1. Inter-American Institute for Global Change Research 2. Columbia University 3. Ministry of Health Barbados 4. Caribbean Institute for Meteorology and Hydrology 5. Barbados Meteorological Services 6. Florida International University 7. University of Florida 8. London School of Hygiene and Tropical Medicine, 2022

Author(s): Anna Stewart-Ibarra (1), Avriel Diaz (2), Leslie Rollock (3), Roché Mahon (4), Cédric Van Meerbeeck (4), Adrian Trotman (4), Sabu Best (5), Willy Dunbar (6), Catherine Lippi (7), Sadie Ryan(7), Rachel Lowe (8).

To protect the health of populations from the effects of climate change, countries must build climate resilient health systems. One way to build these systems is to invest in the development of climate services for the health sector.

In 2017, the development of a prototype climate-driven dengue early warning system for Barbados emerged from a project within the United States Agency for International Development (USAID) funded Programme for Building Regional Climate Capacity in the Caribbean (BRCCC), implemented by the Caribbean Institute for Meteorology and Hydrology (CIMH).

The goal of the project was to work with key stakeholders to co-design and co-develop a climate service for the health sector – namely, a predictive model that used climate information to quantify the risk of dengue outbreaks by generating probabilistic forecasts several months in advance. 

Introduction: 

To protect the health of populations from the effects of climate change, countries must build climate resilient health systems. One way to build these systems is to invest in the development of climate services for the health sector. This case study is addressing an intervention aimed at reducing the incidence and burden of vector borne diseases in Barbados through the development of a climate driven dengue early warning system (EWS). 

Background: 

Understanding the links between climate and health, in particular the impact of climate variability and climate change on vector borne disease risk, is a high priority for small island nations and states in the Caribbean. The economic health of this region is often reliant on tourism, meaning that concerns about recent emerging and re-emerging mosquito borne diseases such as dengue, chikungunya, and Zika, have broader impacts than the purview of the health ministries.  Implementing climate services for vector borne disease forecasting involves stakeholders across multiple sectors in the surveillance, data management, planning and intervention components. This integrated approach requires collaboration, cooperation, and communication, and an understanding of common goals and outcomes, as well as recognition of the contribution of different actors in the stakeholder community to the decision-making and response process.

Case:

In 2017, the development of a prototype climate-driven dengue early warning system for Barbados emerged from a project within the USAID funded Building Regional Climate Capacity in the Caribbean (BRCCC) Programme, implemented by the Caribbean Institute for Meteorology and Hydrology (CIMH) [1,2] and managed by the World Meteorological Organization. The goal of the project was to build a climate service for the health sector – namely, a predictive model that used climate information to quantify the risk of dengue outbreaks by generating probabilistic forecasts several months in advance [3]. The project team comprises staff from Barbados Ministry of Health & Wellness (MHW), the Barbados Meteorological Services, the CIMH (also based in Barbados), the Caribbean Public Health Agency (CARPHA), and international interdisciplinary researchers with diverse expertise in climate risk management and governance, social science research, epidemiology, and modelling.

Stakeholder engagement via in-person meetings were a critical part of establishing the partnership and the co-learning and co-development processes, which have been sustained with virtual meetings. Interviews with climate and health stakeholders took place to identify needs, perceptions, and gaps relevant to the implementation of a dengue EWS [4]. 

Additionally, a data audit was conducted to understand the available data streams for formulating a predictive modelling framework. A key outcome of the research was the discovery of nonlinear and delayed impacts of hydrometeorological extremes on dengue outbreaks [5]. This provided evidence on the importance of proper management of water storage containers during drought events (for example, covering and cleaning containers, and treatment with larvicide) to avoid creating new mosquito habitats and increasing the risk of dengue outbreaks [5]. 

This outcome highlighted the importance of risk-based messaging on water storage container maintenance during drought periods in the Caribbean Health-Climatic Bulletin – a climate early warning information tool operationally co-produced by the CARPHA, the Pan American Health Organization and the CIMH since 2017. The research was incorporated in the December 2020 edition of the Bulletin, advising public health stakeholders to be aware of increased dengue risk due to a widespread drought in the first half of 2020 followed by an intense heat season and excessive rainfall [6]. 

Moreover, during the interview process stakeholders recommended developing an online platform, potentially hosted by the national meteorological services, who issue other routine climate services for a number of socio-economic sectors (e.g. transport (aviation)/ health). It is important to note that stakeholders also recommended that there be as much automation as possible to ensure that this very important initiative does not negatively impact each sector’s human resources in order to ensure sustainability.

Thanks to a subsequent Red Cross Red Crescent Climate Centre consultancy, the team is developing an impact-based forecasting methodology, and an interactive visualization platform and training materials for local partners at the Barbados Meteorological Services and MHW to be able to issue monthly probabilistic forecasts of dengue risk three months in advance. 

Climate and health sector partners and stakeholders identified several implementation challenges, including:

  • Lack of financial resources for sustained engagement
  • Lack of technical expertise in GIS and modelling
  • Lack of personnel dedicated to the curation and management of climate and health data, which prohibits effective data sharing in real-time.
  • Lack of a specific mandate to address climate-health work in both the health and climate sectors, resulting in lack of dedicated personnel and resources.
  • Lack of formalized partnerships (e.g., MOUs) between national-level climate and health communities to facilitate a joint work plan, data sharing and modelling.
  • Challenges in translating probabilistic outbreak forecasts into impact alerts with response messages.

 

These challenges were addressed by:

  • Simplifying the modelling process, to use the most simple and parsimonious model possible to derive skillful dengue forecasts 3 months in advance. This was done by identifying optimum lags in the system and ensuring the model did not have to rely on a live stream of health surveillance data, which can often be disrupted, particularly during a pandemic.
  • Convening several online workshops with MHW, BMS, CIMH and CARPHA to co-develop the tool, refine the model and visualizations according to stakeholder needs and ensure a sense of ownership of the product by local partners.
  • Jointly exploring ways to translate probabilistic outbreak forecasts into impact level warnings, using decision matrices, to combine level of certainty in the forecast with urgency for action based on other impact-based forecasting tools hosted by the BMS. This has resulted in BMS and MHW working together and learning from each other to find solutions to host the online tool and ensure its sustainability in partnership with CIMH and CARPHA.
  • In conjunction with other regional sectoral partners, CIMH and CARPHA signed a partnership agreement (LoA) in 2017, thereby becoming a model for national level cooperation and playing a leadership role in the region. In collaboration with other multi-sectoral regional organizations invested in the Sectoral Early Warning Information Systems across Climate Timescales (EWISACTs) programme, these institutions have played a lead role in setting a regional science and policy agenda [7] that recognizes climate and health as a priority. Both CIMH and CARPHA have identified climate services for health as a priority area and sustained the engagement with the national health and climate stakeholders, despite the short-term project funding cycles.

 

Take away: 

This collaborative approach to co-creating a climate-driven dengue early warning system is only possible through an iterative process spanning the design, development, and implementation of interdisciplinary tools and interoperable climate and health surveillance systems and processes that encourage team members to be open to new ways of thinking and joint ways of working. The approach is inclusive, adaptable, reflective, and flexible to changing conditions, information, and expectations; and team members are committed to a long-term process of collaboration [8]. Key partners are engaged from the beginning of the process to create a legitimate sense of shared ownership of the tools, ensuring that the health sector perceives that their needs and priorities are being addressed, that the tools have an impact on a health outcome that they consider to be important (e.g., arboviral disease), and that the tools can help them to better use their resources to reduce the burden of disease. 

The co-creation of climate-driven dengue EWSs is now being expanded to other countries throughout the Caribbean with support from national, regional, and international investors. There is a critical need for increased funding to enhance this work and make it sustainable. Investing in tools, implementation, capacity building in digital infrastructure and data science to support climate resilient health systems, will support health adaptation and resilience across sectors. 

References

  1. Trotman, A.; Mahon, R.; Shumake-Guillemot, J.;  Lowe, R.; Stewart-Ibarra, A.M. (2018). Strengthening Climate Services for the Health Sector in the Caribbean. WMO Bulletin, 67(2).
  2. Trotman, A., Mahon, R., & Van Meerbeeck, C. (2019). Leveraging Partnerships for Health Climate Services in the Caribbean.
  3. Lowe R, Ryan SJ, Mahon R, Van Meerbeeck CJ, Trotman AR, Boodram L-LG. (2020). Building resilience to mosquito-borne diseases in the Caribbean. PLoS Biol.
  4. Stewart-Ibarra AM, Romero M, Hinds AQJ, Lowe R, Mahon R, Van Meerbeeck CJ. (2019). Co-developing climate services for public health: Stakeholder needs and perceptions for the prevention and control of Aedes-transmitted diseases in the Caribbean. PLoS Negl Trop Dis.
  5. Lowe R, Gasparrini A, Van Meerbeeck CJ, Lippi CA, Mahon R, Trotman AR. (2018). Nonlinear and delayed impacts of climate on dengue risk in Barbados: A modelling study. PLoS Med.
  6. CARPHA, PAHO, CIMH, Caribbean Health-Climatic Bulletin. Vol4 Issue4 December 2020. Available from:
  7. CIMH, CARDI, CWWA, CDEMA, CARPHA, CCREEE, CTO & CHTA 2020. Strengthening Climate Services in the Caribbean through the Sectoral Early Warning Information Systems Across Climate Timescales (EWISACTs) Regional Roadmap and Plan of Action (RPA) 2020-2030. Barbados: The Caribbean Institute for Meteorology and Hydrology
  8. Rouhaud E. (2018). Co-producing climate knowledge: Great in theory, how about practice?. (accessed 22 Jun 2020).
The text of this case study is based on the submission from the case study lead organization received through the 2021 call for case studies on health and climate change, and does not endorse or reflect the views of the World Health Organization or any of its activities.