] ). Needed actions include early warning and response systems, strengthening the resilience of communities and health systems and promoting ecosystem health, water safety plans and sanitation safety plans ( [[#Brubacher--2020|Brubacher et al., 2020]] ; [[#Cisse--2019|Cisse, 2019]] ; [[#Ford--2018|Ford and Hamner, 2018]] ; [[#Lake--2018|Lake and Barker, 2018]] ; [[#Levy--2018|Levy et al., 2018]] ; [[#Nichols--2018|Nichols et al., 2018]] ; WHO and International Water Association, 2009; WHO, 2016a; [[#WHO--2018b|WHO, 2018b]] ; [[#Semenza--2021|Semenza, 2021]] ; [[#Rocklöv--2021|Rocklöv et al., 2021]] ).

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