Climate change: what does it mean for infectious diseases?

Starting out as a new specialist nurse, I often reflected on the impact new strains of highly pathogenic flu might have on a vulnerable global population. Those early worries changed as my understanding of vulnerability evolved. Now the climate crisis, and particularly how that will affect our relationship with infectious diseases, increasingly concerns me.  

As deforestation escalates, closer contact between humans and other species, including insects, will present opportunities for infections to emerge or spread to new geographic areas. The COVID-19 pandemic and our experience with swine flu in 2009 highlighted the effects of human and animal interaction.

Could avian influenza become the next pandemic? It’s possible. We’ve seen the infection spread from birds to mammals and we’ve also had ad hoc human cases. Luckily, we’ve yet to see human-to-human transmission – that would be a game changer. 

Always changing

One certainty is that new infections will continue to emerge that we have very little experience of managing, with risks changing over time. For example, we’re seeing viral haemorrhagic fevers occur in unexpected places. Recently, the Crimean-Congo haemorrhagic fever (CCHF) virus was detected in ticks in southern France.

While no infections have been reported to date, it highlights how the changing conditions driven by global warming will inevitably change insect vectors and the diseases they carry. While they may not pose an immediate threat to the UK, as humans, we’re constantly on the move and can navigate the globe very quickly, creating opportunities for infections to spread. 

The COVID-19 pandemic has demonstrated the hard reality of the havoc infectious diseases can cause – and for many, that’s been a huge shock. Our pre-pandemic world has been rocked to its foundations; our daily lives disrupted almost beyond recognition and we’ve all witnessed the incredible speed at which everything spirals. 

As deforestation escalates, closer contact between humans and other species will present opportunities for infections to emerge or spread

It’s an unfortunate truth that undoubtedly there will be another pandemic. And my prediction is it will be sooner, rather than later. It means we must always remember, learning the lessons from what has gone before. The first rule in infection control is always to expect the unexpected. And the second is, if you take your eye off the ball, that’s when you’re most at risk.

We’re at significant risk now, because we’re exhausted, we want COVID-19 to be over and we don’t want to have to think about pandemics anymore. But this leaves us exposed and vulnerable. 

Forwarding thinking 

Looking towards the future and how we should respond, it’s clear that the whole world must work together in a coordinated way, so we can protect each other. But having said that, general guidance must be implemented in ways that are meaningful for each country, acknowledging specific circumstances and needs.  

Although it's very tempting to think that we can manage infections through purely scientific interventions, such as apps or vaccines, putting all our eggs in one science and technology basket would be wrong. This approach won’t save us from future outbreaks of infectious diseases.

There will be another pandemic. And my prediction is it will be sooner, rather than later

Prevention relies on everyone doing the right thing and reducing any environmental risks that predispose or increase the likelihood of infections spreading. The vaccine has been fantastic in reducing the burden of COVID-19 – but it’s clearly not a silver bullet eradicating it forever. We will be living with this disease, and learning about it, for a long time yet. 

We also can’t just rely on paper policies. We need infection control specialists who can translate the science into practical guidance to ensure it works for health and social care professionals practising in different roles and settings – whether a care home, a mental health unit, a maternity ward or with a patient approaching the end of their life. One size does not fit all. 

Education and empowerment

In practice, we will always need good old-fashioned public health care interventions, alongside specialists in infection control and public health. Back when I started my career in this field, we were working in isolation, in laboratories several floors up or stuck in a remote portacabin. Now at least we are far more embedded in the day-to-day working lives of health care teams.  

But in my view, to be truly effective as infection prevention and control specialists, we need to almost make ourselves superfluous. We must educate and enable, passing our skills on to staff, who must feel empowered to risk assess, making evidence-informed decisions about what should happen next. That’s our professional challenge as we seek to prepare for whatever tomorrow might bring.

Rose Gallagher, RCN Professional Lead for Infection Prevention and Control and Nursing Sustainability Lead