Regional lessons from the COVID-19 outbreak in the Middle East: From infectious diseases to climate change adaptation

Prepared for the polycrisis? The need for complexity science and systems thinking to address global and national evidence gaps

The Sustainable Development Goals are far off track. The convergence of global threats such as climate change, conflict and the lasting effects of the COVID-19 pandemic-among others-call for better data and research evidence that can account for the complex interactions between these threats. In the time of polycrisis, global and national-level data and research evidence must address complexity. Viewed through the lens of 'systemic risk', there is a need for data and research evidence that is sufficiently representative of the multiple interdependencies of global threats. Instead, current global published literature seems to be dominated by correlational, descriptive studies that are unable to account for complex interactions. The literature is geographically limited and rarely from countries facing severe polycrisis threats. As a result, country guidance fails to treat these threats interdependently. Applied systems thinking can offer more diverse research methods that are able to generate complex evidence. This is achievable through more participatory processes that will assist stakeholders in defining system boundaries and behaviours. Additionally, applied systems thinking can draw on known methods for hypothesising, modelling, visualising and testing complex system properties over time. Application is much needed for generating evidence at the global level and within national-level policy processes and structures.

Health systems response to climate change adaptation: a scoping review of global evidence

BACKGROUND

The health system plays a critical role in safeguarding the well-being of communities in the face of health risks associated with climate change. This review maps evidence on health systems' adaptation to climate risk and barriers to effective adaptation.

METHODS

This review followed the recommendations by Arksey and O'Malley for conducting scoping review. Search for records was conducted in PubMed, Central, Web of Science, JSTOR, Google, and Google Scholar. Only peer-reviewed papers published in English language were included in this review. All the 63 included studies were critically appraise d.

RESULTS

We found that efforts are being made to create resilient health systems by incorporating climate change into health policies. Investments are being made in innovative technologies, climate-resilient health infrastructure, enhancing healthcare delivery, developing the capacity of climate specialists and agencies to provide high-quality evidence for resilient health systems. We also found that several obstacles prevent health system adaptation to climate risk, including poor policy implementation and evaluation. The obstacles are further exacerbated by financial constraints, including poverty, a lack of political commitment, inadequate data, and deficient healthcare systems, especially in developing countries. There is also a lack of integration of climate change into mental health actions and the health and safety of healthcare workers.

CONCLUSION

Efforts to develop resilient health systems against climate risks are underway, but persistent obstacles, including inadequate policy implementation, resource limitations, and a lack of integration of climate change into critical health domains, hinder comprehensive adaptation measures, particularly in developing nations.

Exploring the worldwide impact of COVID-19 on conflict risk under climate change

Objectives

Understand whether and how the COVID-19 pandemic affects the risk of different types of conflict worldwide in the context of climate change.

Methodology

Based on the database of armed conflict, COVID-19, detailed climate, and non-climate data covering the period 2020-2021, we applied Structural Equation Modeling specifically to reorganize the links between climate, COVID-19, and conflict risk. Moreover, we used the Boosted Regression Tree method to simulate conflict risk under the influence of multiple factors.

Findings

The transmission risk of COVID-19 seems to decrease as the temperature rises. Additionally, COVID-19 has a substantial worldwide impact on conflict risk, albeit regional and conflict risk variations exist. Moreover, when testing a one-month lagged effect, we find consistency across regions, indicating a positive influence of COVID-19 on demonstrations (protests and riots) and a negative relationship with non-state and violent conflict risk.

Conclusion

COVID-19 has a complex effect on conflict risk worldwide under climate change.

Implications

Laying the theoretical foundation of how COVID-19 affects conflict risk and providing some inspiration for the implementation of relevant policies.

Current and future trends in heat-related mortality in the MENA region: a health impact assessment with bias-adjusted statistically downscaled CMIP6 (SSP-based) data and Bayesian inference

BACKGROUND

The Middle East and North Africa (MENA) is one of the regions that is most vulnerable to the negative effects of climate change, yet the potential public health impacts have been underexplored compared to other regions. We aimed to examine one aspect of these impacts, heat-related mortality, by quantifying the current and future burden in the MENA region and identifying the most vulnerable countries.

METHODS

We did a health impact assessment using an ensemble of bias-adjusted statistically downscaled Coupled Model Intercomparison Project phase 6 (CMIP6) data based on four Shared Socioeconomic Pathway (SSP) scenarios (SSP1-2·6 [consistent with a 2°C global warming scenario], SSP2-4·5 [medium pathway scenario], SSP3-7·0 [pessimistic scenario], and SSP5-8·5 [high emissions scenario]) and Bayesian inference methods. Assessments were based on apparent temperature-mortality relationships specific to each climate subregion of MENA based on Koppen-Geiger climate type classification, and unique thresholds were characterised for each 50 km grid cell in the region. Future annual heat-related mortality was estimated for the period 2021-2100. Estimates were also presented with population held constant to quantify the contribution of projected demographic changes to the future heat-mortality burden.

FINDINGS

The average annual heat-related death rate across all MENA countries is currently 2·1 per 100 000 people. Under the two high emissions scenarios (SSP3-7·0 and SSP5-8·5), most of the MENA region will have experienced substantial warming by the 2060s. Annual heat-related deaths of 123·4 per 100 000 people are projected for MENA by 2100 under a high emissions scenario (SSP5-8·5), although this rate would be reduced by more than 80% (to 20·3 heat-related deaths per 100 000 people per year) if global warming could be limited to 2°C (ie, under the SSP1-2·6 scenario). Large increases are also expected by 2100 under the SSP3-7·0 scenario (89·8 heat-related deaths per 100 000 people per year) due to the high population growth projected under this pathway. Projections in MENA are far higher than previously observed in other regions, with Iran expected to be the most vulnerable country.

INTERPRETATION

Stronger climate change mitigation and adaptation policies are needed to avoid these heat-related mortality impacts. Since much of this increase will be driven by population changes, demographic policies and healthy ageing will also be key to successful adaptation.

FUNDING

National Institute for Health Research, EU Horizon 2020.

Sustainable development goal 13 and switching priorities: addressing climate change in the context of pandemic recovery efforts

The COVID-19 pandemic has had many deep social and economic impacts that go beyond health issues. One consequence is that the pandemic has made it even harder to mobilize the financial resources needed to pursue SDG 13 (Climate Action) as a whole and to fund climate change mitigation and adaptation efforts in particular. This is especially acute in respect of the efforts to achieve the targets set by the Paris Agreement and by the recent decisions in Glasgow. This paper looks at how the COVID-19 pandemic has accelerated poverty and undermined climate change mitigation and adaptation efforts, as a result of the switches in priorities and funding. Using a review of the recent literature, an analysis of international trends, and a survey among climate scientists, it identifies some of the impacts of the pandemic on climate change mitigation and adaptation efforts and discusses their implications. The findings indicate a decrease in funding to climate change research since the pandemic crisis. The bibliometric analysis reveals that a greater emphasis has been placed on the relationship between COVID-19 and poverty when compared to the interrelations between COVID-19 and climate change. Addressing climate change is as urgent now as it was before the pandemic crisis started, and efforts need to be made to upkeep the levels of funding needed to support research in this field.

Climate change and COVID-19: Interdisciplinary perspectives from two global crises

The repercussions of the COVID-19 pandemic and climate change - two major current global crises - are far-reaching, the parallels between the two are striking, and their influence on one another are significant. Based on the wealth of evidence that has emerged from the scientific literature during the first two years of the pandemic, this study argues that these two global crises require holistic multisectoral mitigation strategies. Despite being different in nature, neither crisis can be effectively mitigated without considering their interdependencies. Herein, significant interactions between these two crises are highlighted and discussed. Major implications related to the economy, energy, technology, environment, food systems and agriculture sector, health systems, policy, management, and communities are detailed via a review of existing joint literature. Based on these outcomes, practical recommendations for future research and management are provided. While the joint timing of these crises has created a global conundrum, the COVID-19 pandemic has demonstrated opportunities and lessons for devising sustainable recovery plans in relation to the climate crisis. The findings indicated that governments should work collaboratively to develop durable and adjustable strategies in line with long-term, global decarbonisation targets, promote renewable energy resources, integrate climate change into environmental policies, prioritise climate-smart agriculture and local food systems, and ensure public and ecosystem health. Further, differences in geographic distributions of climate change and COVID-19 related death cases revealed that these crises pose different threats to different parts of the world. These learnings provide insights to address the climate emergency - and potential future global problems with similar characteristics - if international countries act urgently and collectively.

Into the "New Normal": The Ethical and Analytical Challenge Facing Public Health Post-COVID-19

Even though various countries' overall policy for dealing with the pandemic was not particularly innovative, the pandemic was perceived as a unique crisis. "COVID exceptionalism" has seemed to create "a new normal" that we all need to "learn to live with". The main change in perspective, while not new for public health experts, is that health exists within a social and political context. While public health ethics has turned out to be an important discipline, there is a long way to its wider acceptance. Entering the "new normal" calls for a wider embrace of public health approaches to ethics. The renewed emphasis on understanding health as a social concept encompasses central normative implications in relation to dealing with COVID-19 and in relation to dealing with other global crises, chiefly climate change. We argue that entering the era of "the new normal" in healthcare requires a nuanced understanding of the relationship between the individual and society and demands the formulation of a new system of bioethics focused on the concept of solidarity as a central value in public health. Such a concept should refer to the fact that in the "new normal", risks require new social and political formations of standing together in confronting risks that cross national, cultural, and identity borders. Forming and expanding solidarity in health and healthcare, we argue, is the main normative challenge for public health today.

Into the “New Normal”: The Ethical and Analytical Challenge Facing Public Health Post-COVID-19

Even though various countries’ overall policy for dealing with the pandemic was not particularly innovative, the pandemic was perceived as a unique crisis. “COVID exceptionalism” has seemed to create “a new normal” that we all need to “learn to live with”. The main change in perspective, while not new for public health experts, is that health exists within a social and political context. While public health ethics has turned out to be an important discipline, there is a long way to its wider acceptance. Entering the “new normal” calls for a wider embrace of public health approaches to ethics. The renewed emphasis on understanding health as a social concept encompasses central normative implications in relation to dealing with COVID-19 and in relation to dealing with other global crises, chiefly climate change. We argue that entering the era of “the new normal” in healthcare requires a nuanced understanding of the relationship between the individual and society and demands the formulation of a new system of bioethics focused on the concept of solidarity as a central value in public health. Such a concept should refer to the fact that in the “new normal”, risks require new social and political formations of standing together in confronting risks that cross national, cultural, and identity borders. Forming and expanding solidarity in health and healthcare, we argue, is the main normative challenge for public health today.

Climate Change and Diarrhoeal Disease Burdens in the Gaza Strip, Palestine: Health Impacts of 1.5 °C and 2 °C Global Warming Scenarios

The Gaza Strip is one of the world’s most fragile states and faces substantial public health and development challenges. Climate change is intensifying existing environmental problems, including increased water stress. We provide the first published assessment of climate impacts on diarrhoeal disease in Gaza and project future health burdens under climate change scenarios. Over 1 million acute diarrhoea cases presenting to health facilities during 2009−2020 were linked to weekly temperature and rainfall data and associations assessed using time-series regression analysis employing distributed lag non-linear models (DLNMs). Models were applied to climate projections to estimate future burdens of diarrhoeal disease under 2 °C and 1.5 °C global warming scenarios. There was a significantly raised risk of diarrhoeal disease associated with both mean weekly temperature above 19 °C and total weekly rainfall below 6 mm in children 0−3 years. A heat effect was also present in subjects aged > 3 years. Annual diarrhoea cases attributable to heat and low rainfall was 2209.0 and 4070.3, respectively, in 0−3-year-olds. In both age-groups, heat-related cases could rise by over 10% under a 2 °C global warming level compared to baseline, but would be limited to below 2% under a 1.5 °C scenario. Mean rises of 0.9% and 2.7% in diarrhoea cases associated with reduced rainfall are projected for the 1.5 °C and 2 °C scenarios, respectively, in 0−3-year-olds. Climate change impacts will add to the considerable development challenges already faced by the people of Gaza. Substantial health gains could be achieved if global warming is limited to 1.5 °C.

The Middle East and COVID-19: time for collective action

Revised: Nov 6 2021The shortfalls of multilateral and regional organizations in respect of handling the COVID-19 pandemic have been well rehearsed by scholars and policy makers in multiple publications and statements. While the World Health Organization (WHO) and its regional offices have coordinated global responses, regional organizations, like the European Union, Association of Southeast Asian Nations, or African Union, have played complementary roles. However, the response of different regions has varied, revealing multiple deficits in the structures of regional governance. The Middle East and North Africa (MENA) is a region affected by chronic ongoing conflicts and serious inequalities in health and welfare provision, reflected in the absence of concerted responses to the pandemic. Its young population has meant lower comparative mortality rates, but the socio-economic spill-over effects are grave in terms of interrupted education, high unemployment, particularly in respect to vulnerable communities like refugees and migrant workers. With the current situation remaining critical, this paper reviews the impact of COVID-19 on MENA and considers the variable performance of states and institutions to the pandemic, highlighting the shortfalls, but also opportunities for collective action. Drawing on data from the WHO, United Nations (UN), regional organizations, media and secondary sources, it first discusses the wider global-regional context; second, reviews the actions of regional bodies, like the League of Arab States, Gulf Cooperation Council and the cross-regional Organization of Islamic Cooperation; and third, looks at some country-specific situations where both evidence of good practice and the absence of appropriate regional level provision have exposed deep regional divides. It concludes with a call for more collaboration between states and international organizations: better regional coordination is urgently needed to supplement existing multilateral efforts. A collective local response to the COVID-19 pandemic could help transcend regional divides and spur much-needed security cooperation in other areas.

Urban attributes and the spread of COVID-19: The effects of density, compliance and socio-political factors in Israel

Current debates identifying urban population density as a major catalyst for the spread of COVID-19, and the praise for de-densification and urban sprawl that they entail, may have dire environmental consequences. Juxtaposing competing theories about the urban antecedents of COVID-19, our key argument is that urban political attributes overshadow the effects of cities' spatial characteristics. This is true even when considering levels of compliance with movement restrictions and controlling for demographic and socio-economic conditions. Taking advantage of Israel as a living lab for studying COVID-19, we examine 271 localities during the first 3 months of the outbreak in Israel, a country where over 90% of the population is urban. Rather than density, we find social makeup and politics to have a critical effect. Cities with some types of political minority groups, but not others, exhibit higher infection rates. Compliance has a significant effect and density's influence on the spread of the disease is contingent on urban political attributes. We conclude with assessing how the relationship between the politics of cities and the spread of contagious diseases sheds new light on tensions between neo-Malthusian sentiments and concerns about urban sprawl and environmental degradation.

Lessons of the Israeli-Palestinian Conflict for Public Health: The Case of the COVID-19 Vaccination Gap

In early 2020, the COVID-19 pandemic revealed a faceless, non-adversarial threat that endangered Israelis and Palestinians with the same ferocity. However, the capacities of the health systems to address it were not equal, with Israel more equipped for the outbreak with infrastructure, resources, manpower and later, vaccines. The pandemic demonstrated the life-saving benefits of cooperation and the self-defeating harms brought by non-cooperation. These trends are explored here by an international team of public health and environmental scholars, including those from different sides of the Israeli–Palestinian conflict. This article explores the importance of recognizing the Israeli and Palestinian jurisdictions as a single epidemiological unit, and illustrates how doing so is a pragmatic positioning that can serve self-interest. We demonstrate how despite political shocks precipitating non-cooperation, there has been a recurrent tendency towards limited cooperation. The paper concludes with lessons over the need for reframing public health as a potential bridge, the need for structural changes creating sustainable platforms for accelerated transboundary cooperation to enable the steady management of current and future public and environmental health crises regardless of dynamic political crises, and the importance of civil society and international organizations in forging collaboration in advance of governmental engagement.

Climate change during the COVID-19 outbreak: scoping future perspectives

Neither war nor recession or any kind of prior disaster has been considered a prelude to the looming threat of climate change over the past era as coronavirus (hereafter COVID-19) has in only a few months. Although numerous studies have already been published on this topic, there has not been compelling evidence critically assessing the impact of COVID-19 by and on climate change. The present study fills this gap by taking a more holistic approach to elaborate factors, e.g., natural and anthropogenic factors, ocean submesoscales, radiative forces, and greenhouse gas/CO₂ emissions, that may affect climate change in a more prevalent and pronounced manner. Based on the statistical data collected from the NASA Earth Observatory, the European Space Agency, and the Global Carbon Project, the findings of this study reveal that the climate/environment has improved during COVID-19, including better environmental quality and water quality with low carbon emissions and sound pollution. In the lockdown during the epidemic, the emissions of nitrogen dioxide (NO₂) and carbon dioxide (CO₂) significantly decreased because of the lower usage of transportation, decreased electricity demand, and halted industrial activities. The policy implications of this study suggested that keeping the climate healthy even in the post-COVID-19 era is a serious concern that needs to be addressed by investing in clean and green projects, ensuring green energy evolution, dealing with a large volume of medical waste, building health-ensuring and livable societies, and halting the funding of pollution. For governmental and regulatory bodies, these factors will provide a strong foundation to build safer, healthier, and environmentally friendly societies for generations to come.