# Session Overview Examine global environmental change and emerging infections, including trends in emerging infectious diseases (EIDs); global factors contributing to emergence of infectious diseases and their impact on global health; actors, institutional initiatives, and potential conflicting interests; and global and local policy challenges, implications, and what remains to be done for global environmental governance ## Learning outcomes 1. Explain the health impacts of EIDs on the global community; 2. Assess key global environmental (socioeconomic and ecological) factors contributing to the emergence of infectious diseases 3. Critically analyse the role of key actors and the significance of conflicts of interests affecting environmental change and emerging infections; and 4. Examine policy challenges posed by emerging infections and outline potential means of addressing these # 1. Why re-emerging infectious diseases a threat? Research published in 2022 in the journal Nature Climate Change suggests that at least 50% of human pathogenic diseases can be exacerbated by effects of anthropogenic climate change (Mora et al, 2022). We have witnessed the emergence of several important infections, including Zika virus, Rotavirus, Ebola virus, human immunodeficiency virus (HIV), H5N1 influenza virus, various coronaviruses, Monkeypox virus and Marburg virus. The [[World Health Organization (WHO)]] defines an EID as a disease that either has appeared and affected a population for the first time, or has existed previously but is rapidly spreading, either numerically or geographically (WHO, 2014). The adverse impact of infectious diseases is most severe among the poorest and most vulnerable populations with lost productivity, missed educational opportunities, and prohibitive healthcare costs directly impacting families and communities. Economic losses due to infectious diseases extend beyond households, as scarce local and national health system infrastructure and resources are engaged in treating largely preventable diseases (Smith et al, 2019). ## Activity 1 Read the short Nature Medicine editorial from July 2022 on ‘Sleepwalking into the next pandemic’ from the essential readings list. · What is the main message of this editorial? · Comment on the statement ‘research funding seems to flow only when high-income countries are heavily affected’. Why do you think this might be? · Reply to at least one of your colleagues’ comments on the discussion board. # 2. Emerging infectious diseases Infectious disease incidence has increased and decreased throughout human history. We are going through a period of major technological, demographic, social, political, and climatic change. Such as antimicrobial resistance need to be addressed without underminig basic public health services such as clean water, shelter, food and micronutrients, sanitation. Environmental degradation has been ignored or actively encouraged to meet economic needs, e.g., what happend in 1850s during industrial revolution prioritized economic gain over environmental sustainability. Over thirty incidents of emerging and re-emerging diseases in countries across the globe. EID events have increased significantly since 1970, with a peak incidence in 1980s related to the HIV epidemic. Approximately 60% of EIDs are zoonoses, over 70% of which, including SARS and Ebola - originated in wild animal populations. More recent examples include COVID-19, monkeypox, and Marburg. These EIDs have a huge global impact on health, in both higher- and lower-income countries. ## 2.1 What are EIDs? Emerging infectious diseases (EIDs) are a disease that has appeared and affected a population for the first time, or has existed previously but is rapidly spreading, either in terms of the number of people getting infected, or to new geographical areas (WHO, 2014. Therefore, EIDs can be: 1. New pathogens entering human populations 2. Novel variants of existing pathogens (e.g. Extensive drug-resistant TB) 3. Newly recognised causes of common diseases (eg. Helicobacter pylori - stomach ulcers) 4. Pathogens that were once common but experienced a long-term decline before increasing again (TB, malaria) 5. Pathogens considered rare that have recently increased in incidence (eg, Lyme disease) # 3. The process of emergence The process can be divided into four stages of levels, as described in the figure below by Woolhouse and colleagues (2012): 1. Level 1: exposure - influenced by human behavior and ecology. Pathogen prevalence, habitat encroachment, and exposure. Virus are likely to come from birds or other mammals, and exposure can be by any route: saliva, fomites, oral-faecal or vector borne (mosquito) etc. This is going to happen more and more frequently as humans encroach on animals' natural habitat. 2. Level 2: infection - influenced by human susceptibility, for example, viruses overcoming the barriers between species. 3. Level 3: transmission - many virusus require an animal host or reservoir. Viruses can also be transmitted between humans, therefore can lead to epidemic or pandemic. Again, as we encroach on the habitat of other animals, we are more likely to become infected b emerging diseases (or those that are re-emerging) 4. Level 4: epidemic spread - can be ecological, through population mixing or evolutionary, through pathogen adaptation. The virus is transmissible between humans and may cause epidemics. As we build cities and come closer to other humans, we are likely to become infected by these viruses, and in turn, spread them to our neighbours. Ecological changes particularly affect Levels 1 and 4; environmental changes affect Levels 2, 3 and 4. Environmental factors could include climate change, deforestation, habitat encroachment and destruction, poor sanitation (a result of overcrowding), construction of dwellings, and creation of new types of reservoirs for vectors (e.g., used tyres as habitat for dengue-spreading mosquitoes) (Parvez & Parveen, 2017; Bennett et al, 2019). ## 3.1 Global factors contributing to the emergence of selected infections ## 3.1.1 Defining environmental change Environmental change includes changes in the physical and biogeochemical environment, either caused naturally or influenced by an anthropogenic activities such as deforestation, fossil fuel consumption, urbanisation, land reclamation, agricultural intensification, freshwater extraction, fisheries over-exploitation and waste production (Mora et al, 2022). Since 1980s and the emergence of HIV, the originis of most EIDs are related to environmental change, from socioeconomic change (such as urbanisation, transport and travel, extreme poverty) and ecological processes (such as land usage, deforestation, biodiversity loss, habitat encroachment, and climate change). Large-scale changes to the natural environment (including land-use change, climate change, and the deterioration of ecosystem services) are accelerating and interact to generate emerging global public health threats (Myers & Patz, 2009; Baker et al, 2022; Mora et al, 2022). These threats include increasing exposure to infectious disease, water scarcity, food scarcity, natural disasters, and population displacement (Myers & Patz, 2009). A systematic literature review published in 2022 that examined the effects of climatic hazards on communicable disease found that 58% of infectious diseases have at some point been exacerbated by climate change. The authors state that there are over 1000 ‘unique pathways in which climatic hazards, via different transmission types, led to pathogenic diseases’ (Mora et al, 2022). These pathways include floods, drought, fires, heatwaves, storms and increased sea levels (see https://camilo-mora.github.io/Diseases/ for an infographic that shows these pathways in more detail). ### 3.1.2 The role of environmental change in emerging infections The principal drivers have been complacency and de-emphasis of infectious diseases in public health policy, increased population growth, uncontrolled urbanisation without concomitant attention to water and waste management, increased globalisation of trade, the ease with which modern air transport quickly spread pathogens and their vectors, while climate change, related deforestation, and species migration can alter the environment so it becomes more or less suitable for various pathogens and disease-carrying vectors (Hess et al, 2020; Mora et al, 2022). Population growth, urbanisation, and habitat loss Increasing urban population resulted in lower housing quality, overcrowding which aid the spread of airborne infectious diseases such as TB, pneumonia, and influenza. In makeshift and overcrowded spaces, there may be a lack of access to clean water and proper disposal of urine and feces, allowing the spread of diarrheal diseases. Travel and population mobility In 1950, there were only 100 million international travellers. In 2018, there were more than 4.4 billion international airplane passengers, which represented an increase of 6.9% compared with 2017, and this is expected to increase every year (IATA, 2019). EIDs such as SARS, avian influenza and Covid-19 are examples of how quickly international air travel can spread pathogens. South Africa’s detection of the Omicron variant of Covid-19 resulted in immediate travel bans by Israel, the UK and the US, among others (Mendelson et al, 2021). However, the variant was detected in other countries shortly afterward, suggesting that the travel ban was ineffective (Picheta, 2021). Biodiversity, absorbing carbon dioxide, and the role of forest Forests play a role in protecting biodiversity as well as absorbing carbon dioxide emissions. Importantly, increases in a number of infectious diseases are also associated with deforestation, including dengue, Lyme disease, scrub typhus, and chikungunya (Morand & Lajaunie, 2021). In the first two sections we have looked at the global factors influencing the emergence of some of these infections. The following activity will look more closely at Marburg virus disease, of which there was an outbreak in August 2022. Outbreak of EIDs, expand on these topics: 1. Urbanisation, e.g., people living close to each other with overcrowding and make infectious disease more prone to spread 2. Habitat encroachment, making close contact with infected animals more likely 3. Globalisation, diseases can spread more easily as a result of increased air travel 4. Challenges to control, vested interests of large corporations, lack of management of polluting industries 1. [[Industry-sponsored think-tanks seek to promote policies that are favourable to the industries that founded them and fund them]] 5. Poverty and associated issues, lack of sufficient hygiene, air pollution # 4. Global Environmental Governance and Emerging Infections > [!NOTE] Human Rights > In July 2022, the United Nations General Assembly declared the ability to live in “a clean, healthy and sustainable environment” a universal human right (United Nations, 2022a). Although it is not a legally binding agreement and is subject to interpretation, this aspirational resolution may yet have a profound policy impact. Such declarations often lay the foundation for international treaties or national legislation and can be used to pressure governments and corporations to protect or improve human well-being. ## 4.1 Global Environmental Governance The global impact of COVID underscores humanity's vulnerability to infectious diseases. Like almost every other infectious disease agent that has resulted in a pandemic disease outbreak, SARS CoV-2 is probably of zoonotic origin, having been epidemiologically linked to a live animal wholesale market in Wuhan, China (Worobey et al 2022). Increasing biodiversity loss and habitat encroachment enables the persistence of zoonotic hosts in landscapes dominated by humans, hence the frequency of human exposure to zoonotic diseases, some of which have pandemic potential, has also increased. COVID also focused attention on the importance of addressing infectious diseases before they become a threat to health security at a regional, national, and global levels. Most experts agree that environmental governance at all levels is critical to achieve environmental sustainability and prevent the emergence of zoonotic diseases before they become established. Environmental governance at a global level can be approached by considering three interrelated components: 1. the framework of international environmental law; 2. the collection of intergovernmental organisations concerned with environmental sustainability; and 3. various financing and influencing mechanisms (United Nations, 2012). ## 4.1.1 International environmental law The framework of international environmental law is a complex body of international treaties, conventions, statutes, regulations, and laws regulating the interaction of people with the natural environment, with the aim of reducing human impact and increasing environmental sustainability. >Environmental law can be broadly divided into two major areas, namely pollution control/remediation and natural resource management. Some of the guiding principles for international environmental law include: 1. questioning national sovereignty versus common human heritage; 2. legal reciprocity (i.e., the concept of a nation or entity doing its part and respecting international agreements to produce a common good (Francis 2009); 3. environmental procedural rights (i.e. formal steps that can be taken when enforcing legal rights (UNEP, 2019); 4. intergenerational and intergenerational equity; 5. and the polluter pays, precautionary, and sustainable development principles (Hutchinson and Kovats, 2016). The best known of these are the Montreal Protocol on Substances that Deplete the Ozone Layer (1992), the UN Framework Convention on Climate Change or UNFCCC (1992), and the Kyoto Protocol (1997), which operationalizes the UNFCCC by committing industrialized countries and economies in transition to limit and reduce greenhouse gases (GHG) emissions in accordance with agreed individual targets. Protocols are subsidiary agreements built from a primary treaty and are particularly useful because they can be used to incorporate recent scientific knowledge while enabling countries to agree on contentious frameworks. For example, the UNFCCC is revised and renewed annually at the Conference of the Parties on climate change, as exemplified by the Paris Agreement (2015) which sought to deal with greenhouse gas emissions mitigation, adaptation and finance. ## 4.1.2 Intergovernmental organizations concerned with environmental sustainability 1. UNEP, based on UN GA resolution 2997 of 15 December 1972, is to be “the leading global environmental authority, setting the global environmental agenda, promoting coherent implementation of the environmental dimension of sustainable development within the UN system, and serving as an authoritative advocate for the global environment” (see http://www.un-documents.net/a27r2997.htm). 2. The Environmental Management Group (EMG) was established in 2001 to coordinate the response of 51 specialized agencies, programmes and organs of the United Nations on environmental issues. These include the World Meteorological Organization (atmosphere and climate); the Food and Agriculture Organization (agriculture, forests, and fisheries); the United Nations Educational, Scientific, and Cultural Organization (science and environmental education); and the International Atomic Energy Agency (nuclear safety and radioactive waste). 3. [[UNDP]] is the UN’s global development network. Its main areas of focus are sustainable development, democratic governance and peacebuilding, and climate and disaster resilience, including oversight of implementing global goals such as the Sustainable Development Goals (United Nations, 2012). 4. Other major institutions with important roles in global environmental decision-making, such as the [[World Bank (WB)]] and [[World Trade Organization (WTO)]], now claim that sustainable development is central to their overarching goals. The World Bank is an international financial institution that provides loans and grants to low- and middle-income countries with the aim of ending extreme poverty and promoting shared prosperity in an equitable and sustainable way. It has a significant impact on global environmental governance, both indirectly through its development activities for the environment, and directly through its own environmental strategy (World Bank, 2018). The WTO – a global international organization dealing with the rules of trade between nations – now emphasizes the role of trade in promoting sustainable development and achieving the SDGs by 2030 (WTO, 2022). Similarly, regional organizations such as the European Union (EU), the African Union and Organization of American States (OAS) contribute to international governance through their own legislation and through participation in global accords (European Parliament, 2021). ### 4.1.3 Financing mechanisms and environmental advocacy - Biodiversity finance is the practice of raising capital and managing funds for biodiversity conservation, whereas climate finance seeks to support the large-scale investments needed for climate mitigation and adaptation actions. - Climate finance seeks to support the large-scale investments needed for climate mitigation and adaptation actions. Financing mechanisms have also been established to build capacity and interest in implementing treaty commitment, supplement national efforts toward sustainable development in poorer countries, and support UN agencies and treaty secretariats that coordinate or implement environmental efforts. Generally, there is a commitment for financial assistance from high-income countries with more financial resources to low- and middle- income countries. This recognizes that the historical and current contribution of countries to climate change, and their capacity to prevent it and cope with its consequences, vary substantially. Some entities that operate financial mechanisms, such as the [[Global Environment Facility (GEF)]] and [[Green Climate Fund (GCF)]], specifically provide financial support for environmental activities. Others, such as funds administered by the World Bank, are more general in nature. The GEF was established in 1994 when the [[UNFCCC]] came into force. It has its own governing council and sets priorities and processes for funding many environmental projects. It administers three special UNFCCC funds: (i) the Special Climate Change Fund (SCCF); (ii) the Least Developed Countries Fund (LDCF); and (iii) the Adaptation Fund (GEF, 2022). Similarly, the [[Green Climate Fund (GCF)]] was set up in 2010 to specifically address climate change. A year later, the GCF was designated as an operating entity of the financial mechanism, accountable to the UNFCCC’s Conference of Parties (COP), which decides on its policies, programme priorities and eligibility criteria for funding. At the Paris Climate Change Conference in 2015, ==the COP agreed that the operating entities of the financial mechanisms – i.e., the GCD and GEF – as well as the SCCF and the LDCF shall serve the Paris Agreement (2015)==. The agreement reaffirms the obligations of high-income countries, and for the first time encourages voluntary contributions by other organizations, including charitable foundations such as the [[Bill & Melinda Gates Foundation]], while emphasising the need for transparency and enhanced predictability of financial support. ## 4.2 International Environmental Policymaking United Nations Conference on the Human Environment (UNHCE) in Stockholm (1972) set into motion and ratification of numerous international environmental agreements and created the impetus to set up the [[UNEP]] In 1992 - UN Conference on Environment and Development (UNCED) in Rio (the Earth Summit) led to several significant outcomes: 1. Rio Declaration - a political declaration of principles on environment and development 2. a blueprint (Agenda 21 - an agenda for the 21st century) for implementing sustainable development 3. a declaration of Forest Principles; 4. two new multilateral environmental conventions on climate change; the [[UNFCCC]] and the Convention on Biological Diversity [[UNCBD]] The [[UNFCCC]] supreme decision-making body - the Conference of the Parties ([[COP]]) - meets anually. In 2015 the COP adopted the landmark, legally binding [[Paris Agreement]] that obliges all signatory nations to undertake ambitious efforts to mitigate climate change and adapt to its impacts through economic and social transformation, based on the best available science. The Paris Agreement is based on a 5-year cycle of increasingly ambitious plans for climate action known as [[nationally determined contributions (NDCs)]], as well as long-term low carbon and low greenhouse gas emission development strategies (United Nations, 2022b). In 2012, the UN Conference on Sustainable Development (Rio+20) adopted a focused political outcome document entitled "The Future We Want" that renewed the commitment to sustainable development and to ensuring the promotion of an economically, socially and environmentally sustainable future of the planet (UN, 2012). In this document, governments also committed to evaluating the progress made and remaining gaps on the implementation of the outcomes of the summits on sustainable development. At Rio+20, decisions were taken to develop the SDGs in line with the post-2015 development agenda, replacing the MDGs. The [[High-Level Political Forum on Sustainable Development (HLPF)]], established in 2013, convenes annually to follow-up and review the 2030 Agenda for Sustainable Development and the SDGs at the global level, and to discuss financing options for sustainable development (United Nations, 2022c). ## 4.3 Challenges to environmental governance Despite efforts, the threat of anthropogenic climate change and its catastrophic consequences, a 2019 UN report that assessed global environmental rule of law described widespread failure to adequately enforce existing regulations ([[UNEP]], 2019). A lack of ability or motivation to effectively implement environmental policies at an individual country level, in addition to the absence of effective enforcement mechanisms at the international level, have led to criticisms that even legally binding international treaties (such as the 2015 Paris Agreement) are broadly ineffective and unlikely to reach their objectives. Figure 3 shows how current policies are likely to result in an increase in the global average temperature of more than 2.5⁰C above pre-industrial levels by 2100, despite pledges to implement policies to hold planetary warming to below 2⁰C. Other significant challenges include ==high-income countries’ failure to live up to their commitment to deliver capital that had been set aside to fund low- and middle-income nations’ efforts towards climate change mitigation and adaptation== (Timperley, 2021). # 5. Governance Implications of Emerging Infectious Diseases. The spread and societal impact of high profile EIDs in recent years have highlighted the lack of effective governance structures to coordinate the pooling and sharing of resources needed to combat pandemics between countries. - Unequal distribution of capabilities and expertise at the national level - Organizational challenges, operational inefficiencies, and difficulties in coordinating activities among all players limit overall capacity to effectively detect, contain, and manage global infectious disease threats. - Economic argument to be made that EID surveillance and response are global public goods, in that they are non-rival, non-excludable, and affected by externalities. This hypothesis helps explain why organising collective action for EID surveillance, preparedness and response is difficult and suggests that WHO and implementing partners should take greater advantage of pre-existing incentives for countries to collaborate in order to protect themselves and each other from EIDs. ## 5.1 Levels of governance for EID ### International - International governmental organizations (eg, UN and WHO) - International legal agreements ([[IHR]], Nagoya Protocol) - International coalitions and alliances (Global Health Security Agenda and Coalition for Epidemic Preparedness Innovations) - National Governments - Donors - Non-governmental organizations (eg, Greenpeace, World Wildlife Fund) - Public private partnerships (eg, [[GAVI]], [[Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM)]], Red Cross, [[MSF]]) - Financing facilities (eg, Pandemic Emergency Financing Facility from 2016-2021, Financial Intermediary Fund) In 2014, WHO was criticised because of the way Ebola outbreak was handled, so a new health emergencies programme to streamline and align its internal health emergency activities was instituted in 2016 (WHO, 2016). Two years later, the [[Global Preparedness Monitoring Board (GPMB)]] was co-convened by WHO and World Bank as an independent monitoring and accountability body to enhance preparedness for global health crises, while strengthening the WHO's reach adn effectiveness in epidemic preparedness and response. In addition to having national plans in place for EID preparedness and response, some countries collaborate to address governance shortcomings at other levels. For example, the Global Health Security Agenda (GHSA), launched in 2014, is a partnership of over 70 countries, international organizations, and non-governmental stakeholders with a focus on helping participating countries build core capacities for infectious disease outbreak detection, preparedness, and response (Pandemic Action Network, 2022). There is also substantial ongoing collaboration between specialised institutions established at the bloc level on different continents. The European Centre for Disease Prevention and Control (ECDC) in the European Union; the Centers for Disease Control and Prevention (CDC) in the United States, and Africa CDC all have similar roles i.e., to enhance national or regional health security by identifying, assessing and communicating current and emerging threats to human health posed by infectious diseases and by supporting health promotion, prevention and preparedness activities. The exchange of information, expertise and best practices within and between such institutions fosters alignment and promotes good infectious disease governance at an international level. There is also the potential for reverse knowledge transfer for certain infectious diseases that have long been endemic in low- and middle-income countries, but which have emerged relatively recently in high-income countries (e.g., Monkeypox Virus). ### National During infectious disease outbreak emergencies, responses taken by one country often have an impact on other countries (e.g., as demonstrated during the COVID-19 pandemic when travel restrictions and border controls severely impacted international travel and transport of goods). Coordination and collaboration between countries during global infectious disease outbreaks is likely to achieve better outcomes than if each country acted in its own self-interest. ## 5.2 Challenges to global infectious disease governance ### 5.2.1 Coordination failure Evolved in a piecemeal, ad-hoc fashion over several decades, the current system of governance for EIDs lack coherence at the global level. Many stakeholder organizations engage in one or more activities to address part of the problem, but the absence of a reliable, well-resourced global entity for overall coordination has led to inefficiency and missed opportunities during the response to infectious disease outbreaks, as demonstrated most recently during the COVID-19 pandemic. Each additional multilateral organization adds yet another layer of complexity to the overall system, as responsibilities overlap with those assigned to the WHO under the IHR and competition for funding increases. ### 5.2.2 Funding Classic money problem. For example, the failure of member states to agree on an increase to compulsory contributions to the WHO, or event to pay these contributions, has resulted in an increasing reliance on voluntary contributions. ==These are often earmarked for specific activities==, making it difficult for the WHO to coherently respond to broader needs or to perform global normative functions that enable effective EID governance. ### 5.2.3 Self-interest [[Problems without passports]]. Governance via national sovereignty is arguably a fundamental obstacle to progress. National governments may be reluctant to accept governance arrangements that cede their authority over infectious disease preparedness and response to international institutions. For example, during the COVID-19 pandemic, protectionist policies based on national self-interest (rather than global priorities) and gaps in multilateral cooperation on research and information sharing, supplies of personal protective equipment, vaccine development and deployment, and travel or border policies hampered the speed and equity of global recovery. ### 5.2.4 Inadequate representation of civil society The absence of meaningful representation of civil society in international and multilateral institutions has been called the “[[Democratic deficit]]” (Clinton & Sridhar, 2017). There has been a gradual shift in global health governance towards a model characterized by increased transparency and an openness to including community organizations and NGOs within institutional governing structures. Such an approach promotes transparency, increases legitimacy and builds trust among donors and the public, an increasingly important consideration in the age of social media. However, not all multilateral organizations have embraced this approach; ==the WHO in particular has been criticized for not sufficiently engaging with civil society==. ### 5.2.5 Other threats Climate change, anthropogenic activities that bring humans and animals into close contact, antimicrobial resistance, vaccine hesitancy. ## 5.3 Developments in global governance From COVID-19 pandemic, in hindisght, the [[International Health Regulation (IHR)]] were unable to impel a robust, coordinated response against the COVID-19 PHEIC. This recognition has led to a proposal for an international treaty on pandemics that was first announced at the Paris Peace Forum in November 2020. In December 2021, the 194 members of the WHO reached consensus to kickstart the process to draft and negotiate an instrument under the Constitution of the WHO to strengthen pandemic prevention, preparedness and response, with the intention of adopting it by 2024 (WHO, 2021a). #pandemic-treaty In addition,a WHO review of lessons learnt from the global response to the COVID-19 pandemic outlined the need for a new sustainable model to underpin WHO's leadership in pandemic and epidemic preapredness and response. The report, published in 2021, proposed several areas for action, including setting up a framework for coordinated and monitored national health emergency and response plans; implementing sustained and predictable funding for pandemic response; ensuring that supply chains and logistics systems are able to cope with demand during a pandemic; introducing measures to manage misinformation and disinformation, and facilitating the sharing of pathogen/genomic data (WHO, 2021b). ## Integrating activity - Choose a disease outbreak that is of interest to you from https://www.who.int/emergencies/disease-outbreak-news - Consider how all the issues we have discussed during this session may have driven the outbreak, or affected the response to it. - Post a concise summary of it on the discussion board, including what is known about the causative agent, likely response measures and governance challenges to the overall response. # 6. Summary In this session, we have discussed the epidemiology of some emerging infectious diseases affecting the global community, identified several global environmental factors contributing to this emergence, and considered global environmental governance issues related to the control and prevention of emerging infections. Future challenges include addressing the issue that populations in LMIC are likely to bear the brunt of climate change, and the various issues around this, including increased poverty rates, forced migration and equity (Wentworth, 2018). # 7. References ## 7.1 [[Essential readings]] Sleepwalking into the next pandemic. 2022. Nat Med 28, 1325. https://doi.org/10.1038/s41591-022-01918-9 Baker, R.E., Mahmud, A.S., Miller, I.F. et al. Infectious disease in an era of global change. 2022. Nat Rev Microbiol 20, 193–205. https://doi.org/10.1038/s41579-021-00639-z Mora C et al. 2022. Over half of known human pathogenic diseases can be aggravated by climate change. Nat Clim Chang https://doi.org/10.1038/s41558-022-01426-1 ## 7.2 [[Recommended reading]] Hess J, Boodram LG, Paz S, et al. 2020. Strengthening the global response to climate change and infectious disease threats. BMJ 371:m3081 doi:10.1136/bmj.m3081 Parvez MK, Parveen S. 2017. Evolution and Emergence of Pathogenic Viruses: Past, Present, and Future. Intervirology 60:1–7. doi: 10.1159/000478729 Woolhouse M et al. 2012. Human viruses: discovery and emergence. Philos Trans R Soc Lond B Biol Sci 367(1604):2864–2871. doi: 10.1098/rstb.2011.0354