The next pandemic could already be among us and climate change means no country is safe, said Peter Sands, head of the Global Fund, one of the world’s largest funders of HIV, TB and malaria programs, in an interview with POLITICO.
“Are we in a little bit of a danger of kind of fighting the last war, assuming the next threat is going to be like the one we’ve just experienced, when the next health crisis could actually be the impact of climate change fueling existing diseases, as opposed to some new disease X?” asked Sands, who has been executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria since 2017.
The effect of climate change and human encroachment on natural habitats is often identified as increasing the likelihood of the emergence of a new infectious disease — a so-called disease X. But climate change’s effect on existing deadly diseases isn’t a theoretical future scenario — it’s already happening.
In Pakistan, flooding that research indicates was likely made worse by climate change, killed more than 1,700 people in 2022. But, in the aftermath, cases of malaria surged and the deaths from this disease far exceeded direct deaths from flooding, said Sands. That’s because standing water and waterlogged areas make for prime breeding grounds for the mosquitoes that carry the deadly infection. And disrupted health care in the wake of a natural disaster means more people die of the infections.
And with extreme weather events on the rise, Europe might also be at risk. “We may well see malaria coming back,” said Sands.
He’s not a man prone to hyperbole. As former CEO of the Standard Chartered group, Sands built his career not as an activist but as one of the world’s most powerful bankers. At the Global Fund his message has not been about radical new interventions but about building up health systems with things that are proven to work, such as surveillance and community health workers.
While a return of malaria to Europe would be concerning, the region has relatively advanced health systems so would feel the impact less than in places where health systems are already under strain and ill-resourced, said Sands.
‘Not a hypothetical situation’
In March this year, health, water, sanitation and environment ministers from 11 southern African countries came together to call for urgent action on cholera and other waterborne diseases, describing these as “climate-related public health emergencies.” Cholera is being reported in a growing number of countries in recent years, including those that haven’t reported cases in several years or where the disease is not endemic.
“This isn’t a sort of hypothetical impact of climate change on health and people’s lives, but it’s a very real impact,” said Sands.
The Global Fund provides 63 percent of all international financing for malaria programs, but it missed its fundraising target at its last replenishment.
It’s part of a broader pattern of donors having too many pressing crises demanding cash and attention. Recent figures from the OECD indicated that while official development assistance is up significantly, most of this is attributed to countries dealing with an influx of refugees and aid to Ukraine.
So what to do about it? “I think that the most powerful way of preventing, and being prepared for, future pandemics is by dealing with the ones you’ve got in front of you,” said Sands.
It’s a message that Sands has been pushing for years but, even when the COVID-19 pandemic was at its worst, attention on strengthening health systems in developing countries has often slipped off the priority list for donors and wealthy countries.
The EU is working to set that right through its new Global Health Strategy where one of the three priorities is to strengthen health systems.
But to convince the world that malaria or cholera is a pandemic may be even harder.
“Unfortunately, we tend to treat a pandemic as things that threaten those of us who are lucky enough to live in rich countries,” said Sands. But with 2021 seeing 247 million cases of malaria in 84 countries where malaria is endemic, “it feels a bit like a pandemic,” he said.