Programme d'impulsion

CLIMATE

Impact of Climate Change on Tuberculosis Elimination – A Conceptual Framework, Modelling and Mitigation research project

| Overview

Duration: 36 months
Budget: 282 631 euros

Scientific coordination:
Maryline Bonnet, Daniel Chemtob, TransVIHMI U1175 Inserm, IRD, Montpellier University

Partners:
Annabel Desgrees du lou, CEPED (University Paris Cité, IRD, Inserm), ERL Inserm 1244
Franck Cobelens, Amsterdam Institute for Global Health and Development (AIGHD) and Amsterdam University MC (Not funded by the Program)
Emmanuel Roux, ESPACE-DEV, IRD (Not funded by the Program)
Mathilde Savy, MoISA, IRD (Not funded by the Program)
Richard SANYA, African Population & Health Research Center (APHRC), Kenya (Not funded by the Program)
John-Bosco ISUNJU, Makerere University School of Public Health (MakSPH), Uganda (Not funded by the Program)

| Context

Climate change (CC) is estimated to exacerbate nearly two-thirds of infectious diseases affecting humans, and to significantly increase migration. Tuberculosis remains one of the world’s leading causes of death, particularly in low- and middle-income countries (LMICs), with an estimated 10.6 million new cases of TB in 2021 and 1.4 million deaths. After declining by around 2% a year for the past 20 years, the global incidence rate of tuberculosis rose by 3.6% between 2020 and 2021, following the disruption of tuberculosis control services during the COVID-19 pandemic in high-prevalence, low-income countries. Several factors have an impact on tuberculosis: poverty, malnutrition/food insecurity, promiscuity, poor living and working conditions, poor access to diagnosis and care, migration and the HIV epidemic.

Several of these factors can be influenced by CC, particularly through its effects on food insecurity and migration. However, the pathways and mechanisms of interaction between CC and TB have only been partially studied, and a better understanding is essential to assess the extent to which current and future CC will impact TB elimination. There is also the question of how these effects can be mitigated, for example by increasing the resilience of TB services to climate shocks, and what will be the barriers to such efforts? 

The CLIMATE project is highly relevant to the emerging debate and concerns of international health institutions such as the World Health Organisation (WHO), which is preparing a policy brief on the importance of taking CC into account for the elimination of TB.

| Aims

CLIMATE is an interdisciplinary project that addresses the three axes of the INSERM call for proposals and aims to:

  • Analyze the potential health impacts of CC in relation to tuberculosis, in order to inform policy makers
  • Prepare the basis for future analysis and modelling of the impact of CCs on the burden of tuberculosis in regions with a high incidence of tuberculosis and LMICs
  • Analyze barriers and opportunities for strategies to adapt TB services in LMICs

| Methods

The four teams collaborating on CLIMATE will carry out interdisciplinary research and produce the four work packages:

  • Establishment of the conceptual framework for the interaction between CC and TB
  • Preparation for the analysis and modelling of TB and climate data
  • Impact of climate migration
  • Resilience of TB control services in LMICs

The TransVIHMI unit (INSERM U 1175) will carry out most of the epidemiological and public health components of the project and the CEPED team (INSERM ERL 1244) will focus on migration aspects and anthropological studies. The other two partners are the Amsterdam Institute for Global Health and Development (AIGHD), which will contribute to the epidemiological and modelling aspects of the tuberculosis data, and IRD’s ESPACE-DEV, which will work on modelling the climatic components. Contacts have been made with three countries particularly affected by CC that could join the consortium: Kenya, Uganda and Bangladesh.

| Perspectives

To our knowledge, no conceptual research framework linking CC and TB has been produced, and no in-depth modelling work has been carried out. The CLIMATE project is therefore innovative and concerns the world’s 1st infectious disease endemic in terms of mortality. The recent experience of the COVID-19 pandemic demonstrated the fragility and lack of resilience of TB control services in LMICs. Hence the importance of better understanding, anticipating and preparing the response to the impact of CC on TB in LMICs. This 1st preparatory phase of the CLIMATE project should enable us to strengthen the consortium and ultimately to respond to European calls for tenders such as Horizon and the Belmont Fund, in close collaboration with partners in the countries most affected, and the WHO’s Global TB Program. This project is intended to be participatory, involving civil society, hence the importance of the social sciences in our project.