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NATIONAL RESEARCH COUNCIL

COMMISSION ON GEOSCIENCES, ENVIRONMENT, AND RESOURCES
2101 Constitution Avenue Washington, D.C. 20418

Q #21

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Following up on our recent conversation, enclosed is our proposal to develop a global research agenda to address climate impacts on health. The study will be conducted jointly by the Institute of Medicine and the National Academy of Sciences. The National Research Council's Board on Atmospheric Sciences and Climate has the lead.

The proposal stems from the Climate Research Committee meeting on May 9, where the evidence was presented that urged more diligent examination of the evidence and development of an appropriate global research agenda. The NRC Governing Board endorsed a proposal to establish a study committee if support could be obtained.

The new committee (joint between IOM and NAS) would publish 3 reports: first, a
statement of the problem and cardinal issues; second, an assessment of the state-of-the-
science; and third, a global, multi-disciplinary research strategy. We want to do a thorough
job, separating solid and not-so-solid evidence regarding the purported connection between
climate and health. And, we want a consensus view from the leading thinkers as to what
should be done next. A three-year term for the committee, and two international
workshops, are envisioned.

In order to develop a research agenda that international and national agencies can
implement without delay, the new committee would have to focus itself, I believe, on a
problem with fairly defined bounds. Thus, I think the committee will quickly review all the
weather/climate/health issues (including air quality, heat stroke, radiation and cancer, for
example) but narrow its aim to "the emergence and spread of infectious diseases." The
specific charge to the new committee should be developed through consultation with the
likes of you, Duane Gubler, Joel Scheraga, and others with a stake in the outcome, and
with NAS and IOM members and staff. The charge could state, for example, that the
committee should survey and assess the evidence for links between climate and health and
develop a global research and information dissemination strategy that goes beyond our
present capabilities. The global strategy should, perhaps, continue investigation of new and
important links between climate and disease, develop information products for health care
providers, integrate observing and modeling technologies, create appropriate

The National Research Council is the principal operating agency of the National Academy of Sciences and the National Academy of Engineering

Ms. Claudia Nierenberg

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August 28, 1995

surveillance methodologies, and so on. We believe very strongly that many of your interests are involved here, including assignment of useful tasks to the IRICP, targeting of El Niño impacts, bolstering the raison d'etre for GOALS, and providing an opportunity to develop an international program of considerable magnitude on the human dimensions of climate fluctuations.

We have significant interest from very good people who would serve on the panel including Bob Shope, Rita Colwell, Paul Epstein, Mark Wilson, Tom Karl, Jerry Mahlman, Ed Sarachik, and Eric Barron, to name a few.

The WHO endorses the idea. I am sure I will have no problem engaging the WMO. The international organizations will pay for some travel, provide data, and assist in just about all ways except pay for U.S. travel, meeting costs, salaries, overhead, and supplies. The EPA has already provided $25,000 to keep the planning moving along. Preliminary talks with the NSF indicate they will help support the committee. If NOAA/OGP, along with USAMRIID, EPA, NASA, CDC, and NSF each contribute $75,000 for FY 1996, we can proceed on a firm footing. I am also contacting the State Department and USAID to see if they would cosponsor the study. I have been asked to submit the proposal to the Burroughs Wellcome Fund for possible support of one of the two international workshops. My hope is that the agencies just listed will provide the necessary commitment for the first year, and that my continuing efforts to secure funds from private industry and various foundations will reduce the tax on federal agencies. Agency shares of funding would depend on the response to this call for support.

I do hope you can participate in the funding of this study. I provide an estimate of $75,000 per year for three years as a suggestion. The full proposal is enclosed. Should it be convenient to do so, the EPA has agreed to collect the funds, and administer the contract on behalf of all agencies. Joel Scheraga (202-260-4029) is the EPA contact.

Your views on the specific guidance and charge to the committee would be very useful in any case. We hope our efforts will benefit the Office of Global Programs' mission.

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NATIONAL ACADEMY OF SCIENCES-NATIONAL RESEARCH COUNCIL

COMMISSION ON GEOSCIENCES, ENVIRONMENT, AND RESOURCES

BOARD ON ATMOSPHERIC SCIENCES AND CLIMATE

Proposal No. 96-CGER-023-01

Proposal to the

Environmental Protection Agency

for

A Study of Climate, Infectious Diseases, and Health

This proposal is submitted by the National Academy of Sciences, which assumes full technical and financial responsibility under its Act of Incorporation for the work to be performed under any award resulting from this proposal.

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NATIONAL ACADEMY OF SCIENCES-NATIONAL RESEARCH COUNCIL
COMMISSION ON GEOSCIENCES, ENVIRONMENT, AND RESOURCES

BOARD ON ATMOSPHERIC SCIENCES AND CLIMATE

Proposal No. 96-CGER-023-01

CLIMATE, INFECTIOUS DISEASES, AND HEALTH

SUMMARY

Relationships between climate, health and general well being have been recognized for hundreds and possibly thousands of years. Connections between infectious disease vectors (and other pathogens) and elements of the climate system have been investigated. Some of these relationships have been quantified and applied successfully toward preventing the occurrence or spread of a disease vector or mitigating its impact on the health of people, plants, and livestock. For example, temperature and rainfall control the emergence and distribution of mosquitoes the vector for malaria, dengue, yellow fever, and equine encephalitis. Upsurges of water-borne diseases such as typhoid, hepatitis, bacillary dysentery, and cholera have been associated with flooding and possibly El Niño events affecting many parts of the world.' These associations refer to the modulation or control exercised through weather and climate system variability. Over the past five years increasing attention has also been focused on the impact of climate change on health, food, and water supply and quality.

Investigating and quantifying relationships between weather, climate variability (monthly, seasonal, and interannual time scales), and infectious diseases and health would provide information supporting tactical decision making and the management of social and economic resources. Studying the response of disease vectors and other pathogens to decadal and longer climate and global changes would feed into strategic planning and the development of management options. Further studies are urgently needed to examine these relationships more exhaustively.

The NRC study "Climate, Infectious Diseases and Health (CIDH)" will review the evidence behind suspected links between climate and health. It will identify useful weather and climate information products and tools, such as monitoring and surveillance systems, that can be applied today in disease prevention and mitigation efforts. It will recommend a global, international research strategy to further define weather and climate connections to human health and the emergence and spread of infectious diseases (and other pathogens)

'Aperiodic warming of equatorial Pacific Ocean water (the El Niño) is connected with global-scale atmospheric circulation patterns and associated weather a continent and more distant.

and to develop new tools and information products. Due consideration will be given to the hosts and carriers of either the pathogen or the vector such as food, air, and water. It is expected that the study proposed will draw upon and significantly complement other national and international activities involved in climate and health such as the assessment being conducted by the United Nations Intergovernmental Panel on Climate Change, and projects being proposed under the UN Framework Convention on Climate Change and the UN Commission on Sustainable Development.

Strong interest has already been expressed by national agencies and by the World Health Organization. Other agencies, international organizations and foundations will be approached for co-sponsorship. The NRC study was approved by the Executive Committee of the Governing Board of the National Academy of Sciences (NAS), the National Academy of Engineering (NAE), the Institute of Medicine (IOM), and the National Research Council (NRC) on June 15, 1995. It has been proposed that a Committee on Climate, Infectious Diseases and Health (CCIDH) be established to carry out the study under the Board on Atmospheric Sciences and Climate (BASC) in collaboration with the IOM. Three reports and two international workshops are planned over the three year duration of the project. Other cooperating NRC units include the Board on Natural Disasters, the Board on Sustainable Development and its Committee on Global Change, the Polar Research Board, the Office of International Affairs, the Commission on Life Sciences; and the Commission on Behavioral and Social Sciences and Education.

SCIENTIFIC JUSTIFICATION

Infectious diseases are transmitted from one person to another by actual contact or contagion or by a vector. A person's body is colonized by parasites (e.g., viruses, bacteria, protozoa, fungi, and worms). Infectious diseases constitute the major cause of death worldwide. Human health is affected by climate because people are directly sensitive to climate and susceptible to diseases whose vectors are sensitive to climate. Climate affects the survival of viruses outside the host. For example, the influenza virus survives longer in low humidity, while higher relative humidity favors the poliomyelitis virus. Viral diseases with seasonal morbidity are common in both temperate and tropical zones. Influenza A, for example, occurs primarily in winter-its morbidity is aggravated by sudden cold spells. Several enteroviruses on the other hand are most prevalent in summer. It is not clear whether the seasonality of these viruses is due to the impact of climate on the virus, the host, or both. In the case of vector borne diseases, the pathogen is transmitted to a person by another agent called the vector, such as a tick, flea, or mosquito. Climate can affect these diseases in several ways. It can affect both the infectious agent and the vector® directly, or it can affect the vector by influencing the types of vegetation or intermediary hosts of the vector.

*National Institutes of Health (NIH), Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA), and National Science Foundation (NSF).

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