centre stage

A health bomb that’s ticking

Climate change is among the gravest health threats facing humanity, but innovation and collaboration can help mitigate the damage being done

The words bizarre or unusual can no longer be used to describe the unprecedented events unfolding worldwide as climate change reshapes our planet. This is a global phenomenon that is affecting every corner of the planet.

Greenhouse gas emissions from human activities, such as burning fossil fuels and deforestation, have led to the Earth’s atmosphere warming up to a point where practically everything can end in disaster. The crisis is disproportionately impacting vulnerable and marginalised communities, intensifying existing social and economic disparities.

Low-income and developing countries, as so often, are bearing the brunt of these impacts despite contributing the least to the emissions driving climate change. The global scope of the issue is forcing world leaders to thrash out plans for coordinated action.

Scary future

Health, as a sector, has not been spared. The Covid pandemic provided a glimpse into potential future health-related horrors that are sure to unfold as climate change worsens. The economic costs alone are staggering. The World Health Organization projects a $2–4 billion hit in annual direct damage to the health sector within six years.

The toll on human life in the next two decades due to climate-induced maladies such as malnutrition, malaria, diarrhoea and heat stress is predicted to top an additional 250,000 deaths annually. This excludes now-routine disasters like heatwaves, wildfires, floods and tropical storms, which could claim 14.5 million lives and cost $12.5 trillion by 2050, this while the loss of biodiversity remains immeasurable.

The devastating link between climate change and health, in terms of both infectious and non-infectious diseases, is clear. That’s the reason why, for the very first time, it was high on the agenda in the recent COP28 talks.

A review published in Nature Climate Change in 2022 showed that of 375 infectious diseases studied, a staggering 218 (or 58%) have been aggravated by climate change. Scientists tell us that there is an intricate web of 1,006 distinct pathways through which climatic hazards exacerbate infectious diseases, highlighting the extent of human vulnerability to infectious diseases caused by climate change.

This doesn’t account for the unknown diseases and pathogens yet to emerge due to climate-linked changes. For instance, the thawing of permafrost is unearthing viruses that were once frozen in time, opening a Pandora’s box of pathogens. And this has started.

Hot topic, cold facts

Siberian warning

In 2016, a 12-year-old boy’s death and the hospitalisation of about 100 people in Siberia served as a warning about the unforeseen consequences of climate change. Anthrax, dormant for 75 years within a frozen reindeer carcass, resurfaced as permafrost thawed, resulting in the contamination of soil, water and, subsequently, the food supply. More than 2,000 reindeer succumbed to the outbreak, shedding light on the macabre reality of climate-induced health crises.

According to one report, the largest number of diseases aggravated by climate change involve transmission by vectors such as mosquitoes. Climate change-related events are raising temperatures and altering precipitation patterns, creating favourable conditions for the breeding, survival and spread of disease vectors.

Mosquitoes, for example, breed more rapidly in warm, humid conditions, leading to larger populations and higher rates of disease transmission. Additionally, altered precipitation patterns can create breeding sites for mosquitoes in stagnant water, increasing the risk of disease transmission.

Climate change has already begun to disrupt the seasonal patterns of vector-borne diseases, leading to shifts in the timing and duration of disease-transmission seasons. Warmer temperatures are likely to prolong the transmission seasons for diseases such as malaria, allowing vectors to remain active for longer periods of time and increasing the opportunities for disease transmission.

Warmer temperatures are also extending the geographical range of vectors into areas that were previously unsuitable for their survival. For instance, a study published in 2023 by the UK-based Royal Society notes that climate change is already leading a transition: tropical species are spreading towards the poles, and species everywhere are raising their body temperature to survive in higher locales.

The study found that millions of species — among them, and along with them, pathogens — have been moving uphill at a pace of 1.1mt per year, and to higher latitudes at a pace of 1.7km per year. It notes that in recent years mosquito-borne diseases such as malaria, dengue and the Zika virus have expanded to new latitudes and elevations, and will continue to do so in the future.

Field workers at a training session in Thiruvananthapuram on the use of Moskeet, a device that enables mosquito surveillance

Malaria menace

While the mosquitoes carry on with their onward march, they don’t spare old territory. A recent example is Pakistan, which saw a four-fold rise in malaria — in excess of 1.6 million cases — in the aftermath of the October 2022 floods in the country. India, meanwhile, already reports around 3 million malaria cases every year (according to the World Malaria Report).

Despite the gloomy outlook, there’s hope. Madhav Joshi, chief executive of India Health Fund (IHF), an initiative of the Tata Trusts, says several cutting-edge innovations are being developed for infectious diseases, especially in the area of surveillance and early diagnosis. A nonprofit, IHF was set up in 2017 with funding from the Trusts and strategic support from the Global Fund to Fight AIDS, Tuberculosis and Malaria, an international financing and partnership organisation.

“There was very little capital available to take promising technology that would aid in the diagnosis, treatment and prevention of communicable diseases, and to take a product from the lab to the market”, says Mr Joshi. “This is a space that needs far more attention than it gets, particularly because climate change is going to lead to a spurt in infectious diseases.”

Maroudam Veerasami, the founder of CisGEN Biotech Discoveries, which has developed a hand-held test kit to detect tuberculosis in cattle

The IHF mandate is to identify tech-driven solutions for infectious diseases that can be deployed through India’s primary healthcare system. To this end, it has funded 15 startups thus far, many of which are now addressing the dual-edged sword of climate change and infectious diseases by strengthening diagnostics and surveillance and by applying a ‘One Health’ approach.

[One Health is a collaborative, multisector and multidisciplinary approach that operates at the local, regional, national and global levels, the objective being to achieve optimal health outcomes while recognising the interconnection between people, animals, plants, and their shared environment.]

The impact of climate change on the rising burden of infectious diseases can be tackled by making better diagnostics available to people, especially the underserved, right where they need them. Point-of-care diagnostic tools, faster active case finding and digital screening solutions must be accessible and available to everyone, everywhere — and at minimal cost — to cut down the time and expenses linked to disease detection and treatment.

The human element in all of this is critical. Binita Shrivastava Tunga lost her 11-year-old niece to dengue in 2014. Devastated, she couldn’t get over the fact that it was due to a misdiagnosis. “We have world-class medical facilities in India and yet we didn’t have a way to detect which disease the mosquito bite had caused, at least not fast enough for us to prevent fatality,” says Dr Tunga.

She and her husband, Rashbehari Tunga, quit their jobs in 2015 to set up a company to help solve this problem. Their startup, Ameliorate Biotech, has developed an affordable and user-friendly device that detects which of the three most prevalent mosquito-borne diseases — malaria, chikungunya or dengue — is affecting a patient. Pinpointing the disease is vital, given that mosquito-borne ailments often present similar symptoms at an early stage, which can lead to misdiagnosis.

Easy field use

With support from IHF, Ameliorate developed a diagnostic kit that identifies the disease with just two drops of blood, and within 10 minutes. The device uses a single test kit and a single blood sample and can be easily used in field conditions by frontline workers with minimal training.

Other features make it suitable for rural India or remote areas: it does not require serum or plasma samples to make a diagnosis, it does not need a cold-chain facility or biosafety labs, the results are quick, and it generates minimal medical waste. This kit will probably become a necessity across the world because mosquitoes are reaching higher altitudes and temperate regions where they were absent before. “My niece would have survived if she’d been rightly diagnosed in time,” says Dr Tunga.

As soon as a new disease emerges or an old one reemerges, strong disease surveillance measures must be in place to detect them quickly at the local level, and authorities must take action to stop them before the disease has had a chance to spread.

Hotspot determination and disease modelling that takes into account variations in weather are going to be vital in the context. For this, public spaces and utilities such as the water supply system need to be tested regularly, and early-warning systems need to be set up to generate data and alerts in real time.

India is more vulnerable than most countries on this count, and not just because of its socioeconomic situation — a large number of impoverished people, crowded urban centres, pollution, tropical heat, and sparse diagnostic and treatment facilities — but also because of the high prevalence of disease-carrying mosquitoes.

That last is a cause for worry. “Mosquitoes are now being found where they were unable to thrive earlier, at high altitudes or in colder regions, for instance,” Mr Joshi points out. That means a greater need for surveillance and vigilance by health authorities in preventing epidemics.

TrakItNow is an IHF-funded startup that does exactly that: it supports the surveillance and reporting of disease-carrying mosquitoes as a way to predict mosquito-borne disease outbreaks.

Antimicrobial resistance

Surveillance is critical especially as cures are getting less useful. “From what we see, about 80% of our population is affected by antimicrobial resistance and climate change is going to worsen the situation,” says Mr Joshi. “Basic medicines that used to work in the past are not as effective now because bacteria are adapting and mutating. We will need stronger and stronger antibiotics.”

Approximately 60% of all infectious diseases that affect humans spread from animals to humans. There is an increasing consensus that addressing human health issues must go hand in hand with animal health and environmental health. The One Health approach that values interconnectedness is a must if we are to comprehensively tackle the impact of climate change on infectious diseases.

IHF is paying attention to the threat of zoonotic diseases transmitted from animals to humans. CisGEN Biotech Discoveries is an IHF-funded startup pioneering solutions in animal health to prevent such outbreaks. Led by technopreneur Maroudam Veerasami, CisGEN has developed a pen-sized test kit to swiftly and affordably diagnose tuberculosis (TB) in cattle. This innovation helps safeguard livestock while reducing the risk of disease transmission to humans.

Typically, it takes a veterinary doctor three days and multiple visits to diagnose TB in cattle. The CisGEN kit is quicker and cheaper, making it affordable and convenient for farmers and vets. The rapid diagnostic format gives instant results, enabling farmers to isolate infected animals before they can spread the disease.

Given that 28% of all TB cases in humans may be of zoonotic origin, early detection in animals is crucial in preventing outbreaks. The company is planning to create combo kits for other zoonotic diseases (the kit has already been adapted for brucellosis, another common zoonotic disease).

While science and technology hold the potential to combat some of these threats, the not-so-good news is that, apart from a few government initiatives, funding for research and solutions in infectious disease is barely a trickle. Even those science- and technology-led innovations that have proved effective struggle to find support.

So, what will it take to have many more of these innovations reach the last mile, and prevent the devastating effect that climate change holds for human health? More investments and strong partnerships will be key ingredients.

A field worker in the process of deploying the Moskeet device at a site in Hyderabad where mosquitoes breed
A field worker in the process of deploying the Moskeet device at a site in Hyderabad where mosquitoes breed

Targeting vectors

The phrase ‘spray and pray’ describes most of India’s efforts to combat mosquito-borne diseases. A general-purpose mosquito repellent is sprayed by town and city municipalities before and during the monsoons because that is when the insects breed in large numbers. But with climate breakdown leading to erratic rain patterns, it’s difficult to accurately schedule such actions.

Widely used vector-control practices like fogging and anti-larvae operations are only partially effective as these methods do not account for the specific treatment requirements for different species of mosquitoes (owing to a lack of surveillance data). Real-time mosquito surveillance can address this. 

Vector surveillance, which is integral to vector control, depends on manual processes for sample collection and requires entomologists for analysis and reporting. The time required for this — and the shortage of entomologists — makes timely vector control activities difficult to implement.

The India Health Fund has been involved with TrakItNow and has backed Moskeet, the world’s first commercially available smart mosquito surveillance solution. Moskeet can identify and measure concentrations of different species of infected mosquitoes and enable vector surveillance and control measures.

TrakItNow, a startup that focuses on AI-based solutions for health security, studied mosquito behaviour and consulted experts. What it found was insightful: mosquitoes carrying different viruses and parasites have different habits. Some are active during the day, others bite at dawn and dusk. Breeding habitats are different, too.

Moskeet attracts mosquitoes and traps them without killing the insects. With the help of AI, it uses wing-beat frequencies as a way of identifying the breed and gender of mosquitoes, and transmits this information to local health authorities.

Thanks to its autonomous operation and data-transmission capabilities, Moskeet overcomes the challenges of slow manual data collection and the shortage of epidemiologists to analyse and interpret information. This precise approach not only helps in preventing disease outbreaks but also minimises the resources required for disease-control efforts.

What sets Moskeet apart is its affordability and accessibility. Designed as a scalable solution for developing countries, it aims to ease mosquito surveillance and disease control by disseminating real-time information by location and species.

Moskeet is being used by several communities across five cities in India — Hyderabad, Thiruvananthapuram, Panjim, Vijayawada and Yanam (Puducherry) — and it has been helpful to about 325,000 people so far.

There are several advantages to Moskeet:

  • It gathers and interprets disease surveillance data 20 times faster than comparable devices, three times more accurately and at 15% of the current cost of manual methods.
  • It delivers nearly 85% savings on surveillance alongside the value addition of real-time data.
  • It reduces fumigation costs by 20% by identifying more effective pesticides.
  • And it focuses resources on high-risk areas, reducing mosquito populations by up to 60% and decreasing the disease burden by about 40%.

Moskeet has been listed in the United Nations’ ‘development program solution catalog’, which is accessible by 170 country offices. These are places where it can be considered for adoption and scaling up.