EXECUTIVE SUMMARY COVID-19 AND CLIMATE- SMART HEALTH CARE Health Sector Opportunities for a Synergistic Response to the COVID-19 and Climate Crises CLIMATE INVESTMENT FUNDS EXECUTIVE SUMMARY INTRODUCTION This is a summary version of the report, COVID-19 This report provides a framework that builds and Climate-Smart Health Care: Health Sector on the World Bank’s climate-smart health care Opportunities for a Synergistic Response to the approach (World Bank 2017) and integrates the COVID-19 and Climate Crises. It describes the World Bank’s multiphase programmatic approach actions that the health sector can take during the (MPA) into the global COVID-19 response (World COVID-19 response and recovery efforts to tackle Bank 2020). It is intended to guide ongoing as well both the pandemic and climate change threats. as pipeline activities and investments targeted at The emergence of the COVID-19 pandemic has the pandemic, with a view to enabling the health brought with it a sharp focus on public health sector to leapfrog toward climate-smart UHC. services and health systems, with climate Furthermore, the report is also targeted at leaders change further exacerbating this challenge. In and operational teams in multilateral development combination with COVID-19, the climate crisis has banks (MDBs) and other development finance shed light on the chronic lack of capacity to manage institutions, particularly those in the areas of emerging public health risks. The convergence of health, nutrition, and population. It can guide these two crises presents a clear risk because it the design of health investments addressing the can disrupt and overwhelm health systems, health global COVID-19 emergency as well as prepare for care facilities, and the health care staff on which the next pandemic and potential future social or these systems rely, thereby reducing the progress environmental crises. The messages of this report toward universal health coverage (UHC). This risk is will also be useful for other development agencies, of particular concern in settings with already weak nongovernmental organizations (NGOs), ministries health systems, leadership challenges, insufficient of health, and health agencies, as well as other resources, and limited capacities. However, the policy makers committed to building enduring, collective global effort to respond to and recover resilient, and sustainable health systems. from COVID-19 also presents important opportu- nities for implementing cross-cutting efforts in the health sector to tackle both the pandemic and the LINKS BETWEEN COVID-19, climate crises. CLIMATE CHANGE, AND HUMAN The objective of this summary is to HEALTH describe the actions that the health There are several important interactions between sector can take during the COVID-19 the health impacts of the COVID-19 and the climate crises, despite climate change not being directly response and recovery efforts to implicated in the emergence or transmission of tackle both the COVID-19 pandemic the virus. and climate change threats. 2 | COVID-19 and Climate-Smart Healthcare The COVID-19 pandemic has led to a global that opportunities to build back better are not loss of life not seen since the Spanish influenza missed. pandemic of 1918. This exceptional challenge to • Climate change and its drivers are known to public health, food systems, global economies, increase the risks of emerging and reemerging and social norms is not only leading to millions infectious diseases, and therefore, of pandemics. of deaths, and ill health, but also pushing tens of For example, deforestation contributes to carbon millions of people back into extreme poverty. It is dioxide (CO2) emissions and the destruction of substantially increasing the prevalence of under- habitats that, in turn, increase the risks of zoonotic nutrition and likely precipitating significant future spillover events of infectious diseases from chronic disease and mental health burdens. wildlife and livestock to humans. The health risks of climate change are also immediate, but unlike COVID-19, they are • Several of the populations most vulnerable to projected to rise over the coming decades, the health impacts of climate change overlap unless rapid and profound action is taken. Rising with the groups most at risk from COVID-19. temperatures, changing rainfall patterns, sea-level These include elderly populations, people with rises, shifting disease vector ranges, and extreme preexisting or chronic conditions (especially climate-related weather events all threaten human those related to respiratory illnesses), ethnic health and well-being through a number of direct, minorities and indigenous groups, as well as indirect, and cascading pathways. those of lower socioeconomic status or in poverty. The dual threats of COVID-19 and The COVID-19 and climate change challenges climate change, which exacerbate existing share a number of overarching drivers and affect inequalities, can produce a compounding effect, similar vulnerable populations. Each requires leading to health systems being overwhelmed frequently overlapping health sector responses, and adding layers of complexity to already either in dealing with current threats or ensuring strained public health preparedness and response efforts. Despite climate change not • Measures to control COVID-19 can also have being directly implicated in the adverse implications for managing climate emergence or transmission of risks. Impacts on the ability of the infrastruc- ture to respond to extreme weather events COVID-19, there are several include reducing the capacities of emergency important interactions between shelters in times of windstorms, flooding, and the health impacts of the wildfires due to social-distancing requirements. Moreover, extreme weather events related to COVID-19 and the climate crises. climate change, such as heat waves, tropical storms, and wildfires, as well as ongoing issues The COVID-19 and climate like air pollution, have not disappeared during the COVID-19 pandemic. change challenges share a number of overarching drivers • Health sector responses to the COVID-19 pandemic have the potential to make health and affect similar vulnerable systems more resilient and adapted to populations. climate-related events. These measures include Executive Summary | 3 strengthening the health workforce capacity; INTEGRATING CLIMATE-SMART improving disease surveillance and health information systems; enhancing the rapidity of HEALTH CARE IN COVID-19 medical supply chains; along with streamlining RESPONSE AND RECOVERY health technology development processes to ACTIVITIES speed and scale up innovations, such as tele- medicine and vaccine development. The World Bank’s COVID-19 Strategic Prepared- ness and Response Program, using MPA, provides • The convergence of COVID-19 and climate an operational framework for supporting individual change also offers opportunities for health systems to become more sustainable and countries in preventing the spread of the virus; move further toward system decarbonization. strengthening public health and essential medical Measures could include more efficient public care structures; building resilience to emerging and health systems, such as integrated surveillance, reemerging infectious diseases and reducing their energy-efficient health facilities and transporta- risks; along with procuring and deploying vaccines. tion, along with the incorporation of sustainable This “menu” presents an opportunity for incor- cooling practices in the medical cold chain. porating climate-smart health care in COVID-19 responses, thus ensuring that the unprecedented “Climate-smart health care” encompasses both global health investment and effort do not inadver- climate change mitigation and adaptation efforts tently worsen the climate crisis but instead actively by the health sector. The climate-smart health contribute to the climate goals set out in the Paris care approach recognizes the need to ensure Agreement. that adaptation and resilience measures are put in place for the changes we know will come so To ensure an efficient and effective pandemic that we can integrate them, while addressing the response while also tackling climate change, health sector’s own contribution to the problem real and perceived tradeoffs must be carefully by limiting net global greenhouse gas (GHG) considered in the design and implementation of emissions. Climate-smart health care also seeks any climate-smart interventions. This requires a to facilitate the incorporation of the potential health high level of innovation and collaboration across co-benefits of actions to mitigate climate change multiple sectors. Therefore, it is useful to follow in order to deliver further reductions in mortality several key principles to guide this process: and morbidity in a changing world. evidence-based decision-making, country owner- The collaboration witnessed in the global ship, multisectoral approaches, as well as iterative response to COVID-19 provides lessons that monitoring, evaluation, and learning. Each of these can be replicated in our response to the climate principles is equally important for reducing the implications of population health and health health risks of pandemics and climate change systems. Essentially, ensuring that investments now and in the coming decades. Nine areas have and resources for recovery are structured with been recommended for action. They are listed a longer-term green, resilient, and inclusive and elaborated upon in table 1 — Menu of Inter- development perspective provides greater value ventions for Climate-Smart Health Care Actions than short-term panic and neglect. for COVID-19 Response. “Climate-smart health care” encompasses both climate change mitigation and adaptation efforts by the health sector. 4 | COVID-19 and Climate-Smart Healthcare CONCLUSION dual crises and prepare for future events. Building on the unprecedented international action around The COVID-19 pandemic has reshaped the COVID-19, this report has identified opportunities world—magnifying gaps in the health system for implementing synergistic interventions that can and exacerbating existing inequalities. Similarly, enhance the resilience of the health system to the climate change, in combination with current and COVID-19 crisis, future pandemics, and climate future global health risks, is threatening the ability of change. Many of these interventions can also help health systems to protect and improve population limit health sector emissions by helping to decouple health and will continue to do so in the future. progress toward UHC from global environmental Nevertheless, opportunities exist to tackle these damage. TABLE 1. Menu of Interventions for Climate-Smart Health Care Actions for COVID-19 Response Climate-Smart Health Care Actions COVID-19 Health Climate Adaptation Climate Mitigation and/or Response Areas and Resilience Low-Carbon Health Care A. Public Health • Adopting the One Health approach in disease • Instituting integrated (instead of separate) Surveillance and surveillance and environmental monitoring surveillance systems for health, weather, Risk Assessment (including climate services for health) for the early and the environment that are powered by detection of climate-sensitive infectious diseases renewable energy • Strengthening the surveillance of climate-sensitive • Conducting energy use audits and needs health impacts (for example, dengue, malaria, heat- assessments of health care facilities to inform related illnesses, air pollution-related diseases, energy-efficiency measures and the availability and nutritional deficiencies), using lessons from of alternative renewable sources COVID-19 • Integrating the health co-benefits of mitigation • Conducting integrated risk and vulnerability options into risk and vulnerability assessments assessments to include pandemics and climate • Adopting low-carbon and energy-efficient change [for example, Vulnerability and Adaptation rapid-testing and contact-tracing technologies (V&A) assessments, stress testing, and business (such as those enabled by mobile phones) continuity plans], with special attention to as well as facilities (for example, conducting vulnerable populations testing outdoors) B. Emergency • Adopting a multihazard approach to emergency • Establishing sustainable low-carbon backup Preparedness, planning that covers pandemics, climate-related options for electricity [for example, solar Planning, and disasters, and other external shocks photovoltaic (PV)], clean water, adequate food Rehabilitation supply, and transport • Setting up coordinated governance mechanisms (including community networks), service protocols, • Adopting low-carbon and energy-efficient and information systems, based on a multihazard devices (for example, flashlights and vehicles) approach to external shocks for immediate emergency response • Training health workers and other personnel for • Incorporating green sustainability principles in deployment in times of emergency rehabilitation plans for affected or destroyed health facilities and other infrastructure • Establishing multihazard disaster financing for pandemics, climate-related disasters, and other external shocks as well as strengthening financing for key community-based organizations serving high-risk communities to reach out to them • Maintaining and restoring natural environments around health care facilities to support cooling and minimize flooding impacts Executive Summary | 5 C. Capacity for • Ensuring the resilience of health facilities against • Adopting low-emission energy and energy- Testing, Isolation, climate-related disasters and their effects, such as efficiency measures for COVID-19 testing, and Treatment electricity disruption isolation, and treatment facilities, including natural lighting and ventilation • Setting up strong referral networks and contingency plans to ensure the continuity of • Establishing sustainable health care COVID-19 services during climate-related disasters waste management in testing, isolation, and treatment facilities, including waste • Revitalizing national plans for human resources minimization, segregation, safe recycling, and for health, as well as volunteers and workers from incineration phaseout in favor of steam-based other sectors, to sustain the COVID-19 response disinfection and prepare for climate-related health risks D. Supply of • Ensuring a steady supply of personal protective • Adopting renewable energy and energy- Essential Medical equipment (PPE), mechanical ventilators, medicines, efficiency measures in the manufacturing and Commodities and other essential commodities, including transport of essential commodities non-mercury-based thermometers, waste collection • Establishing sustainable management for all bins, and bags, throughout the entire COVID-19 waste, including waste minimization and the response and in preparation for potential climate- segregation of all items, such as used PPE that related shocks includes masks and medicine packaging • Using energy-efficient and low-carbon mechanical • Producing washable and reusable PPE made ventilators, as well as diagnostics, including X-rays out of sustainable materials and microscopy, which can still function despite electricity disruptions resulting from climate-related • Adopting sustainable procurement standards disasters for PPE, equipment, cooling devices, and medicines, including prioritizing the minimization of waste production and avoiding the purchase of products with high carbon levels, high global warming potential (GWP), or high-energy consumption • Strengthening local production and supply chains to ensure the steady supply of commodities while reducing transport emissions E. Health Services • Strengthening non-COVID-19 public health • Promoting low-carbon and energy-efficient for Non-COVID programs, including those for climate-sensitive telemedicine services (along with support for Conditions diseases increased access to communication device and wireless connectivity) to ensure the • Enhancing resilience against climate-related continued provision of primary care and close impacts and their effects (such as electricity last-mile delivery gaps disruption) on health facilities that render non- COVID-19 services • Improving the efficiency of care pathways to ensure health provision, reduce emissions, and • Strengthening health financing mechanisms that save costs ensure universal coverage to people with COVID-19 and other non-COVID-19 conditions, including • Adopting low-carbon and energy-efficient climate-sensitive diseases technologies, as well as cooling practices, for health care provision • Training health workers on the detection and treatment of climate-related diseases, while • Strengthening the capacity to manage health managing COVID-19 care waste, using environmentally friendly and safe techniques • Building the mental health resilience of health staff and volunteers while responding to multiple crises, such as pandemics and climate change F. Non- • Promoting with consistency regular handwashing • Maximizing temporary improvements in Pharmaceutical and other personal hygiene practices to prevent air quality due to lockdowns by identifying Interventions COVID-19 and climate-related waterborne diseases long-term measures for reducing air pollution • Designing temporary shelters for victims of climate- • Promoting healthy, low-carbon, and COVID- related disasters to ensure the continuation of compliant environments, travel, and lifestyles physical-distancing measures 6 | COVID-19 and Climate-Smart Healthcare • Creating social protection programs informed by high-risk communities that can enable them to adapt to different forms of external shocks, such as pandemics and climate-related disasters G. Public • Developing integrated, robust, and cross-sectoral • Transitioning to low-carbon and energy- Health Risk risk-communication plans and channels that can be efficient electronic systems for public Communication applied to all types of external shocks, including information dissemination pandemics and climate-related disasters • Incorporating health promotion messages into • Incorporating relevant climate change and COVID-19 advisories to encourage healthy environmental sustainability messages into and low-carbon lifestyles, while surviving the COVID-19 advisories to convey links between pandemic climate change and COVID-19 • Targeting COVID-19 communication containing climate-relevant information at populations vulnerable to climate-related disasters and other health effects • Raising the health, climate, and risk literacy of communities to enable them to prepare for and adapt to future external shocks and stresses H. Vaccine • Increasing the capacity of the health workforce for • Setting up energy-efficient, climate-friendly Readiness, vaccine delivery for COVID-19 and other climate- cold chain infrastructure, technology, storage, Procurement, and sensitive diseases and distribution Distribution • Putting national COVID-19 vaccine plans in place to • Establishing vaccine manufacturing that is provide a template for enhancing vaccine coverage powered by renewable energy for climate-sensitive infectious diseases • Using medical equipment and packaging made out of sustainable and recyclable or reusable materials • Adopting fuel-efficient modes of transport to deliver vaccines to health facilities and communities • Instituting environmentally-friendly management, recycling, and disposal of used syringes and other waste from immunization programs I. Building Back • Investing in essential services, such as clean water • Decarbonizing of health care systems and Better and sanitation, as well as water, sanitation, and aligning the sector with the ambition of the hygiene (WASH) in health care facilities, to uplift the Paris Agreement baseline health status of populations • Accelerating the shift from fossil fuel-based • Investing in climate-resilient health care electricity generation to clean renewable infrastructure to build multifaceted resilience energy that is resistant to future shocks • Revitalizing the momentum toward achieving • Investing in low-carbon, healthy, and equitable universal health coverage (UHC) to protect citizens transport systems that ensure human mobility from future health shocks during crisis situations when fuel supplies are disrupted • Investing in nature-based solutions to enhance the natural environment and protect communities from • Transitioning to sustainable agricultural climate-related shocks and future pandemics systems that also provide steady and equitable supplies of nutritious food to communities Executive Summary | 7 REFERENCES World Bank. 2017. Climate Smart Healthcare: Low Carbon and Resilience Strategies for the Health Sector. Washington, DC: World Bank. http://documents1.worldbank.org/curated/en/322251495434571418/ pdf/113572-WP-PUBLIC-FINAL-WBG-Climate-smart-Healthcare-002. pdf. World Bank. 2020. “Project Paper on a Proposed Additional Financing to the COVID-19 Strategic Preparedness and Response Program Using the Multiphase Programmatic Approach (Global COVID-19 MPA).” Washington, DC: World Bank. http://documents1.worldbank.org/curated/en/882781602861047266/ pdf/World-COVID-19-Strategic-Preparedness-and-Response-Pro- gram-SPRP-using-the-Multiphase-Programmatic-Approach-MPA-Pro- ject-Additional-Financing.pdf. CLIMATE INVESTMENT FUNDS 8 | COVID-19 and Climate-Smart Healthcare