By Brigitte Hugh, Lillian Parr, and Dr. Dan Regan

A recent study published in Nature found that 218 of the 375 infectious diseases that have impacted humanity have been exacerbated by climate hazards intensified by greenhouse gas emissions. In addition, the study highlighted that there are over 1,000 pathways in which climatic hazards can lead to disease outbreaks, which powerfully demonstrates the inextricable relationship between climate change and health security. 

As the most recently declared Public Health Emergency of International Concern (PHEIC) by the World Health Organization, monkeypox is a timely case study which demonstrates how climate change and ecological disruption exacerbate the threat of emerging and re-emerging infectious diseases through two mechanisms: increasing the likelihood of outbreaks and  making outbreak response more challenging. The added complications from equity issues, governmental challenges, and struggling healthcare systems highlight the security risks at the nexus of climate change, ecological degradation, and biological threats that states must face in the years to come.

The Origin and Spread of Monkeypox 

Limited to the Congo Basin when the first human case was documented in 1970, monkeypox is now endemic within 10 countries in Central and Western Africa. By 2010, experts warned that monkeypox was increasing by significant margins, with habitation near wildlife among those with no prior vaccination history contributing significantly to the twenty-fold increase in cases. Despite these warnings, it was still alarming when the ongoing monkeypox outbreak was first detected outside of its endemic region on May 7, 2022. It has now spread to over 106 countries with over 56,400 confirmed cases, as of September 8th.

As experts seek to uncover what led to the recent surge of monkeypox from its endemic region to a global concern, many are highlighting the global trends exacerbating the emergence and impact of infectious diseases. The monkeypox virus jumps to humans from animal reservoirs, and is then spread within humans via extended skin-to-skin contact or physical exposure to a contaminated surface like bedding, clothing, and bodily fluids. Trends in deforestation and climate change have put human populations and animal reservoirs in greater contact with one another. 

Intersection with Climate and Ecological Security

Climate change and ecological degradation are contributing to a world in which infectious diseases are able to spread more rapidly and broadly. Rising temperatures and changes in precipitation patterns have increased the threat of water-borne illnesses and expanded the geographic range of some vector-borne diseases, including malaria, Zika, dengue fever, and West Nile fever. Once cooler regions are having to cope with novel diseases not historically within their domains. 

Ecological disruption exacerbates these issues. Practices that put humans in closer contact with animals, including deforestation, poor agricultural management, and the encroachment of urban communities into wild spaces, make disease spillover from animal to human populations much more likely.

This heightened likelihood of disease spillover, along with a globally connected population which has little to no immunity against emerging and re-emerging infectious diseases, increases the possibility of multiple diseases reaching epidemic or pandemic levels: a situation that may stretch resources and health practitioners too thin to fully address multiple disease outbreaks simultaneously. Though we are not yet at the stage of two overlapping pandemics, this effect can already be seen: health systems have been under-staffed and under-supplied in the wake of COVID-19, leaving them less equipped to cope with the emergence of monkeypox.

Focusing on the intersections of climate, ecology, and human health will be crucial to find solutions that mitigate spillover events, manage future outbreaks, and reduce local, regional, and global fragility. This highlights the relevance of the One Health framework, an approach which acknowledges that resilience to biological threats depends on sustainable and healthy relationships across the entirety of human, animal, and environmental systems.

Justice and Equity Issues

Systemic issues regarding global health inequity and inequality have played a significant role in the prolonged monkeypox presence within Sub-Saharan Africa and the global response to the ongoing outbreak. Issues related to disease response in the Global South, public health messaging and stigmatization, and access to health care should be examined for their role in the current monkeypox outbreak and future disease emergence. 

Nigerian scientists attempted to raise the alarm when they observed monkeypox behaving unusually in a 2017 outbreak, but were largely ignored. This is part of a larger trend: scientists in the Global South are not taken seriously when they raise concerns about infectious disease threats, and the health of individuals residing in these countries is undervalued and even disregarded. Rather than waiting to address disease outbreaks when they affect the Global North, resources and attention need to be put into halting diseases when and where they emerge. As of this writing, the African continent still does not have access to a single dose of monkeypox vaccine, highlighting severe health inequities that are all too familiar. 

Some social scientists and public health experts have noted that mistakes made during the AIDS epidemic in the U.S. in the 1980s and 90s are being repeated. Early public health messaging concerning monkeypox focused exclusively on the community of men of who have sex with men, which created stigmatization and complications to care, as well as obfuscated the message that other communities are at risk of getting and transmitting the disease. 

Monkeypox, and COVID before it, have further demonstrated the importance of the careful selection of disease names and narratives about outbreaks. Activists have noted that the name “monkeypox” has racist overtones and has increased negative narratives about the disease. 

Much like water and food security, biosecurity impacts state legitimacy—inadequate or unfair responses and messaging in the face of disease outbreak erodes trust in government. This makes the adequate protection of health a key component of state resilience against fragility, especially in a climate-changed world.

CSR’s Upcoming Work

As the spread of monkeypox has made clear, the intersection between climatic, ecological, and biological threats requires immediate attention and action. Assessing the linkages and overlaps in these threat landscapes is critical to making meaningful progress in this space. In the coming months, CSR’s cross-cutting centers will be tackling this intersection, with a particular focus on understanding how prioritizing the ecological/biological nexus can advance security goals in both areas. Keep an eye out for our upcoming work on this crucial issue. 

Related Reading:

• BRIEFER: 100 Days of Monkeypox: Evaluating the U.S. Response to the Emerging Global Outbreak
• As the World Health Organization Meets on the 2022 Monkeypox Outbreak, an Early Examination of U.S. Responses 
• The Nexus of Climate Change, Ecological Disruption, Stability, and Security
• Within the Health, Climate, and Security Nexus, Prevention is Better than a Cure