Antigua and Barbuda is a Small Island Developing State (SIDS) in the Caribbean Sea (1). The climate is tropical maritime, wet and dry, with minimal seasonal variation except for the hurricane season, which runs from approximately June to November (1,2). Tourism is the country’s dominant sector, accounting for around 80% of GDP and approximately 70% of employment; the sustainability of this sector is largely reliant upon Antigua and Barbuda’s natural resources (1).
As a SIDS, Antigua and Barbuda is considered highly vulnerable to climate change impacts, including sea level rise, increasing temperatures, changing precipitation patterns, and extreme weather events. Human health and well-being are also threatened by climate change, with particular threats being water insecurity (due to saltwater intrusion of freshwater aquifers); economic insecurity; heat stress; spread of vectorborne, waterborne and foodborne diseases; and death and injury from extreme weather events. With the country’s economy being so reliant on tourism, threats to Antigua and Barbuda’s natural environment and infrastructure could have serious implications for the country’s economy and thus the social and economic development of its population.
The Government of Antigua and Barbuda recognizes the current and future threats of climate change and is working to adapt to these impacts. The water sector has been identified as a priority for adaptation, owing to risks of decreasing freshwater supply and saltwater intrusion of aquifers (1). In 2015, the government of Antigua and Barbuda published its Nationally Determined Contribution (NDC). Its NDC highlights the threats to the health sector, particularly due to the spread of vector-borne and waterborne diseases; in response, the government has committed to protecting all waterways, to reduce flood risk and protect human health, by 2030. Furthermore, the health co-benefits of mitigation and adaptation are recognized (3).
Country-specific projections are outlined up to the year 2100 for climate hazards under a ‘business as usual’ high emissions scenario compared to projections under a ‘two-degree’ scenario with rapidly decreasing global emissions (see Figures 1–5). The climate model projections given below present climate hazards under a high emissions scenario, Representative Concentration Pathway 8.5 (RCP8.5 – in orange) and a low emissions scenario (RCP2.6 – in green). 1 1Model projections are from CMIP5 for RCP8.5 (high emissions) and RCP2.6 (low emissions). Model anomalies are added to the historical mean and smoothed.
The text describes the projected changes averaged across about 20 global climate models (thick line). The figures 2 2Analysis by the Climatic Research Unit, University of East Anglia, 2018. also show each model individually as well as the 90% model range (shaded) as a measure of uncertainty and the annual and smoothed observed record (in blue).3 3Observed historical record of mean temperature is from CRU-TSv3.26 and total precipitation is from GPCC. Observed historical records of extremes are from JRA55 for temperature and from GPCC-FDD for precipitation. In the following text the present-day baseline refers to the 30-year average for 1981–2010 and the end-of-century refers to the 30-year average for 2071–2100.
Modelling uncertainties associated with the relatively coarse spatial scale of the models compared with that of small island States are not explicitly represented. There are also issues associated with the availability and representativeness of observed data for such locations.
Under a high emissions scenario, the mean annual temperature is projected to rise by about 2.8°C on average by the end-of-century (i.e. 2071–2100 compared with 1981–2010). If emissions decrease rapidly, the temperature rise is limited to about 0.9°C.
Total annual precipitation is projected to decrease by about 20% on average under a high emissions scenario, although the uncertainty range is large (-48% to +6%). If emissions decrease rapidly there is little projected change on average: with a decrease of 3% and an uncertainty range of -17% to +7%.
The percentage of hot days 4 4A ‘hot day’ (‘hot night’) is a day when maximum (minimum) temperature exceeds the 90th percentile threshold for that time of the year. is projected to increase substantially from about 25% of all observed days on average in 1981–2010 (10% in 1961–1990). Under a high emissions scenario, almost 100% of days on average are defined as ‘hot’ by the end of century. If emissions decrease rapidly, about 85% of days on average are ‘hot’. Note that the models tend to overestimate the observed increase in hot days (about 30% of days on average in 1981–2010 rather than 25%). Similar increases are seen in hot nights (not shown).
Under a high emissions scenario, the proportion of total annual rainfall from very wet days 5 5The proportion (%) of annual rainfall totals that falls during very wet days, defined as days that are at least as wet as the historically 5% wettest of all days. (about 28% for 1981–2010) could decrease a little by the end-of-century (to about 23% on average with an uncertainty range of about 5% to 45%), with little change if emissions decrease rapidly. Total annual rainfall is projected to decrease (Figure 2).
The Standardized Precipitation Index (SPI) is a widely used drought index which expresses rainfall deficits/excesses over timescales ranging from 1 to 36 months (here 12 months, i.e. SPI12). Under a high emissions scenario, SPI12 values are projected to decrease to about -0.5 on average by the end of the century (2071–2100), with a number of models indicating substantially larger decreases and hence more frequent and/or intense drought. Year-to-year variability remains large with wet episodes continuing to occur into the future. 6 6SPI is unitless but can be used to categorize different severities of drought (wet): above +2.0 extremely wet; +2.0 to +1.5 severely wet; +1.5 to +1.0 moderately wet; +1.0 to +0.5 slightly wet; +0.5 to -0.5 near normal conditions; -0.5 to -1.0 slight drought; -1.0 to -1.5 moderate drought; -1.5 to -2.0 severe drought; below -2.0 extreme drought.
These findings underscore the importance of the government’s commitment to adapting the water sector. Drought is already a common experience in Antigua and Barbuda. The probability of at least one (moderate or serious or severe drought) in a year is 45.1%, and in 5 years is 95.0%. For severe droughts alone, the probability of at least one in a year is 15.1% and at least one in 5 years 56.0% (5).
In recent years Antigua and Barbuda has experienced significant drought conditions. The year 2015 was the driest on record at rainfall stations in many Caribbean islands, including Antigua, and drought conditions with some short periods of relief persisted until August 2016. The 2014–16 drought periods led to decreases in agricultural production and reduced local food supply in Antigua and Barbuda. Water shortages forced water rationing. The Potworks Dam in Antigua was only 10% full by the end of 2014, and by the end of 2015, consumption of desalinated water was greater than 90%, compared with the normal 60% (6).
Tropical cyclones have made landfall in Antigua and Barbuda on multiple occasions. Hurricanes can occur from June to November; historically, the most likely time is mid-August to mid-September. On average, there is a 33% chance of at least one hurricane affecting (passing within 120 miles) of Antigua and Barbuda in any given year or roughly once every three years (7).
The year 2017 was exceptional as Antigua and Barbuda was affected by three major hurricanes: Irma, Jose and Maria. Hurricane Irma was the strongest storm ever to hit the Caribbean Leeward Islands. It reached its maximum intensity on 5 September 2017 and continued with this intensity – with windspeed of 155 knots (178 mph/ 287 kmph) – when it made landfall on Barbuda on 6 September (9). This hurricane damaged or destroyed almost all infrastructure in Barbuda, forcing evacuation of the population (10). By the end of 2018, only some residents of Barbuda had returned. The recovery needs assessment conducted in partnership with the World Bank concludes that the total damage of the hurricanes Irma and Maria for Antigua and Barbuda comes to EC$ 367.5 million (US$ 136.1 million), while losses amount to approximately EC$ 51.2 million (US$ 18.9 million). Recovery needs amount to EC$ 600.1 million (US$ 222.2 million) (11).
It is anticipated that the total number of tropical cyclones may decrease towards the end of the century. However, it is likely that human-induced warming will make cyclones more intense (an increase in wind speed of 2–11% for a mid-range scenario (i.e. RCP4.5 which lies between RCP2.6 and RCP8.5 – shown on pages 4/5) or about 5% for 2˚C global warming). There are better than even odds that the most intense events (category 4 and 5) will become more frequent (although these projections are particularly sensitive to the spatial resolution of the models). It is also likely that average precipitation rates within 100 km of the storm centre will increase – by a maximum of about 10% per degree of warming. Such increases in the rainfall rate would be exacerbated if tropical cyclone translation speeds continue to slow (12–20).
Sea level rise is one of the most significant threats to low-lying areas on small islands and atolls. Research indicates that rates of global mean sea level rise are almost certainly accelerating as a result of climate change. The relatively long response times to global warming mean that sea level will continue to rise for a considerable time after any reduction in emissions.
The average change in Caribbean sea level over the period 1993–2010 (21) is projected at 1.7 mm/year (± 1.3), with substantial spatial variability across the region. A further 0.4–0.5m rise is expected in the Caribbean by the end of the century (22) with variation amongst models and emissions scenarios.
Potential impacts of sea level rise include:
Some of the world’s most virulent infections are also highly sensitive to climate: temperature, precipitation and humidity have a strong influence on the life-cycles of the vectors and the infectious agents they carry and influence the transmission of water and foodborne diseases.
In the Caribbean, most cases of vector-borne are transmitted by Aedes aegypti mosquitoes (23). These mosquitoes reproduce more rapidly in warmer temperatures. Mosquito-breeding sites often proliferate in groundwater in periods of high precipitation, and in water storage receptacles in dry or drought periods (24,25). This mosquito is responsible for the transmission of the vast majority of cases of chikungunya, dengue and Zika in the Caribbean.
Antigua Barbuda remains vulnerable to disease outbreaks. Figure 7 shows when the chikungunya epidemic began in Antigua Barbuda in 2014, cases rose to 1005.5 per 100 000 population at the peak of the epidemic in 2015 (26). A Zika epidemic affected Latin American and Caribbean countries heavily in 2015 and 2016; the incidence of Zika in Antigua and Barbuda by the end of 2016 was 509.6 per 100 000 population (27). Furthermore, dengue is endemic to Antigua and Barbuda and, following the chikungunya and Zika epidemics, once again became the most prevalent mosquito-borne disease. In January 2020, there were 396.1 cases per 100 000 population in Antigua Barbuda (28).
Small island developing States (SIDS) face distinct challenges that render them particularly vulnerable to the impacts of climate change on food and nutrition security including: small, and widely dispersed, land masses and populations; large rural populations; fragile natural environments and lack of arable land; high vulnerability to climate change, external economic shocks, and natural disasters; high dependence on food imports; dependence on a limited number of economic sectors; and distance from global markets. The majority of SIDS also face a ‘triple-burden’ of malnutrition whereby undernutrition, micronutrient deficiencies and overweight and obesity exist simultaneously within a population, alongside increasing rates of diet-related noncommunicable diseases.
Climate change is likely to exacerbate the triple burden of malnutrition and the metabolic and lifestyle risk factors for diet-related NCDs. It is expected to reduce short- and long-term food and nutrition security both directly, through its effects on agriculture and fisheries, and indirectly, by contributing to underlying risk factors such as water insecurity, dependency on imported foods, urbanization and migration, and health service disruption. These impacts represent a significant health risk for SIDS, with their particular susceptibility to climate change impacts and already overburdened health systems, and this risk is distributed unevenly, with some population groups experiencing greater vulnerability.
The following section measures progress in the health sector in responding to climate threats based on country reported data collected in the 2021 WHO Health and Climate Change Country Survey (46).
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has a national health and climate change strategy or plan been developed ? | NO | ||
| Are the health co-benefits of climate change mitigation action considered in the strategy/plan? | N/A | ||
| Level of implementation of the strategy/plan? | N/A | ||
| Portion of estimated costs to implement the strategy/plan covered in the health budget | N/A | ||
| Are health adaptation priorities identified in the strategy/plan? | N/A |
Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy?
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Transportation | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Electricity generation | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Household energy | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Agriculture | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Social services | NO | |
| Is there an agreement in place between the ministry of health and this sector which defines specific roles and responsibilities in relation to links between health and climate change policy? | Water, Sanitation & Waste-water management | YES |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has an assessment of health vulnerability and impacts of climate change been conducted at a national level? | NO | ||
| → Level of influence of the assessment findings on policy prioritization to address the health risks of climate change | N/A | ||
| → Level of influence of the assessment findings on human and financial resource allocation to address the health risks of climate change | N/A |
| Climate-sensitive diseases and health outcomes | qid | Health surveillance system is in place (a) | Health surveillance system includes meteorological information (b) |
|---|---|---|---|
| Thermal stress (e.g. heat waves) | 22111 | YES | YES |
| Vector-borne diseases | 22121 | YES | YES |
| Foodborne diseases | 22131 | YES | NO |
| Waterborne diseases | 22141 | YES | NO |
| Nutrition (e.g. malnutrition associated with extreme-climatic events) | 22151 | YES | |
| Injuries (e.g. physical injuries or drowning in extreme weather events) | 22161 | NO | NO |
| Mental health and well-being | 22171 | YES | NO |
| Airborne and respiratory diseases | 22181 | YES |
| Climate hazard | qid | Health early warning system (HEWS) in place? | Health sector response plan in place? | Health sector response plan includes meteorological information? |
|---|---|---|---|---|
| Heat waves | 23111 | YES | YES | NO |
| Storms (e.g. hurricanes, monsoons, typhoons) | 23131 | YES | YES | YES |
| Flooding | 23141 | YES | YES | YES |
| Drought | 23161 | YES | YES | YES |
| Air quality (e.g. particulate matter, ozone levels) | 23171 |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is there a national curriculum developed to train health personnel on the health impacts of climate change? | NO | ||
| Does your human resource capacity as measured through the International Health Regulations Monitoring Framework (IHR) adequately consider the human resource requirements to respond to climate-related events? | Partially |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Has there been a national assessment of the climate resilience of health infrastructure and technology? | |||
| Have measures been taken to increase the climate resilience of health infrastructure and technology? | |||
| Is there a national initiative/programme in place to promote the use of low-carbon, energy-efficient, sustainable technologies in the health sector? |
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Is your government currently accessing international funds to support climate change and health work? | YES |
Greatest challenges faced in accessing international climate funds
| Question | questioncategory | question | Answer |
|---|---|---|---|
| Greatest challenges faced in accessing international climate funds | Lack of information on the opportunities | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of country eligibility | ||
| Greatest challenges faced in accessing international climate funds | Lack of connection by health actors to climate change processes | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of capacity to prepare country proposals | YES | |
| Greatest challenges faced in accessing international climate funds | Lack of success in submitted applications | ||
| Greatest challenges faced in accessing international climate funds | None (no challenges/challenges were minimal) | ||
| Greatest challenges faced in accessing international climate funds | Not applicable | ||
| Greatest challenges faced in accessing international climate funds | Other (please specify) |
Develop and implement a national health and climate change plan, ensuring that adaptation priorities are specified, health co-benefits from mitigation and adaptation measures are considered, necessary budget requirements are allocated, and regular monitoring and review of progress will support its full implementation. Involve departments and ministries responsible for health and health-determining sectors, as well as private sector, nongovernmental organizations and civil society stakeholders in the development and implementation of the plan.
Conduct a national assessment of climate change impacts, vulnerability and adaptation for health. Ensure that results of the assessment are used for policy prioritization and the allocation of human and financial resources in the health sector.
The main barriers have been identified as a lack of information on the opportunities and a lack of capacity to prepare country proposals.
Measures can be taken to prevent the potentially devastating impacts of climate change on health service provision, including; conducting hazard assessments, climate-informed planning and costing, strengthening structural safety, contingency planning for essential systems (electricity, heating, cooling, ventilation, water supply, sanitation services, waste management and communications). A commitment towards low-emission, sustainable practices to improve system stability, promote a healing environment and to mitigate climate change impacts can also be taken.
Alliances can be formed between the Ministry of Health and the Environment and ministries/ departments responsible for food and water safety and security (e.g. public works, agriculture, trade) and monitoring and response to meteorological and environmental threats (e.g. Meteorological Services and National Office of Disaster Services). These may be supplemented by international and local partnerships to develop and implement strategies to address food and water vulnerabilities to climate change and develop vibrant and effective models of operation and structural resilience.
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WHO/HEP/ECH/CCH/20.01.06
© World Health Organization and the United Nations Framework Convention on Climate Change, 2020
Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence
All reasonable precautions have been taken by WHO and UNFCCC to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall WHO and UNFCCC be liable for damages arising from its use.
Most estimates and projections provided in this document have been derived using standard categories and methods to enhance their cross-national comparability. As a result, they should not be regarded as the nationally endorsed statistics of Member States which may have been derived using alternative methodologies. Published official national statistics, if presented, are cited and included in the reference list.
Design by Inís Communication from a concept by N. Duncan Mills
Photos: Ministry of Health, Antigua and Barbuda
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