8. Environmental Change and Emerging Infections

Question 1

Overview Summary

Answer 1

In this session, we will 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.

Question 2

Overview Aim

Answer 2

The aim of this session is to provide an overview of the science and policy debate related to environmental change and emerging infectious diseases (EIDs).

Question 3

Overview Learning outcomes

Answer 3

By the end of this session, you should be able to: Explain the health impacts of EIDs on the global community; Assess key global environmental (socioeconomic and ecological) factors contributing to the emergence of infectious diseases; Critically analyse the role of key actors and the significance of conflicts of interests affecting environmental change and emerging infections; and Examine policy challenges posed by emerging infections and outline potential means of addressing these.

Question 4

Key terms Emerging infectious disease

Answer 4

: 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).

Question 5

Key terms Environmental health

Answer 5

Environmental health addresses all the physical, chemical, and biological factors external to a person, and all the related factors impacting behaviours. It encompasses the assessment and control of those environmental factors that can potentially affect health. It is targeted toward preventing disease and creating health-supportive environments. This definition excludes behaviour not related to environment, as well as behaviour related to the social and cultural environment, and genetics (EHPA, 2022).

Question 6

Key terms Global environmental change

Answer 6

Global environmental change encompasses changes in the physical and biogeochemical environment, either caused naturally or influenced by human activities such as deforestation, fossil fuel consumption, urbanisation, land reclamation, agricultural intensification, freshwater extraction, fisheries over-exploitation and waste production. These may manifest at the global scale (e.g. increasing atmospheric CO2) or on a local scale but sufficiently widespread as to be a global phenomenon (e.g. soil degradation) (McMichael et al, 2008).

Question 7

Key terms Sustainable development

Answer 7

Sustainable development is development that meets the needs of the present, without compromising the ability of future generations to meet their own needs (Brundtland, 1987; SDC, 2022).

Question 8

1 Why are (re)-emerging infectious diseases a threat?

Answer 8

The rise in prevalence of infectious disease since the 1990s has disproven the assumption that concurrent technological advances will prevent infectious diseases posing a threat to humans (Snowden, 2008). Moreover, 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). Diseases once believed to be under control have re-emerged as major global threats to health. The emergence of drug-resistant strains of bacteria, viruses and other parasites pose new challenges in controlling infectious diseases. 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.

Question 9

1 Why are (re)-emerging infectious diseases a threat?

Answer 9

Emerging and re-emerging infections increase awareness of our global vulnerability and the borderless impact of infectious diseases, underscoring the need for strong health systems and cooperation between states’ health systems. 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).

Question 10

1 Why are (re)-emerging infectious diseases a threat?

Answer 10

Infectious diseases have not disappeared, despite the existence of effective prevention and treatment tools for some of them. The WHO Health Statistics report of 2022 describes the disproportionate impact one infectious disease, Covid-19, has had on populations with less access to vaccination programmes and sufficient healthcare than those living in higher-income countries. The report also states that communicable diseases are responsible for almost 50% of all deaths in low-income countries, with these and middle-income countries bearing the impact on health of diseases such as malaria, tuberculosis (TB), HIV and neglected tropical diseases (WHO, 2022a).

Question 11

1 Why are (re)-emerging infectious diseases a threat?

Answer 11

Infectious diseases, caused by viruses, bacteria, fungi and other parasites, are major causes of death, disability, and disruption for millions of people. Many people, particularly in low-income countries, lack access to essential preventive and treatment interventions. Children are particularly vulnerable to infectious diseases, with 65% of deaths among children under age five in low-income countries caused by preventable infections such as pneumonia, diarrhoea and malaria. Thus, 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). This can also be seen on a global scale, for example the global economic loss due to severe acute respiratory syndrome (SARS) was estimated at US$40 billion (World Bank, 2012).

Question 12

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.

Answer 12

Feedback: you may have mentioned that this is likely to be because high-income countries fund research programmes, which in turn makes them more likely to fund research that will impact their own populations rather than those of other countries. In addition, this may win voters’ approval in elections, as people see themselves as likely to benefit from research, rather than anonymous recipients in LMIC. You may also have discussed the concept of enlightened self-interest (the idea that trying to further the interests of others ultimately serves your own interests, e.g., paying for research into vaccines means that others will become vaccinated and therefore less likely to infect you with a disease).

Question 13

2 Emerging infectious diseases

Answer 13

Incidence of all infectious diseases had declined significantly since the advent of routine vaccinations, including the Expanded Programme on Vaccination instituted in 1974 (Greenwood, 2014). In 1990, 1.1 billion disability-adjusted life years (DALYs) were lost to communicable diseases globally, decreasing to 670,000 DALYs in 2016: a 40% reduction (see Roser and Ritchie, 2021, for these and other interesting data). Since 2000, improved sanitation, advances in medical care and access to this care led many to extrapolate that this trend would continue into the future (Baker et al, 2022). However, this decrease in incidence has not occurred globally, with a larger burden of communicable disease in low- and middle-income countries (Coates et al, 2021).

Question 14

2 Emerging infectious diseases

Answer 14

In reality, 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. Real-world interventions are implemented within a complex system, which cannot be reduced to the simplicity of the laboratory. Outcomes, such as the spread of antibiotic resistance, need to be addressed. Basic public health services, such as clean water, shelter, food and micronutrients, and sanitation are unavailable for many people, particularly those in low-income countries. Environmental degradation has been ignored or actively encouraged to meet economic needs. The environmental impact of the extraction and unsustainable use of natural resources since the industrial revolution in 1850 has been ignored due to the prioritisation of economic gain. This has resulted in significant health impacts from pollution, destruction of habitats and loss of biodiversity, and climate change (see https://www.statista.com/statistics/264699/worldwide-co2-emissions/ for a visual representation of this).

Question 15

2 Emerging infectious diseases

Answer 15

Looking at Figure 1, we see over thirty incidents of emerging and re-remerging diseases in countries across the globe. EID events have increased significantly since 1970, with a peak incidence in the 1980s related to the HIV epidemic. While this figure was published in 2016, it is helpful in helping us understand the range of EIDs around the world over time and how some of these still affect us. Approximately 60% of EIDs are zoonoses, over 70% of which, including SARS and Ebola - originated in wild animal populations (Jones et al, 2008). More recent examples include Covid-19, monkeypox and Marburg virus disease. These EIDs have a huge global impact on health, in both higher- and lower-income countries. However, although many new diseases have emerged, such as SARS and the 2009 pandemic influenza strain, significant advances have also occurred in EID control, prevention and treatment (Morens & Fauci, 2012). For example, antiretroviral drugs mean that people living with HIV now have life expectancies similar to those of HIV-negative people, although this is not true for all populations (e.g., injecting drug users) (Katz & Maughan-Brown, 2017).

Question 16

2.1 What are EIDs?

Answer 16

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: new pathogens entering human populations (e.g. HIV-1, SARS); novel variants of existing pathogens (e.g. extensively drug-resistant TB [XDR-TB]); newly recognised causes of common diseases (e.g. Helicobacter pylori – stomach ulcers); pathogens that were once common but experienced a long-term decline before increasing again (e.g. TB, malaria); and pathogens considered rare that have recently increased in incidence (e.g. Lyme disease).

Question 17

2.1 What are EIDs?

Answer 17

Below we provide some examples of these categories of EIDS and their impact on health: New pathogen strains, such as HIV-1 and Ebola, are what people usually think of as EIDs. Both are zoonoses (transferred from vertebrate non-human animals to humans) due to anthropogenic activities which bring humans and animals into close contact, such as trade in wildlife as food or medicine, global travel, and habitat encroachment.

Question 18

2.1 What are EIDs?

Answer 18

The Ebola Virus epidemic is an example of an emerging infection that spread rapidly in West Africa and potentially threatened populations over the whole continent. This epidemic occurred mainly in Guinea, Liberia, and Sierra Leone, with a death toll of over 11,400 and 21,200 cases by 15 January, 2015. In August 2014, the WHO declared it a Public Health Emergency of International Concern (PHEIC), resulting in a massive global response (see Wilder-Smith and Osman, 2020, for an overview of this, PHEICs will also be discussed later in the session). Travel-associated cases were documented in five additional countries, and the effects were felt over the entire region, including on local economies (Dramé et al, 2021). Although it is not entirely clear how Ebola initially spreads from animals to humans, it is believed to involve direct contact with an infected wild animal or fruit bat. Besides bats, other wild animals sometimes infected with Ebola virus include several monkey species, chimpanzees, gorillas, baboons and duikers (Briand et al, 2014).

Question 19

2.1 What are EIDs?

Answer 19

Novel variants of existing pathogens include XDR-TB, multidrug resistant falciparum malaria (MDR Plasmodium falciparum), and methicillin-resistant Staphylococcus aureus.

Question 20

2.1 What are EIDs?

Answer 20

Pathogens increasing in incidence include those that experienced an initial decline (such as MDR and XDR-TB), or those originally considered rare that are now increasingly prevalent (such as Lyme disease). Lyme disease, a vector-borne disease, is caused by Gram-negative spirochetal bacteria from the genus Borrelia, transmitted by the bite of infected Ixodes ticks. Urbanisation and other anthropogenic factors are implicated in its spread to and increased frequency among humans. Human expansion has led to gradual localised deforestation, increasing contact between humans and tick-dense areas, and has reduced natural predators of deer, chipmunks, and other small rodents, which are primary reservoirs for Lyme disease. Increased human-vector contact has also been linked to global temperature increases (Milman, 2022). In addition, the promotion of use of green spaces for exercise also means increased exposure to ticks and therefore potentially to Lyme disease (Medlock & Leach, 2015).

Question 21

3 The process of emergence

Answer 21

So how do these diseases emerge? The process of emergence can be divided into four stages or levels, as described in the figure below by Woolhouse and colleagues (2012). This has also been discussed in a paper focusing on emergence of pathogenic viruses, much of which also applies to bacterial and other infections that cause communicable diseases (Parvez & Parveen, 2017).

Question 22

3 The process of emergence Level 1 (exposure)

Answer 22

is influenced by human behaviour and ecology: pathogen prevalence, habitat encroachment, and exposure. Viruses are likely to come from birds or other mammals, and exposure can be by any route: saliva, fomites, oral-faecal or vector borne (e.g., mosquito) etc. This is going to happen more and more frequently as humans encroach on animals’ natural habitat.

Question 23

3 The process of emergence Level 2 (infection)

Answer 23

is influenced by human susceptibility, for example, viruses overcoming the barriers between species.

Question 24

3 The process of emergence Level 3 (transmission)

Answer 24

Many viruses require an animal host or reservoir. Viruses can also be transmitted between humans, and therefore can lead to an epidemic or pandemic – there will be some barriers to transmission, but not all transmission will be prevented. Again, as we encroach on the habitat of other animals, we are more likely to become infected by emerging diseases (or those that are re-emerging).

Question 25

3 The process of emergence Level 4 (epidemic spread)

Answer 25

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.

Question 26

3 The process of emergence

Answer 26

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). There are some important differences between existing and emerging pathogens. The majority of these pathogens are zoonotic, vector-borne and bacterial or viral. Excluding drug resistance, most emerging infections are viral zoonoses, associated with mammals or birds and usually with a broad host range (Jones et al, 2008).

Question 27

3.1 Global factors contributing to the emergence of selected infection Defining environmental change

Answer 27

Environmental change includes changes in the physical and biogeochemical environment, either caused naturally or influenced by 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).

Question 28

3.1 Global factors contributing to the emergence of selected infection Defining environmental change

Answer 28

Since the 1980s and the emergence of HIV, the origins of most EIDs are related to environmental change. These changes include socioeconomic (such as urbanisation, transport and travel, and 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).

Question 29

3.1 Global factors contributing to the emergence of selected infection The role of environmental change in emerging infections

Answer 29

Many factors have contributed to the re-emergence of epidemic diseases throughout much of the world, but 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,

Question 30

3.1 Global factors contributing to the emergence of selected infection The role of environmental change in emerging infections

Answer 30

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).

Question 31

3.1 Global factors contributing to the emergence of selected infection The role of environmental change in emerging infections

Answer 31

In the next section, we will look more closely at population growth, urbanisation and habitat loss, and how these global environmental changes impact health.

Question 32

3.1 Global factors contributing to the emergence of selected infection The role of environmental change in emerging infections

Answer 32

In 2018, over half of the world’s population (55%) lived in urban areas, although there is still substantial variability in the levels of urbanisation across countries (United Nations, 2018). About 80% of people in Latin America and the Caribbean, 50% in Asia and 43% of those in Africa reside in urban areas. Continuing urbanisation and overall population growth are projected to add 2.5 billion people to the urban population by 2050, with nearly 90% of the increase taking place in Asia and Africa. Factors such as housing quality and overcrowding 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 faeces, allowing the spread of diarrheal diseases.

Question 33

3.1 Global factors contributing to the emergence of selected infection The role of environmental change in emerging infections

Answer 33

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).

Question 34

3.1 Global factors contributing to the emergence of selected infection The role of environmental change in emerging infections

Answer 34

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.

Question 35

Activity 2 Look at the information from the CDC website on Marburg virus disease (https://www.cdc.gov/vhf/marburg/index.html ) Outline some background epidemiological information on Marburg virus disease (e.g. via internet search, library or other source) on what causes it, how it is transmitted, natural host, prevention and treatment. Explain two or three possible reasons for why an outbreak of the disease occurred in 2022 (for example, consider urbanisation, habitat encroachment, challenges to control, globalisation). Post your responses on the relevant session discussion thread on Moodle and comment on one other post

Answer 35

Feedback: you could have discussed the issues outlined above: urbanisation (e.g., people living close to each other allowing quick spread of disease/virus; people living in informal communities (slum dwellings)), habitat encroachment (e.g., making close contact with infected animals more likely), globalisation (e.g., diseases can spread more easily as a result of increased air travel), challenges to control (e.g., vested interests of large corporations, lack of management of polluting industries), poverty and associated issues (e.g., lack of sufficient hygiene, pollution).

Question 36

4 Global Environmental Governance and Emerging Infections

Answer 36

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.

Question 37

4.1 Global Environmental Governance

Answer 37

The global impact of the COVID-19 pandemic underscores humanity’s vulnerability to infectious diseases. Like almost every infectious agent that has resulted in a pandemic disease outbreak (e.g. influenza, Ebola, HIV/AIDS, SARS, etc.), 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.

Question 38

4.1 Global Environmental Governance

Answer 38

The COVID-19 pandemic 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. Since environmental problems have global ramifications even though they may have resulted from actions at regional or national 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. Strengthened environmental governance at all levels could enable faster and more effective responses to the challenges posed by emerging infections. The rapid global spread of COVID-19 in 2020, as well as that of other infectious disease outbreaks such as Monkeypox in 2022, has highlighted the urgent need for concrete action at the international level to promote good environmental governance.

Question 39

4.1 Global Environmental Governance

Answer 39

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).

Question 40

4.1 Global Environmental Governance International environmental law

Answer 40

Climate change and air pollution do not respect international borders. As outlined in section 3, increasing urbanisation, international travel, deforestation and other anthropogenic factors mean that environmental problems cannot be resolved through national environmental regulations alone; action at the international level is required to effectively protect the environment.

Question 41

4.1 Global Environmental Governance International environmental law

Answer 41

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. It covers areas such as climate change, environmental migration, biodiversity, toxic and hazardous substances, ozone depletion, sea and transboundary water pollution, conservation of marine resources, geo-engineering etc. Some of the guiding principles for international environmental law include questioning national sovereignty versus common human heritage; 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); environmental procedural rights (i.e. formal steps that can be taken when enforcing legal rights (UNEP, 2019); intergenerational and intergenerational equity; and the polluter pays, precautionary, and sustainable development principles (Hutchinson and Kovats, 2016).

Question 42

4.1 Global Environmental Governance International environmental law

Answer 42

International environmental agreements are generally multilateral or bilateral treaties (e.g., conventions, agreements), some of which[1] are signed within the framework of the United Nations (UN), an international organization founded in 1945 that at the time of writing is composed of 193 Member States.

Question 43

4.1 Global Environmental Governance International environmental law

Answer 43

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.

Question 44

4.1 Global Environmental Governance Intergovernmental organisations concerned with environmental sustainability

Answer 44

A second component of international environmental governance, intergovernmental organizations, starts with the UN and includes numerous UN agencies and programmes involved in environmental management. Some of these are highlighted below.

Question 45

4.1 Global Environmental Governance Intergovernmental organisations concerned with environmental sustainability

Answer 45

The UN Environment Programme’s (UNEP) mandate, based on UN General Assembly resolution 2997 (XXVII) 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).

Question 46

4.1 Global Environmental Governance Intergovernmental organisations concerned with environmental sustainability

Answer 46

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).

Question 47

4.1 Global Environmental Governance Intergovernmental organisations concerned with environmental sustainability

Answer 47

The United Nations Development Programme (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).

Question 48

4.1 Global Environmental Governance Intergovernmental organisations concerned with environmental sustainability

Answer 48

Other major institutions with important roles in global environmental decision-making, such as the World Bank 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).

Question 49

4.1 Global Environmental Governance Financing mechanisms and environmental advocacy

Answer 49

Various types of finance mechanisms to support environmental sustainability exist, with funding drawn from public and private local, national, or international sources. Among others, 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. 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.

Question 50

4.1 Global Environmental Governance Financing mechanisms and environmental advocacy

Answer 50

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.

Question 51

4.1 Global Environmental Governance Financing mechanisms and environmental advocacy

Answer 51

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.

Question 52

4.1 Global Environmental Governance Financing mechanisms and environmental advocacy

Answer 52

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 and Melinda Gates Foundation, while emphasising the need for transparency and enhanced predictability of financial support.

Question 53

4.1 Global Environmental Governance Financing mechanisms and environmental advocacy

Answer 53

Governments and non-state actors (including intergovernmental and non-governmental organizations, private sector and civil society) all play a role in environmental governance. Not only has the number of influential actors increased, but they have become more diverse in their interests and the ways in which they influence the system. An increasingly influential role is being played by non-state actors. These include large international NGOs (such as Greenpeace and World Wildlife Fund), transnational corporations (such as BP and Unilever), corporate interest groups (such as the World Business Council for Sustainable Development) and networks of community-based organizations.

Question 54

4.2 International Environmental Policymaking

Answer 54

Several key global conferences have helped guide and develop the body of international treaties, conventions, statutes, regulations, and laws aimed at reducing human impact on planetary health and increasing environmental sustainability. Highlights include:

Question 55

4.2 International Environmental Policymaking

Answer 55

The United Nations Conference on the Human Environment (UNHCE) held in Stockholm in 1972 set into motion the negotiation and ratification of numerous international environmental agreements and created the impetus to set up the United Nations Environment Programme (UNEP).

Question 56

4.2 International Environmental Policymaking

Answer 56

In 1992, the UN Conference on Environment and Development (UNCED) in Rio (the Earth Summit) led to several significant outcomes. These included: a political declaration of principles on environment and development (Rio Declaration); a `blueprint’ (Agenda 21 - an agenda for the 21st Century) for implementing sustainable development; a declaration of Forest Principles; and two new multilateral environmental conventions on climate change: the UN Framework Convention on Climate Change (UNFCCC) and the Convention on Biological Diversity (UNCBD).

Question 57

4.2 International Environmental Policymaking

Answer 57

The UNFCCC’s supreme decision-making body – the Conference of the Parties (COP) – meets annually. 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).

Question 58

4.2 International Environmental Policymaking

Answer 58

The UNCED led to the inclusion of different civil society groups in the debate around policy and established a new mechanism (the UN Commission on Sustainable Development) to monitor and promote implementation of the Rio conference outcomes. This was followed by the UN General Assembly Special Session on Sustainable Development (Earth Summit II) held in 1997 in New York, and the World Summit on Sustainable Development (WSSD) 2002 in Johannesburg, where progress since the 1992 Rio conference was reviewed and a new global deal on implementation of sustainable development goals was agreed upon.

Question 59

4.2 International Environmental Policymaking

Answer 59

In September 2000, leaders of 189 UN member states signed the historic Millennium Declaration, in which they committed to achieving a set of eight measurable goals – the Millennium Development Goals (MDGs) - that ranged from halving extreme poverty to ensuring environmental sustainability, by 2015 (UN General Assembly, 2000). These were eventually replaced by the Sustainable Development Goals (SDGs) (UN General Assembly, 2015).

Question 60

4.2 International Environmental Policymaking

Answer 60

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 (United Nations, 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).

Question 61

4.3 Challenges to environmental governance

Answer 61

Environmental policy happens at local, regional, national and international level with varying degrees of motivation, strength of legislation and enforcement. Despite efforts to address 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.

Question 62

4.3 Challenges to environmental governance

Answer 62

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).

Question 63

5 Governance implications of emerging infectious diseases

Answer 63

Despite the involvement of numerous stakeholders, the spread and societal impact of high profile EIDs in recent years (including COVID-19, Monkeypox, Ebola, Zika, SARS, and pandemic influenza H1N1) have highlighted the lack of effective governance structures to coordinate the pooling and sharing of resources needed to combat pandemics between countries.

Question 64

5 Governance implications of emerging infectious diseases

Answer 64

There is an unequal distribution of capabilities and expertise at the national level, whereas 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. Furthermore, there is an 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 (both national and international) for countries to collaborate in order to protect themselves and each other from EIDs (Jit et al, 2021).

Question 65

5.1 Levels of governance for EID

Answer 65

As already discussed, monitoring, preventing, and responding to EIDs comprises a complex network of international governmental organizations (e.g., the UN and the WHO) (Bloom & Caderette, 2019); international legal agreements (e.g., the 2005 International Health Regulations (WHO, 2022b) and the 2010 Nagoya Protocol) (CBD, 2022); international coalitions and alliances (e.g., the Global Health Security Agenda and the Coalition for Epidemic Preparedness Innovations) (https://cepi.net/); national governments; donors (e.g., the Gates Foundation and the Wellcome Trust); non-governmental organizations (e.g. Greenpeace and World Wildlife Fund); public-private partnerships (e.g., Gavi, the Vaccine Alliance; the Global Fund to Fight HIV/AIDS, TB and Malaria; the Red Cross; and Médecins Sans Frontières); and financing facilities (e.g., the Pandemic Emergency Financing Facility from 2016-2021 and the Financial Intermediary Fund (World Bank, 2022) established in 2022). Additional information on these actors and the challenges they face is provided below.

Question 66

5.1 Levels of governance for EID International

Answer 66

Under international law, the WHO is the global coordinating body for EID surveillance, obtaining its funding from Member States paying their assessed contributions (membership dues calculated as a percentage of gross domestic product), and voluntary contributions from Member States and other partners. It is the only multilateral organization with the legal mandate, legitimacy, and technical capacity to serve in this role (WHO, 2002). However, it also suffers from a chronic lack of funding and staff and relies on inadequate country-level surveillance and response systems (Reddy et al 2018). In 2002, the Global Outbreak Alert and Response Network (GOARN) was established to organise the institutions and professionals that the WHO relies upon to detect infectious disease outbreaks.

Question 67

5.1 Levels of governance for EID International

Answer 67

In 2005, particularly influenced by the SARS epidemic, the WHO and its partners revised the International Health Regulations (IHR). These are the primary international instrument for infectious disease law designed to “prevent, protect against, control and provide a public health response to the international spread of disease” for 194 countries. Under the revised IHR, the WHO’s mandate was broadened to using non-governmental surveillance data (WHO, 2016a). It also enabled the WHO to declare and coordinate efforts on PHEICs, including the most recent COVID-19 pandemic and Monkeypox outbreak. Declaring a PHEIC enables rapid mobilization of international coordination, opens and streamlines new avenues of funding and speeds up the development of vaccines, therapeutics and diagnostics under emergency use authorization (Wilder-Smith & Osman, 2020).

Question 68

5.1 Levels of governance for EID International

Answer 68

Following criticism of the way in which the 2014 Ebola crisis in West Africa was handled by the WHO, a new Health Emergencies Programme to streamline and align its internal health emergency activities was instituted in 2016 (WHO, 2016b). Two years later, the Global Preparedness Monitoring Board (GPMB) was co-convened by the WHO and the World Bank as an independent monitoring and accountability body to enhance preparedness for global health crises, while strengthening the WHO’s reach and effectiveness in epidemic preparedness and response. The GPMB provides an independent and comprehensive appraisal for policy makers about progress and has a limited coordinating role.

Question 69

5.1 Levels of governance for EID International

Answer 69

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).

Question 70

5.1 Levels of governance for EID International

Answer 70

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).

Question 71

5.1 Levels of governance for EID National

Answer 71

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.

Question 72

5.2 Challenges to global infectious disease governance

Answer 72

Numerous challenges to good governance exist, some of which are briefly outlined below.

Question 73

5.2 Challenges to global infectious disease governance Coordination failure

Answer 73

Having evolved in a piecemeal, ad-hoc fashion over several decades, the current system of governance for EIDs lacks 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.

Question 74

5.2 Challenges to global infectious disease governance Funding

Answer 74

Insufficient funding is also an issue of concern. For example, the failure of member states to agree on an increase to compulsory (assessed) contributions to the WHO, or even to pay these contributions, has resulted in an increasing reliance on voluntary contributions (Health Policy Watch, 2022; Gostin et al 2020). 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.

Question 75

5.2 Challenges to global infectious disease governance Self-interest

Answer 75

During public health emergencies, responses taken by one country often affect other countries. Although coordination between countries is likely to achieve better outcomes than each country independently pursuing its own self-interest, 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.

Question 76

5.2 Challenges to global infectious disease governance Inadequate representation of civil society

Answer 76

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.

Question 77

5.2 Challenges to global infectious disease governance Other threats

Answer 77

Lastly, in addition to an ever-evolving array of EIDs whose range is likely to expand because of climate change and anthropogenic activities that bring humans and animals into close contact (such as deforestation), the threat represented by related global health problems should not be underestimated. These include rising antimicrobial resistance among disease-causing pathogens and vaccine hesitancy in human populations, both of which result in increased human susceptibility to preventable infectious diseases (WHO, 2019).

Question 78

5.3 Developments in global governance

Answer 78

The COVID-19 pandemic has galvanized international efforts to address the deficits that led to millions of lives being lost worldwide. In hindsight, the 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).

Question 79

5.3 Developments in global governance

Answer 79

Furthermore, in addition to these international developments, 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 preparedness 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). Whether these efforts meet with success or prove difficult to implement remains to be seen.

Question 80

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. Provide feedback on at least one other post.

Question 81

Summary

Answer 81

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).