At a glance
- Managing the threats posed by climate change to human health requires a rapid upscaling of adaptation interventions. This will entail innovation in new interventions that can better meet healthcare needs driven by climate risk, for example, managing heat stress and supply chain resilience. It will also involve initiatives to scale interventions that are immature or not widely adopted in regions most vulnerable to climate risk, including through new policy, financial, or implementation models.
- This article highlights three areas of opportunity for innovation and the scaling of solutions that specifically target climate-related health challenges: 1) medical products and technologies that seek to reduce the burden of climate change on health; 2) health-related climate surveillance, early-warning, and response systems; and 3) climate-resilient healthcare infrastructure, supply chain, and workforce capabilities.
- Actors across the global public health ecosystem could consider three relevant enablers: establishing ecosystems of research and innovation that are grounded in local contexts and offer support for more targeted product development; market-shaping incentives that strengthen the economic sustainability of solutions and promote investment in climate and health innovations, including from the private sector; and integration of climate criteria into health policy and investment decisions that can encourage an uptake of climate-resilient healthcare solutions and the development of health-informed early-warning systems.
The United Nations Climate Change Conference in 2023 (COP28) yielded an unprecedented focus on the intersection of climate change and human health.1 More than 120 countries endorsed the COP28 United Arab Emirates (UAE) Declaration on Climate and Health and a billion dollars in funding was committed to tackling the issue, building on momentum from a range of earlier initiatives.2 The topic is expected to see continued emphasis at the 2024 G20 summit in Brazil, followed by the COP29 Azerbaijan and COP30 Brazil presidencies, which will focus on climate-finance goals and nationally determined contributions (NDCs).3 The Climate Change and Health resolution recently adopted at the 77th World Health Assembly provides further impetus for the field.4
Adaptation—that is, managing current or projected impacts of climate risks5—is a major imperative in climate and health, with climate change having been identified as “the greatest threat to global health in the 21st century” by the World Health Organization (WHO).6 Adaptation can be pursued alongside mitigation in an effort to reduce the 4 to 5 percent of global emissions that come from health value chains.7 The need for adaptation is particularly acute to protect vulnerable populations, including women, children, the elderly, low-income earners, Indigenous and migrant groups, and those in lower-income countries. These groups can often face greater climate hazards, are more physically vulnerable, and have the least adaptive capacity.8
Effective adaptation will involve a mix of new and established interventions. Locally, health sectors could consider how to scale existing programs to manage the risks exacerbated by climate change: for example, heightened flood risk may call for a scaling of efforts to vaccinate against cholera, outbreaks of which have been caused by severe flooding events.9 They could also consider how to establish new programs in cases where climate change introduces novel threats or makes them newly salient—such as greatly increased risks of heat stress, or threats to supply chains that were previously considered resilient. Globally, the mix of adaptation interventions will similarly include some well-established public health solutions that are deployed differently or at greater scale, as well as other more novel solutions, to meet new sources of demand.
The magnitude of the required shift is significant, with the annual shortfall of investment in adaptation in health systems globally estimated at between $26 billion and $56 billion.10 Creating change at this scale in line with related priorities and sustainable development goals and objectives is likely to require new policy and financing models.11
This article considers opportunities for the global ecosystem to do things differently in response to these challenges, with a particular focus on solutions that specifically target acute and chronic climate-related risks to health. It considers opportunities for breakthrough innovations in new solutions; areas where existing solutions remain nascent or untested in the most vulnerable regions; and novel policy, financial, or implementation models that could support more effective interventions. It identifies three potential solutions: 1) a set of priority areas for impactful and equitable innovations and scalable solutions, especially relevant to low- or middle-income countries (LMICs) and vulnerable populations; 2) promising solutions, drawing on the Health Innovation Exchange’s (HIEx’s) Climate Health Innovation Equity Fund’s (CHIEF) global call for climate and health innovations; and 3) a potential way forward for actors across the climate and global public health ecosystem, including new ways in which decision makers and investors could address underlying challenges. In addition to case study evidence from HIEx’s call for applications and other sources (such as PATH and Global Climate Coalition), the article draws on a mix of literature, public and private data sources, and expert interviews. The research was conducted by the McKinsey Health Institute (MHI), HIEx, the Oswaldo Cruz Foundation (Fiocruz), and the Asian Development Bank (ADB).
Priority areas for innovation in adaptation
There is a myriad of pathways through which acute and chronic climate hazards can affect health and healthcare systems.12 Exhibit 1, building on existing work from organizations such as WHO and the Organisation for Economic Co-operation and Development, provides an overview. Climate risks can affect a wide range of health conditions, both directly (for example, the impact of heat stress or trauma from floods or wildfires) and indirectly, through impacts on variables such as water quality and vector ranges. Climate risks can affect health systems’ ability to provide care because of their effects on infrastructure, value chains, and workers—as well as shape both physical and economic accessibility of care. Critically, the nature of risks and outcomes will vary widely by locality, as they are dependent on localized exposure and vulnerability factors.
Exhibit 1
This article focuses on adaptation strategies to address eight major risk sources that are widely relevant across lower- and middle-income countries and hence potentially important focal areas for innovation and scaling solutions.13 The sources are heat, wildfires, severe storms, floods/heavy precipitation, air quality (indoor and outdoor), water availability and quality, food security and safety, and vector spread/behavior. See table for an overview of the evidence of their importance, drawing from sources such as the Intergovernmental Panel on Climate Change Sixth Assessment report (IPPC AR6), the 2023 Lancet Countdown report, and other prominent contributions in this space.14
High-impact areas for innovation and scaling solutions
To identify opportunities for innovation or scaling solutions for adapting to these risk sources, we grouped possible adaptation measures into seven categories, ranging from measures to better understand risks to interventions to protect health systems and treat health threats, represented in Exhibit 2. For each pairing of risk source and adaptation type, represented as a matrix in Exhibit 2, we assessed the opportunity using two criteria: the degree to which a mature set of effective solutions was well defined and widely adopted in LMICs and the need for further innovation in the solution set or more effective deployment of existing solutions.
2
Based on this assessment, we identified three adaptation areas where further innovation could help address climate threats, considering innovations in both product development and effective and equitable deployment in LMICs (though their applicability will vary by locality). The three adaptation types are:
- medical products and technologies that seek to reduce the impact of climate change on health, notably in managing the effects of heat on populations, patients, and healthcare provision
- enhanced surveillance, early-warning systems, and response systems to support climate-informed emergency preparedness
- increased climate resilience of healthcare infrastructure, supply chains, and workforces to build capacity and capabilities that effectively respond to climate-induced shocks
In all three areas, the successful development and deployment of new or immature solutions depend on the presence of enabling conditions. These range from “fundamental” enablers (those that provide knowledge and financial resources to carry out innovation through in-country regulatory frameworks and research and innovation ecosystems that assist in the development of solutions that are tailored to local needs) to field-level conditions (those that ensure interventions are effectively deployed, such as community engagement and monitoring and evaluation systems).
The remaining sections of this article outline in more detail the opportunities in each of the three high-impact areas and critical enabling conditions, and drawing from the HIEx’s CHIEF call for applications, showcase promising solutions.
The recently launched CHIEF call for applications from HIEx (Exhibit 3) invited innovators from around the world to submit their solutions addressing the health impacts of climate change. This included a particular focus on lower-income countries and vulnerable populations. More than 80 of the 130-plus applications received pertained to adaptation (as opposed to mitigation). The applications are diverse, with examples across all seven adaptation types outlined in this article (see Exhibit 2), with a spike in digital health solutions (about 36 percent of all solutions). In terms of geographic spread, about 44 percent of the applications in adaptation stem from organizations in Africa, 29 percent in Asia, 10 percent in Europe, 10 percent in North America, and 7 percent in Oceania, the Middle East, and Latin America.
3
Innovation in medical products and technology reducing the impact of climate change on health
Opportunities for innovation. There is evidence (including studies referenced in table) that climate change amplifies the risks of a host of important conditions. While many solutions to manage these impacts are not specifically designed for climate-induced health needs, there is a need for evolution and innovation of existing products and technologies. This could include, for example, the development of new vaccines and point-of-care diagnostics for existing diseases whose burden is increasing due to climate change, such as malaria, dengue, Zika, and chikungunya, as well as evolving or completely new diseases, such as Mesoamerican nephropathy, which has been linked to heat stress.15 It could also include products and tools for water and sanitation management (for example, low-cost chlorine-based water purification systems), food security and safety (for example, microbiome interventions), vector-control interventions (for example, “next generation” insecticide-treated mosquito nets, Wolbachia method), and treatments against heat-related illnesses.16 Solutions and their means of deployment must be tailored to account for local and individual needs, for example, by addressing attitudes that give rise to vaccine hesitancy or ensuring that accessibility to products is equitable (such as avoiding formal ID requirements).
In other areas, climate more strongly shapes the challenges and requisite solutions. Such areas include:
- Climate-resilient products. Climate change can affect the resilience of supply chains, especially the temperature-controlled or “cold” chain. In 2013 to 2022, the global ten-year mean temperature reached 1.14°C above preindustrial levels, while the number of heat wave days from 2013 to 2022 increased 94 percent globally, compared with 1986 to 2005.17 This affects medical products and supply, especially in remote regions that lack reliable cold chains. For instance, in Nigeria, over a million doses of COVID-19 vaccines had to be destroyed by the end of 2021, largely due to inadequate storage/cold chains.18 Some innovation in this space already exists, such as heat-stable carbetocin used to prevent postpartum hemorrhage, which does not require cold-chain transportation and storage.19 Vaccine microarray patches (vMAPs) offering enhanced thermostability have also recently gained momentum, accelerated through the Bill and Melinda Gates Foundation–supported MR vMAP positive Phase I/II study for measles and rubella.20 However, these examples are scarce, and substantial time and resources are likely to be required to develop and deploy vMAPs for other conditions. More innovation in the development or modification of climate-resilient medical products, in line with approval processes and clinical guidelines as well as adequate training of healthcare workers, could help avoid increasing disruptions in healthcare provision going forward.
- Innovation for heat-related diseases. Increased temperatures and extreme heat lead to more heat-related illnesses, particularly affecting vulnerable and exposed population groups. This includes children under the age of five, seniors, pregnant women, Indigenous communities, outdoor workers, displaced populations, and individuals with existing health conditions or comorbidities.21 Projections estimate a 1,120 percent increase in heat wave exposure for people older than age 65 in the time period 2041 to 2060, compared with 1995 to 2014, according to one Lancet study.22 Beyond general guidance to reduce risks, such as increasing water intake and monitoring for symptoms, limited innovation has emerged in the space. Emerging medical devices include wearable heat-stroke-detection devices that use physical sensors, such as galvanic skin response, heartbeat, and body temperature, to detect increased risk of heat stroke,23 as well as passive cooling wearables to protect exposed people (see sidebar, “New technologies can help adaptation to climate”). However, these are not yet readily accessible and affordable to lower-income populations.
Identifying enabling conditions to advance innovation. Three enabling factors could help further innovation in this area. First, signaling demand for climate-resilient products requires systematic and consistent integration of climate considerations throughout the entire healthcare value chain, from initial product design to the delivery of healthcare services. As an example of this, Unitaid’s Climate and Health Strategy introduces the concept of climate-smart health products that are aligned with WHO’s comprehensive approach to climate-resilient health systems.24
Second, setting policy frameworks, regulatory conditions, and financial incentives to meet risk/return requirements of private investors could increase investment. In the case of vMAPs, high up-front costs (for example, in clinical trials, establishing manufacturing capacity) have deterred investment in the face of volatile profits.25 Policy measures that reduce costs of clinical trials and support intellectual property rights (including regulatory alignments across regions) or require climate risk preparedness in key medical infrastructure investments could enhance the attractiveness of innovation more broadly. These could be enhanced by more targeted market-shaping interventions in priority areas such as advanced market commitments, stacked equity models, development impact bonds, priority review vouchers, viability gap funding, or extended exclusivity.
Third, the expansion of R&D activities in LMICs may ensure that products are better tailored to local needs and overcome practical difficulties in product development and supply (for example, the lack of available serum and blood samples for validation in developing diagnostics for “disease X”). This could build on existing initiatives to bring onshore manufacturing to LMICs such as those led by the African Union’s and India’s G20 presidencies.26 Institut Pasteur de Dakar, comanaged by the Senegalese government in partnership with local players and international organizations (for example, the European Investment Bank) has developed into a robust innovation hub for R&D, manufacturing, diagnostics solutions, and public health activities in Africa.27 Similarly, Fiocruz’s Innovation Portfolio program in Brazil aims at building an innovation ecosystem of national and international partners for the development of solutions for the problems of public health.28
Enhanced surveillance of climate-related health issues, early-warning systems, and response systems to support climate-informed emergency preparedness
Opportunities for innovation. The effects of climate on health are most immediately evident in the increased frequency and severity of extreme events: climate pressures are estimated to have increased the intensity of rainfall by 50 percent during the 2022 floods in Pakistan, which destroyed 1,460 health facilities and precipitated a more than threefold increase in malaria cases.29 Surveillance and early-warning systems are a critical part of emergency preparedness, resilience, and response programs. These can cover climate hazards themselves, as well as climate-induced episodes of food insecurity, migration, or outbreaks of disease, with 218 of 375 existing infectious diseases affecting humans being aggravated by climatic hazards.30 Increasingly, advanced technologies are being adopted for these purposes31: for instance, the Global Flood Awareness System allows satellite-based near-real-time monitoring and forecasting of flood events up to 30 days in advance, while local sensors based on Internet of Things (IoT), Internet of Drones (IoD), and Light Detection and Ranging (LiDAR) sensors have been developed to provide more granular data.32 However, there remains a gap for the development and deployment of solutions that link climate and health/social data to support decisions on the ground.
A first-priority area is developing advanced forecasting systems and machine learning/AI solutions that include climate and health/social data to enhance climate-specific health-risk assessments. These may account for social vulnerability factors, meteorological data, and/or information on ecosystems—linking, for example, weather data to hospital admittance records to better understand impacts of heat or tying air quality data to the use of respiratory masks. WHO research shows that only a third of 95 surveyed countries have climate-informed early-warning systems for heat-related illness (33 percent) or for injury and mortality from extreme climate events (30 percent), despite strong evidence of these hazards.33 Some international initiatives have emerged to cover infectious diseases, including examples led by WHO, Wellcome Trust, and PATH.34 At the country level, some research projects and climate and health observatories are also gaining traction, such as the Brazil Observatory of Climate and Health; the CIDACS Climate, Environmental, and Health Data Platform in Brazil; and the Lancet Countdown, which is hosted in London.35 Tech companies such as Microsoft, Google, and Amazon are increasingly contributing to the innovation agenda by leveraging their cloud and AI systems to link climate events and potential health outcomes.36
A second priority could integrate community-level data into these platforms, including through social cartographic methods, to support collaborative models of policy making and local emergency response systems. This may provide particular focus on the needs of disadvantaged groups, including women who are disproportionately affected by climate-related disasters.37 Social media technologies and mobile phones can contribute to more effective warning systems by providing social and qualitative data directly from communities. Examples include Khushi Baby’s Climate Health Vulnerability Mapping developed in Rajasthan (India), which leverages data collected by community health workers on the impacts of climate-related events and allows rapid and effective response through direct communication with these workers. In Brazil, the Alert-Early System of Outbreaks with Pandemic Potential (AESOP), developed by Fiocruz, the Rockefeller Foundation, and the University of Rio de Janeiro, was designed in consultation with communities to provide decision-relevant information to local authorities.38 The Australian Warning System is another example, as it provides information and alerts for hazards such as bushfires, floods, storms, cyclones, extreme heat, and severe weather, then broadcasts them via websites and certain apps.39
Identifying enabling conditions to advance innovation. While tailoring solutions to the needs of local communities is critical for innovations to be impactful, collaboration and data sharing across geographies can drive economies of scale and enhance the performance of underlying technology.40 For example, WHO’s Global Influenza Surveillance and Response System (GISRS) and the Global Initiative on Sharing All Influenza Data (GISAID)41 foster collaboration and sharing of virus samples and data for more effective surveillance, preparedness, and response. Interregional coordination can link to funding, as in the case of World Bank’s PEF insurance window, which, in the case of major cross-border disease outbreaks, disburses resources through premiums paid by donor countries.42
The integration of climate, health, and community data also requires collaboration among organizations and platforms across different sectors, potentially spanning solutions from various companies, nongovernmental organizations, academic institutions, or international organizations. Breaking down silos and fragmentation relies on climate-transformative leadership and governance creating integrated, consistent, and interoperable approaches at country and regional levels while ensuring data sovereignty.43 This approach can avoid the pitfalls of the fragmented response to COVID-19 in certain areas, where a lack of data sharing created barriers to coordination and response.44
Increased climate resilience of healthcare infrastructure, supply chains, and workforce to build capacity and capabilities that effectively respond to climate-induced shocks
Opportunities for innovation. Climate resilience of health systems is increasingly prioritized by leaders.45 Many interventions to enhance the resilience of health systems and supply chains have been pursued independently of climate risk. These include asset strengthening (for example, on water and waste management systems), new models of service (such as telemedicine), and measures to improve reliability of supplies (for example, strategic stockpiles, diversification of supply sources, or use of digital supply networks to track availability in real time).
Other interventions specifically target climate-related exposure and vulnerability, including the use of heat-resistant building materials, elevating buildings to protect against flooding, and the design of climate-resilient transport routes and supply chains (for example, battery-powered portable refrigerators). Some programs enhance resilience and mitigation goals in parallel: for example, the UNDP initiative Solar for Health (S4H) installs solar panels at health centers and storage facilities to improve the reliability of power supplies, while PATH and WHO, who have developed a green supply chain project, install photovoltaic modules on medical-store rooftops and solar direct-drive refrigerators to power facilities and vaccine storage systems.46
A critical area for innovation is in developing technologies that can be deployed in emergency scenarios, thus meeting climate-induced healthcare needs at a time when healthcare systems and value chains are under stress. Battery-operated portable refrigerators for vaccines and other biologicals such as Emvolio allow for climate-resilient healthcare provision, especially for last-mile delivery to communities in remote areas and during crises.47 “Diagnostics-in-a-suitcase” solutions can allow rapid, inexpensive, and simple diagnostic solutions to circumvent central laboratories in remote settings.48
Finally, healthcare professionals are at the front line of the climate-induced health risks faced by populations worldwide. In particular, community health workers help promote community resilience to climate change through community-based strategies, education, and awareness campaigns and as a link to vulnerable communities.49 Relevant training and workforce management models could enhance their capability and capacity to respond to climate-induced emergencies and healthcare demand, as well as to play a central role in climate-related health education and leadership. WHO highlights that there is a need for expanding the climate-related health competencies of healthcare workers and ensuring more systematic training.50 For instance, the European Commission and European Environment Agency’s platform Climate ADAPT has developed a tool kit with guidance, examples, and resources to incorporate teaching on the intersection between climate change and health in medical school curricula.51 Governments could consider how to translate and integrate this knowledge into local contexts and train in-service workforces and community health workers.
Identifying enabling conditions to advance innovation. Policy frameworks that embed climate risk into decision making and align with adaptation efforts in other areas (for example, specific climate-risk-related requirements for real estate, urban planning in general, education, disaster management) could assist in the wider uptake of health sector resilience measures. This may act as an incentive for more innovation. WHO’s Alliance for Transformative Action on Climate and Health (ATACH) has been a pioneer in developing the operational framework for building climate-resilient and low-carbon health systems, as have related initiatives around “smart hospitals.”52 At a national level, the government of Fiji has developed guidelines in consultation with local, national, and international stakeholders to strengthen the climate and energy resilience of healthcare infrastructure (including water, sanitation, and waste) and develop health workforce capabilities to respond to climate-induced challenges.53
These can be supplemented by financial incentives for private capital to support the development of adaptation measures. For instance, the Green Climate Fund, United Nations Development Programme, and WHO launched the Climate and Health Co-Investment Facility to strengthen climate resilience of health systems in 14 countries in Africa, Asia, and Southeastern Europe by addressing the financing gap through public and private capital.54 Novel insurance models can supplement these incentives by supporting surge capacity in emergencies (thus supporting innovation in specific technologies) and providing timely support for recovery and reconstruction of healthcare facilities.
Potential path forward
Climate change has wide-reaching effects across health systems in LMICs, affecting the most vulnerable populations disproportionately. This article contributes to defining the adaptation space and drawing attention to innovations needed and their enabling conditions. To move forward, three common threads of action can be of central importance.
First, public and private sector leaders can prioritize and mainstream both the climate risks to health systems and the health consequences of climate change. On the one hand, this could involve systematically accounting for climate risk in healthcare infrastructure, supply chain, and workforce planning (for example new builds, retrofits, workforce trainings). On the other hand, adaptation plans could account for health impacts of climate risks and the needs of the health sector, including through cross-sectoral engagement of the wider ecosystem at all levels. For instance, cities could develop heat action plans55 to counter the health effects of climate change. Furthermore, private sector leaders could better understand how health-related climate risks (such as heat waves or floods) are faced by their workforce and develop adequate adaptation measures for their most vulnerable employees. Overall, community engagement is an important ingredient to successful adaptation given varying local needs: for innovation to be equitable and effective, local engagement should extend from research and development to implementation, monitoring, and evaluation.
Second, the research community could advance data-informed research on the climate–health nexus, develop context-specific indicators, and monitor the effectiveness of adaptation measures on the ground. This could facilitate scientific evidence that could help mobilize the private, public, and not-for-profit sectors as well as private investors and decision makers. Importantly, research should be prioritized at a local level in LMICs to account for the environmental, geographic, social, and economic specificities of the challenges addressed in each context. Over the longer term, the development of innovation ecosystems within LMICs can help in localizing solutions and bringing together the relevant stakeholders, financial resources, and capabilities.
Finally, global public health players, financial institutions, and governments could work together to provide resources and establish financial incentives and market-shaping mechanisms to unlock private sector investments. This could include expanding finance in the climate and health space to ensure adaptation at scale is affordable and mechanisms to derisk investments in LMICs can crowd in other sources of private capital. While many innovative financial instruments exist (for example, advanced market agreements, catalytic funding), they could be tailored to address health-related climate adaptation strategies at the community level. Discussions at multilateral forums and international negotiations could help create a consensus on the scale of climate-specific health funding required.
