The CommonHealth Live! with Dr. Vanessa Kerry and Minister Austin Demby

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This transcript is from a CSIS event hosted on February 29, 2024. Watch the full video here.

Julie Gerberding: Welcome to CommonHealth Live! Today, we’re going to be discussing climate change and health.

 Welcome. I’m Julie Gerberding, the president and CEO of the Foundation for the NIH, and also the co-chair of the CSIS Bipartisan Alliance for Global Health Security.

I’m joined today by two fantastic panelists, first, the WHO special envoy for climate change and health Vanessa Kerry and also the minister of health of Sierra Leone Austin Demby. Welcome to my guests and I really hope we can have a productive and candid conversation on this important topic.

You know, people understand the importance of climate change but they don’t always understand the health consequences or the predicted health consequences of climate change. So why don’t we start by just kind of setting the stage and talking about, first, the direct consequences and then some of the indirect consequences that we are pretty confident will be the ripple effect after all this?

So let me start with you, Vanessa, and just kind of level set what are we worrying about here in the health space?

Vanessa Kerry: Well, thank you very much for this conversation and the only way to be as candid and productive in this moment in time. So I appreciate – I’m all in for that and I’m sure the honorable minister is, too. And thank you to CSIS for having this conversation because I think the climate crisis is most fundamentally a health crisis.

I mean, we always talk about climate change in terms of degrees Celsius and sort of greenhouse gases, and those are critically important because that is one step in what we’re feeling.

But at the end of the day, we’re really talking about lives being impacted, people’s health and well-being, and we’re talking about lives getting cut short by what’s happening through the direct impacts of climate change and the indirect as well.

Already over half the world is vulnerable to the impacts of climate change in what’s happening. Most of those vulnerabilities are happening in areas that are the least contributing to climate change but have the least amount of resources with which to respond, to adapt, to build the resilience they need, and we’ll hear about that in a moment in a little bit more detail.

But what it really means is that we’re seeing very, very clearly the impact of climate change on human health. The new estimates are that there is going to be 14.5 million excess deaths from climate change coming in the next 20 years just directly from what’s happening and the impacts are seen through extreme weather, extreme heat like we’ve experienced around the globe. Last year was the hottest year in history that we have seen and it is also the year that we finally crossed the 1.5 degree threshold that we’re supposed to be bound to by Paris.

And so then what we’ve seen is wildfires in Maui and Canada and Europe. We’ve seen extreme heat and drought around places in the world. Zambia, which is in sub-Saharan Africa, has just declared an emergency, you know, for the country around drought that is impacting it. The Horn of Africa is being impacted by that, a hundred and twenty million population being hit and that’s resulting, you know, in malnutrition and aspects there.

We’re seeing rises in noncommunicable disease and death from noncommunicable disease. We are seeing it in mental health. We are seeing it in trauma from floods. We’re seeing it in vector-borne diseases. We’re seeing it across the board. So directly human health is being impacted.

We’re also seeing the indirect impacts. You know, talk about drought and food security. If you don’t have food you can’t grow and thrive. Childhood stunting has a lifelong impact across, you know, for being socioeconomically disadvantaged throughout your lifetime.

We’re seeing economic impacts on a household. A quarter of households that have noncommunicable disease will face catastrophic costs that could drop them below the poverty line. So this is really real for households but it’s also real on a macroeconomic level for governments and for countries where you don’t have a healthy labor force, you aren’t able to grow your GDP, and you see really real impacts.

And, finally, I would add it’s insecurity. We’re speaking of 1.2 billion climate migrants by 2050. We’re already feeling the pressure of migration. You look at the numbers passing through the Darien Gap in South America right now to Central America, it’s done an exponential inflection upwards. So this is really a crisis.

And I guess the final point I would end on is that we see it in poverty, for example, too. There (should be ?) 132 million people driven into poverty from climate change. A third of those are actually going to be related to health problems.

So this is an incredibly real crisis that we’re facing that is impacting human lives, impacting human well-being, and whether it’s in the United States across communities or whether it’s in Sierra Leone where Minister Demby is we’re all shared in our challenges.

I think that the resources we have and the types of challenges might be variably different in some senses but the fundamental big picture is that we are dying from climate change.

Dr. Gerberding: Well, we’re going to come back to that crisis that you mentioned. But I will, of course, be asking why don’t we experience it as a crisis because I don’t think many people really appreciate the severity of the problem that we’re facing.

But let me turn to Sierra Leone and ask the Minister Austin, you know, here you are in a country that arguably has one of the smallest carbon footprints in the world and yet you will experience predictably one of the largest impacts of climate change in your country.

How do you see the threats and what are you most worried about in that context?

Minister Austin Demby: Well, thank you very much, Julie and Vanessa, and CSIS for hosting this really important event.

I think this has a special meaning for us in Sierra Leone. Sierra Leone faces unique challenges. We’re grappling with unique weather events be it heat waves, droughts, wildfires, and floods.

As you know we had an 11-year civil war in Sierra Leone and the challenges with that is that we struggled quite a bit. The population moved very, very closely to the coastal areas, and we had major population increases, from half a million people to over 2 million people, on the coast of Sierra Leone. And these people were, like, literally living on the ocean and eking the mangrove swamps and getting closer and closer in to the ocean itself, which creates incredible vulnerabilities.

Firewood is critically important. So they were denuding the hillsides to get firewood for their regular cooking, and one evening in 2017 we had a major landslide and in one evening alone over 1,000 people died.

For us climate change is real. We see it every day and it’s impacting us, like, drastically.


Dr. Gerberding: It is a tragedy. I also am aware that at baseline before the worst climate changes are really apparent that malaria was one of the leading causes of mortality in Sierra Leone and I can’t help but think that that will be exacerbated as well as you see these very dynamic changes in weather patterns and the vector distribution will no doubt be influenced. Not to mention access to treatment, sort of the indirect effects that we were talking about earlier. People are unable to receive the therapy or the bed nets and the other interventions that would help protect them.

Are you planning for that or, you know, is there progress being made to anticipate these difficulties?

Dr. Demby: I mean, just we’re really, really concerned about the malaria rates. In the provinces we have erratic rainfalls, unpredictable rainfalls, extended rainy seasons, and water puddles all over. The mosquito population has rocketed, the associated malaria rates are extremely high, and we expect mortality to also increase.

But I think, fortunately, as part of our effort at adaptation this year, fortunately, we’ve bought several million doses of malaria – the new malaria vaccine. We have about 5 million bed nets that we’re beginning to distribute. It’s a big challenge and, you know, even cases like Lassa fever are increasing considerably because the rodents are moving much, much closer into living populations.

And so all of these malaria like illnesses, all of these vector-borne diseases, are skyrocketing and they are going to increase even more. And so we’re doing all we can to look at mitigation. It’s a very, very challenging environment. We’re looking at adaptation. It’s also really a critical challenge for us.

Dr. Gerberding: So, Vanessa, he was just describing the importance of a distribution system for bed nets, for vaccines, for this infrastructure of the health workforce. I know that’s a big theme of how we do prepare for this but it’s also a big theme of Seed Global Health that you lead.

So how are you thinking about workforce infrastructure and sort of the systemic solutions to these problems?

Dr. Kerry: I mean, the reason I got into the climate change and health space was because the work that we do at Seed Global Health, which focuses on training a health-care workforce to build out strong, resilient health systems that respond to the needs of the population, and we’ve been doing this for about a decade now.

We’ve trained over 47,000 doctors, nurses, and midwives and, you know, it’s a particular honor to be here with Minister Demby because we have the privilege of working with Minister Demby in Sierra Leone on maternal mortality and to really think about how through training – education and training we can transform health outcomes for the population.

Maternal mortality is also one of the leading killers in Sierra Leone and so being able to support the ministry’s plans across their lifecycle to really address the needs of the population is important. But what that is driven from is really vesting in the fundamental needs of a population, which is the same thing as the climate change and health argument.

So as we were doing our training in health-care workforce what we’ve seen is that climate change was making the work harder because there were bigger challenges. There was more diseases.

The malaria beds, you know, where we used to have one or two patients in a bed could surge to six in a bed because of the numbers of cases we’re seeing now from rainfall, changes in patterns and things like that.

We have seen disruption of services in Malawi, a country where we work. You know, we’ve seen disruption of services from extreme weather that have washed bridges out to maternal centers and women couldn’t get access to services and, again, we see the health-care workforce coming front and center.

Chancy Banda, who is a nurse midwife in Malawi, became an advocate for the need to build new health centers that women could deliver at and it was through her advocacy partnering with the government that we were able to help staff and to build up a workforce in those centers so that no lives were lost in the five months those centers had to be utilized in the wake of the cyclone and the climate change.

And so the work that we’ve always been advocating that workforce is the front and center of a strong health system because they can advocate for what is needed, where the financing should go, the technology that is required, the drug products, they are the biggest sort of ability to organize everybody around what is needed to save patients’ lives and that’s the same in the climate change argument.

We are going to need a health care – we already have a critical shortage of health-care workers. We’re going to need more, well distributed, prepared, educated, and ready for the challenges that we’re seeing in climate change and the growing burdens of disease that we’re going to see or health systems are going to fall even farther behind.

But I think people make the mistake far too often of saying that there’s the climate argument and there’s the health argument and they’re in competition or they shouldn’t be confused. But they should be – it’s not a confusion. The reality is we need strong health systems to address what’s coming down the pipeline for climate change.

We need strong health systems with clean, accessible steady energy to support the health systems. We also need that to mitigate the health systems’ contribution to climate change, and it turns out we actually can solve many problems at once if we stop parsing them into vertical definitions and understand that we need a health system that is responsive to the health needs of a community where the community is based and to be able to deliver high-quality services to meet those needs.

If we do that we can address the burdens of disease from climate change. We can save lives and build a healthy workforce. We can create the tax base that countries need to be able to grow their GDPs and to have a healthy labor market that can attract private investment.

We can also treat HIV, TB, and malaria. We can also address mental health. We can address all of these things if we’re very – if we’re thoughtful about prioritizing prevention, primary care, strong health systems, and thinking about these not as different things in competition but one solution for multiple problems.

And I think that that’s the work that we have already started to see at Seed. It is the power, I think, of investing in workforce and I think it’s actually the opportunity that this crisis presents.

Every crisis is an opportunity and I think we can be very proactive about accelerating our response to solve the problems we’ve known existed for a long time but we also know are about to magnify, coming down the pipeline.

Dr. Gerberding: You’re making one of the most cogent arguments for the importance of the horizontal integration of programs, not to abandon the vertical systems that are targeting specific high-priority problems, like you said, maternal mortality or malaria or whatever the Health Ministry’s priority is but, nevertheless, the multifunctional health system really is the foundation for all kinds of health improvements, and the debate shouldn’t be an either/or. I think it should really be an and.

So I’m really glad that that’s part of the thinking that you’re bringing to this overall effort.

We had an important meeting recently, the U.N. Framework Convention on Climate Change Conference of the Parties, otherwise known, fortunately, affectionately, as COP-28, being the 28th version of the Assembly on Climate Change.

But what was remarkable about this particular meeting was the first time that there was a health day when there was the concerted effort to focus on the health consequences of climate change, and a number of things happened in that conversation including a declaration.

So walk us through what you like about the declaration and then I’ll ask you what are the areas of the declaration that you hope might be strengthened in some way.

Dr. Kerry: COP-28 was incredibly exciting because it did dedicate a first ever day of health and that really reflects the climate and health community’s long hard work for years and I think to really position this and the WHO’s incredible work to get this prioritized and to help position this conversation front and center in a – you know, in the climate response conversation.

What was exciting was it was the first ever day of health. It fell on the third day of COP right after the two high-level political days. It was the first thematic day so it really kind of presented itself as mission critical.

It had strong leadership from the COP presidency of the UAE government. They were very devoted to making sure that this subject was carried forth. It came on the heels of the historic loss and damage announcement that there’d be a loss and damage fund.

It had the first ever climate and health ministerial with over a hundred and ten ministries of health represented at a COP. Previously, the record had been three so that’s a big change, and it was exciting to see, you know, that there was a declaration itself, which I think that, you know, 148-plus countries have signed on to, which is a big statement –

Dr. Gerberding: Including the U.S.

Dr. Kerry: Including the U.S., including China, including Brazil, some big countries that, you know, really could participate in this.

So that was exciting, and there was one – you know, big funding announcements that came forth. There was 1 billion (dollars) pledged to climate and health, 770 million (dollars) to neglected tropical diseases from the Reaching the Last Mile.

So you started to see momentum really come out of it. I think though, again, we’ll choose to see this through opportunities. You know, the climate and health declaration was imperfect. It did not include the word fossil fuels, and yet fossil fuels actually came out of the whole COP as a critical term for being responsible for climate change.

So there’s an opportunity for us as the health community to get stronger on the fossil fuels and the reality that there – we are not going to save those lives unless we see a phase out from fossil fuel use and we need to be strong that that’s the number-one piece.

The 1 billion (dollars) in climate and financing that was pledged over 800 million (dollars) of it is already pre-pledged, pre-earmarked, and kind of got bundled into that announcement. So there isn’t as much funding as there needs to be.

So the second thing is we really do need more and new flexible financing that can be available to countries to be plugged into their priorities and to be able to really build the responses we need especially in adaptation and resilience because the majority of the funding has been going to the mitigation side, and we need both.

It’s not an and/or. It’s a both. But it is going to be important that we mobilize more funding because whether you like it or not climate change is happening. We have to adapt and we have to be ready to be resilient against the shocks.

And so I think the second opportunity is to do sort of more financing, and I think the third opportunity also related to financing, though, is to really double down into how that financing is mobilized because, unfortunately, a loss and damage fund is years away from being actualized and being available.

And, you know, one of your colleagues, Minister Demby, reached out to me right after and said, “How do I get that money?” And I think that’s exactly the question, right – how are countries going to access this money.

And then I would say the final opportunity is to change our metrics, right, to really build climate and health into our metrics within the global stock take, build in more detailed metrics into the national – the determined contributions of countries and also to make sure that we are studying the interventions that we’re doing and seeing how they work, learning from them, reiterating and making sure that we’re measuring things, not just in degrees Celsius, right, but in lives saved and starting to really shift our thinking and opportunity there. So –

Dr. Gerberding: Let me push just a little bit on a piece that I think you mentioned earlier today and that was the accountability, that people don’t always understand that a declaration isn’t actually –

Dr. Kerry: Oh, I love that.

Dr. Gerberding: – isn’t actually an accountability document. So, you know, how are we going to get to the point where we’re beyond rhetoric and we’re really getting serious about what needs to happen and who’s going to do what?

Dr. Kerry: So I’ll answer the first part of this question and then I’m going to ask Minister Demby to weigh in too through both your, you know, really robust and diverse roles that you’ve played throughout time but also what you would want as a minister of health from Sierra Leone to help create accountability to the international community for this moment to be in service to the priorities of your country and sort of – and this world.

So my issue with the declaration is that it was a watered down document. Again, no fossil fuels and, again, there were no targets. There were no real metrics. There was no description beyond we need just transitions.

There wasn’t really creating a framework of accountability for how the funding or how we’re going to rise to this moment and be in service to those that are most vulnerable in the world and are contributing the least and are – and so that needed to be articulated more within the funding conversations overall at COP that also needed to be articulated, right?

So we talk about raising the billion (dollars) in funding but, again – or, you know, phasing out or transition fossil fuels but there’s no timeline on that. It’s not who is transitioning faster and is in the strongest position to transition, who needs more time to transition because they actually rely on fossil fuels for development right now and then over time we’ll build out the – in energy systems and I think South Africa is a terrific example of that.

They got rid of fuel subsidies and they’ve tried to close down coal mines but nobody supported them to support the labor force through that moment. So it led to a huge amount of discontent and made a very economically difficult situation for the country.

Dr. Gerberding: And politically difficult.

Dr. Kerry: And politically difficult. So, sorry, economics and politics may go hand in hand but it’s a good distinction.

Dr. Gerberding: (Laughs.)

Dr. Kerry: So I think that there’s – so one of the things we tried to do with this – with the declaration was we actually asked countries to write 300-to-500-word addendums or annexes that could really outline their position, their call to action, their priorities, in a way that brought detail and life to the declaration so that of the hundred and forty-eight countries assigned it might be that a hundred and twenty have very strong, very bold, and progressive needed stances for meeting this moment of climate change and the 28 that were a little lukewarm and, you know, couldn’t get there are a little bit more declared or didn’t submit anything at all.

And the hope is that we can help push momentum through some of that detail and by making some of that available and, you know, we’re grateful to partner with countries like Sierra Leone and Uganda, Malawi, Zambia where Seed works and other countries to help think through how to make those strong stands and that big call to action on the international level.

But if I can, this accountability question is a thorny one because there are the countries that hold the money and the countries that hold power or the markets that tend to dictate the agenda, and they’re the countries that are trying to really meet their priorities and don’t necessarily have the same amount of resources for adaptation and resilience that are more vulnerable to some of this dynamic.

And, you know, if I may, Minister Demby, I’d love to ask you a little bit how do you see accountability in this moment in this international sphere? You’ve worked for – you know, you’ve had the privilege of working for multiple governments and have seen this on both sides and I’m curious to hear, you know, how an international community can rise to this occasion or how the U.S. government can rise to this occasion as they’re thinking through their strategy.

Dr. Demby: Well, thank you very much, Julie.

Again, I am really excited. I think COP-28 was one of the most exciting moments for us in Sierra Leone to talk about commitment. Sierra Leone was one of the few countries that actually put up half a million dollars of our meager resources towards neglected tropical diseases as our own contribution to the $777 million that was raised.

We’re really quite proud of that. It shows our commitment to it. I think, clearly, having the whole world gather and have a health day when usually all of the conversation is around carbon sequestration and whatever all this fancy economic jingle that goes on to be able to focus on health – how does all of this boil down to impact on individuals’ health and communities’ health and nations’ health – was really quite powerful for us.

We walked out of there with a bold internal commitment from Sierra Leone. We said we were going to go green for health – we’re going to go a hundred percent green for health and we’re looking at – I mean, we’re not doing a lot of contributing to greenhouse gases but I think what we’re looking at is how do we look at energy solutions that would help the health sector contribute a little bit to the solution, on the one hand, but really build resilience as well.

You have situations here now where we are making some tremendous gains around reducing maternal mortality. We’re making some tremendous gains around reducing infant mortality. But, clearly, one of our biggest challenges is energy.

You know, all of the hospitals we cannot rely on power and the grid. When the baby wants to come the baby wants to come. When the mother is or, you know, a sick person wants to breathe oxygen they want to breathe oxygen. They really don’t care about what the source of the energy is.

It turns out for some of the hospitals listed 20 percent and 30 percent of their budget is expended on getting diesel to run these generators, and so what we’ve done is to completely work towards getting rid of all of the diesel power generators in our hospitals and our health facilities and go green.

We have 1,600 facilities in the country. We are hoping that – right now 85 percent of the population has a health facility within a five kilometer radius. We’re trying to see if we could expand that 1,600 to 2,000 facilities and this time ensure that every facility has solar solutions for them.

The solar solutions will address the electricity and ensuring that women no longer deliver in the dark, that children have an opportunity to have clean air and be able to have the equipment for the nebulizers for them to breathe properly. And we want to be sure that as communities – riverine communities get cut off in the rainy season or when you have floods that we have redundancies built in and we’re focusing on renewable energy.

Right now we’ve just provided solar solutions for 18 – sorry, for six major hospitals. We have funding for 11 additional hospitals. We have funding for 200 primary health-care units and we’re looking to aggressively over the next five years completely transition from fossil fuels into renewable energy for all of Sierra Leone’s medical facilities. That’s our commitment.

Dr. Gerberding: I think we need to have a recording of what you just said because it really is – it epitomizes why this is such a valuable approach. Thus, we may be thinking about solving a climate change problem but everything you just said has multiple values.

It will reduce infant mortality, maternal mortality. Children will have cleaner air. You know, the hospital systems will work better. You’re bringing training to your workforce. We may be trying to solve a climate change problem but the value of that investment far exceeds the impact on climate change per se. It’s going to really, as you said, transform your whole health system.

And I think that’s the hard argument. You’ve argued for paying for the prevention, that if we invest now we can save so much more in the future, you know, by 2050 and what you’re describing is exactly that – investing now, building these hospitals, training this workforce so that you have the resilience to really be able to respond.

But that argument is not penetrating in very many places yet. So as the envoy how will you help get his story to the other health ministers and the other people who are the partners who need to support the financing and the implementation of all of this?

Dr. Kerry: It’s a great question and I think there is certainly an opportunity to –you know, and I – there’s an opportunity to be able to gather these stories and I think that one of the challenges is Minister Demby and his team are doing this extraordinary work, and then you ask them to disseminate it and to take the time. You know, that’s – it’s hard to find the time and the ability to get some of these stories out.

So that’s one of the places that, certainly, in this role we can partner is to help ensure that those examples are put out there and are both studied and understood but also are told in a full way and I think that, you know, the role of the envoy I think is going to be able to very much ideally being complement to the WHO and a complement to our partners to help bring to certain platforms these terrific examples and also what the continued needs and challenges are, and also to help think through, frankly, what are the questions that need to be answered and to help see if we can drive some of the research and some of the pieces to answer those questions for our partners in a way then that are actionable, can be funded, and can then support what the priorities are and to help shift some of that thinking.

Because right now a lot of research questions often get driven by the interests of the researcher, not actually to problem solve for the communities that we’re in service to, and I think that’s a huge opportunity to think about.

And I think another opportunity is to think about the framing of the argument, right? So we talk about climate and we talk about – I wish health were a sexy and interesting topic to people. I really do because then it’d be a lot easier to fund and get these things done.

But the truth is I feel like we are constantly clamoring for health to be invested in. It’s like education, too. Yet, health and education are the two most fundamental things and tools and kind of requirements for people to go out in this life and to thrive and to take care of their families and to achieve their goals, and we don’t treat it that way and we don’t invest in it that way.

So what are we motivated by that will start to change the game so that health has a higher primacy? And I think if we can think about what will drive some of these private sector – the funding flows, people – governments to prioritize health and to not see it as a cost but to see it as an investment the way Sierra Leone is and to shift what that looks like then I think, you know, that can be hopefully a role that can – I can help play because I do think what we’re fighting for right now is very much an economic argument, a security argument.

Mia Mottley said at COP-28 when she was addressing – you know, in the climate and health session on day two she pointed out that for every dollar we invest in kind of building and adaptation we would save seven (dollars) in loss and damage.

Translated to coastal communities where there’s a lot of flooding in lower resource settings, if we spent 1 billion (dollars) preventatively for adaptation to coastal flooding we would say 14 billion (dollars) in loss and damage outcomes in coastal flashes, coastal flooding.

That’s not even looking at the health piece, which is there’s 800,000 additional cases of hypertension in those communities that are going to need to be treated and managed that is going to cost billions to treat, and I think that that’s one of the things we have to start to translate is that if we can invest upfront now we will save trillions on the back end in costs.

The problem is a lot of people don’t want invest now for something that feels a lot farther down the road so one of the things I think we have to answer and one of the core questions we’re going to have to get into is what’s the immediate return on investment and how do we quantify that in a way that is attractive to politicians you want to get elected to, you know, private sector businesses that have the money but need to see investing in health as a cost of doing business, to governments who are constantly battling, you know, what their domestic budget is going to go to and it’s hard to justify health when you’re trying to build roads to attract private sector investment that feels like it’s going to have a huge promise.

So I’m very appreciative, for example, what Sierra Leone has done because if you start to create that clean energy grid, right, that you’re in service to the hospitals but that also can be used for other things, then you start to shift the whole equation in a way that hopefully you’re solving for many problems at once. But –

Dr. Gerberding: So if you – I know you’re talking to a lot of people as you explore and learn, you know, how to have the biggest impact in this role. Do you think – in the United States do you think that people understand how climate change is affecting them or their health in particular?

Dr. Kerry: I think the health is a different question. I think people are feeling the impacts of climate change around this country everywhere. Phoenix, Arizona, lived above 110 degrees for 31 straight days. People are losing their homes to flooding. They’re losing their homes to high winds. They are feeling the impacts of climate change across the board. California is now inundated by rain nonstop.

Dr. Gerberding: Wildfires.

Dr. Kerry: Wildfires are happening in Maui, elsewhere, you know, around the U.S. and in the West. I mean, New York was living in an orange cloud. More people wore masks from the wildfires in Canada than I think they did in COVID.

So I think people are definitely feeling climate change. Republicans are now saying, you know, that climate change is real. I think the question now is what do we do about the human health aspect I think is a little bit harder and I think we as a health community can do a better job.

I’m a physician, you know, at my core. We can do a better job of, one, we need to get educated on how our patients are being impacted by climate change but then we need to think about how we can help prepare our patients for climate change.

What do you do if you have a child living at home with a disability that relies on electricity for a monitor and the electricity goes out because it’s a heat blackout, right, and you lose it? That’s very damaging for that child, for the family, for everybody.

We see a rise of emergency room visits in communities that have fossil fuel-burning buses than communities that are on electric buses, and so how do we bring that data forth so communities can actually understand how their health is being impacted by this and start to demand a different way of doing business.

Dr. Gerberding: Well, in a sense, we have to connect the dots, right, because attribution – like, what proportion of the asthma visits in the emergency room can you attribute to the Canadian wildfires and how do you really – how do you really make those kinds of models and estimates? It can be done.

I’m just got sure that we’ve really put that as a priority research area but we need to. We need to really be able to clearly connect the dots between what’s going on with our weather and our climate and how it is changing the profile of people’s health issues. You know –

Dr. Demby: May I jump in there at some point?

Dr. Gerberding: Yeah, please.

Dr. Demby: So I think this is a really opportune moment for us in Sierra Leone. In spite of all of the odds I think we’ve got a lot of support from Seed Global. I think, Vanessa, in your new role here as the climate envoy for health, you know, I think we’re struggling a bit in Sierra Leone to tackle these things. Sierra Leone is a small country of 7 ½, 8 million people. It’s a round country. And we’re doing some really exciting things.

But it’s like a tree falling in the forest. Like, nobody hears it and, you know, it didn’t happen. So what we’re looking for is look for opportunities to be able to showcase what we’re doing here and to see how this is impacting and changing health outcomes. That’s our focus.

So I think partnering with you, Vanessa, and being able to shine the spotlight on what we’re trying to do and get some additional assistance to us to be able to really expand on what we’re doing. What we’re showing is proof of concept and we want that to be documented enough to show the rest of the world what is possible with some commitment.

So again, I saw this forum as an opportunity to share that and I think also just using the bully pulpit of your role as the climate and health envoy to see what’s possible in a country like Sierra Leone.

Dr. Kerry: Yeah, I really appreciate that and that’s exactly – you know, I feel very committed to doing that so and would love to partner on that and I think that that is one of the things that I’m thinking very actively about is also how do we really take those examples and bring them forth and how do we magnify the examples of some of your colleagues that are also doing this.

And I think – so just to know you have my commitment. So we will do this and that is the important opportunity and, you know, one of the things I can do also as I speak, right, is to ensure that Minister Demby, you know, and opportunities are also brought forth.

That’s been a big commitment of Seed Global Health and a big commitment in me as the special envoy is to make sure that the voices of those that are doing the work, that understand the opportunity, and can really showcase what’s possible are being brought to these fora because, frankly, for far too long a lot of these foras have been dominated by those that can get there or those that are organizing it, you know.

And I was in Davos earlier this year and you look at who’s there supposedly talking about the economic world order and it’s grossly weighted to one particular group of – or groups – a few groups of people and not actually being represented enough by those that are really being exploited by some of the global economic ecosystem that we live in today.

And so I think that that is certainly one of the things that is a huge opportunity and I appreciate your raising that as well, Minister.

Dr. Gerberding: You know, talking a little bit about what do we need to know in order to really get this story told, and storytelling is going to be critical because that’s ultimately where we engage people’s emotions and motivate action.

But we also need data, right? So you’ve already mentioned, you know, really being able to create an attributable estimate of the impact that climate change is having on health in different populations.

What are some of the other things that you wish we knew now that we really need to get the research or the data together to help get this information packaged in a way that motivates policy action and investment?

Dr. Kerry: I think we’re still playing catch up on the data, to be honest. I mean, the WHO, unfortunately, still has 250,000 additional deaths, you know, that we’re going to see between now and 2050 which is, you know, or – I mean, a year – sorry, a year, you know, in the March of 2050 base case, with, like – that’s a –

Dr. Gerberding: No intervention, yeah.

Dr. Kerry: That data’s incredibly old. They’ll be the first to tell you that data’s incredibly old and needs to be updated. The World Economic Forum just came up with a new number, 14.5 million deaths by 2050, which is more than 600,000 deaths a year.

So it’s over double what the WHO had. But the truth is I think that’s still an underestimation. To your point earlier, the attribution science isn’t there in a way that we’re not actually really documenting I think accurately enough who is actually dying from climate change.

There’s a movement in Australia right now to be able to put climate change on a death certificate in a more accountable way so that we can start to track this data a little bit differently.

So I think that we have to understand truly how we’re being impacted and quantifying that full degree in which health is being impacted by climate change right now. I think we need to be able to also understand how it’s really impacting communities in detail. We tend not to do our – we do our research on a much more macro level.

But our ability to come up with solutions is going to be to really understand how it’s impacting different communities and then to study also how those solutions are working so that these pilot cases that the honorable minister is doing in Sierra Leone as they work to tell that story of success and of learning so that other people can pilot them quickly they’re not reinventing the wheel and we can try to get to scale faster, and so I think that there’s a real need for that research as well.

Dr. Gerberding: In a sense, it’s implementation research, right?

Dr. Kerry: Implementation and translation.

Dr. Gerberding: It’s so easy to let inertia be the barrier to really taking the steps and making the investments. But if you have good evidence that a particular intervention actually will derive the outcome you’re looking for it’s a little bit harder to ignore it.

Dr. Kerry: I think that’s true, and I think the other place we have to do a better job is translating the economic arguments – what is the immediate economic return on investment or what are the economic returns in communities and what are the costs because I think that will be very helpful.

Understanding how the – I think the private sector is probably already doing this data – they’re not sharing it – but how their markets are being impacted, how their pipelines are being impacted, because I think that will help motivate the private sector to take a different and more proactive stance in this space.

And then I would say the security. We have big numbers on migration but we have not done a great job and there is some work going on this that I’m learning about now but I think that really understanding in detail the ways that our human security on an individual, community, national, global level are being impacted by the climate and health space is also an area that could really be deeply explored because we don’t, I think, have a real sense.

And there’s some studies happening in places that are looking very actively at migration as a form of adaptation but where people are migrating to, the pressures that are putting on communities, on health systems, that hasn’t been detailed, I think, yet in full.

Dr. Gerberding: Where do you think the private sector is in all of this, and I don’t just mean the pharma sector or the – you know, the medical supply chain sector. But, broadly speaking, the private sector has tremendous risk but also tremendous opportunity and, in a sense, a tremendous responsibility to be providing more leadership in these areas.

And, you know, we hear about great companies that are really going green like Sierra Leone is really going green. But what does that really mean in the denominator sense? How are we getting that piece of the action mobilized?

And part of the reason I ask that because eventually in building the response to AIDS in PEPFAR when the private sector actually got mobilized things moved a lot faster and investments were made at a higher level of scale.

Dr. Kerry: Well, now, I think the private sector is going to be critical partners in this space because they are, to your point, going to help get to scale. They’re going to help drive the funding and kind of the investments that are going to be needed to accelerate this process.

The private sector to date in the climate and health space has primarily been in the mitigation, the health sector’s contribution to climate change. The United States 10 percent of green is – the health sector is responsible for 10 percent of greenhouse gases. Globally on average health sectors are responsible for 5 percent of greenhouse gases. About 50 percent of that is actually the drug supply pipeline.

Dr. Gerberding: The chain.

Dr. Kerry: The chain and the production of drugs, the delivery of drugs. About 45 percent of that is the patient care pathway so delivering services to patients, and that’s mostly in, you know, industrial countries and about 5 percent of it is in the R&D pathway.

And so but that’s really looking at the mitigation side of things. There’s not been the same kind of investment in the adaptation and resilience and I think part of it is not understanding the ways that climate change is impacting the health of their workforce and impacting the health of their communities and their markets and so making that connection for the private sector is an opportunity.

I think that, you know, part of it is figuring out the arguments to be able to help this really be a cost of doing business in a way that folks can see the opportunity if they make these investments.

There are some private sector groups that I think are trying to think about this space a little bit differently and are starting to step into it either through their foundations or – you know, mainly through foundations I think it’s been so it still remains a philanthropic endeavor.

Foundation S is one such example, which is the foundation for Sanofi that has done this. GSK has been doing some philanthropy in this space from the pharma sector. Philips is looking at opportunities in this.

But the adaptation and, I think, resilience space is less understood as a sort of cost of doing business and I think that is the opportunity.

Dr. Gerberding: I think, though, that it is emerging in more and more risk registries at a corporate C suite level because of the supply chain disruptions and, you know, the flow of goods and services we’ve seen in the pharmaceutical space, what happens when a plant’s in the fire zone and then suddenly we don’t have a supply of drugs.

We saw the hurricane devastation in Puerto Rico and what that did to a whole set of businesses that had a great deal of manufacturing activity there. So it’s starting to creep in as a real threat to the economic model of the business and I’m not sure it’s causing investment – capital allocation changes yet but I think people are thinking a little bit differently about continuity of operations in the context of chaotic weather.

They may not be looking end to end in terms of the full spectrum of what they could be doing but the consciousness is – at least from my view I think it’s increasing.

Dr. Kerry: It certainly is, and I think from that standpoint, but I think what that’s not necessarily translating into is how that relates. So maybe for a supply chain of drugs or things like that they’re looking at it but I think the opportunity to be thinking about what strong resilient health systems is as a means of adaptation to climate change to protect human health is not yet really on the radars of the private sector in the same way.

And yet I would think that, you know – and that’s the challenge that we have to close.

Dr. Gerberding: Yeah. I think I was thinking, broadly, about business continuity, not necessarily about the health connection.

Dr. Kerry: Yeah. Mmm hmm. Yeah.

Dr. Gerberding: But I get that. And you’re right; I think the foundation sort of ESG framework is probably where most of the action in the latter space is going.

You know, in addition to thinking about the private sector we want to think about the government sector and the policymakers and, you know, we’re here at CSIS which is arguably one of the most important resources for evidence-based policy recommendations and, you know, advice in Washington.

We’re operating under the umbrella of the Bipartisan Alliance for Global Health Security and we want to help you. We, you know, recognize that biosecurity, global health security in the sense of infectious disease threats, et cetera, is not the same thing necessarily as climate change and health but there is an awful lot of interrelatedness here.

So, first of all, I’d love to hear your impressions about that interrelatedness from your perspective as the envoy but also from the perspective of Sierra Leone where, you know, you also have bio threats. You certainly went through the Ebola situation, the crisis there in 2014-2016.

So biosecurity has to be a very important part of your role and at the same time we’re talking about climate change and health here. So what’s the intersection and how do we think about that from the standpoint of giving really clear messages to policymakers about how to prioritize or where to invest?

Dr. Kerry: I think that – you know, and I – very much when Mr. Demby answered this too I think that the reality is that climate change is changing habitats. It is changing our movement of people.

It is changing our interaction with our environment in a way that we are – you know, when you think about the source of bio threats and the source of sort of pandemics and you think about the source of outbreaks and things like that it’s often because we are crossing into habitats and places that we haven’t already been.

Dr. Gerberding: Incursion.

Dr. Kerry: Right. And there’s the migration also of people that are being driven and when you have disruption of communities and you have migration of people, the loss of the health services, there’s also the potential for disease movement. I mean, we’re seeing cholera in Lebanon that originated in Yemen and we’re seeing cholera in Malawi that – Zambia that originated also in –

Dr. Gerberding: In Haiti and Nepal. (Laughs.)

Dr. Kerry: In Haiti and Nepal. So we’re seeing huge examples of where outbreaks are being moved through people or being moved through ruptures in health systems and so climate change is creating a lot of that disruption and is changing habitats and is driving vector-borne diseases in a way that we are seeing increases in disease and we’re seeing, you know, we’re going to lose 9 billion (dollars) in GDP just from dengue now, you know, because of its expansion into new territories and new communities that aren’t used to seeing it and don’t know how to deal with it and health systems that aren’t prepared for it.

And so this is very much a security threat on a number of levels – climate change – and it is the disruption of water, it’s the disruption of habitats, it’s the movement of people, and it is the drive of disease that is going to be a threat.

Now, it can either be an outbreak threat from biosecurity or it can be the fact that you’re just going to have rising burdens of noncommunicable disease that cost trillions to treat and take – and or last over a lifetime, you know, or a second half of a lifetime. That can be really costly to communities. That can be a problem. Loss of productivity is going to be a problem.

If we – if all of our manufacturing plants for biodefense are in the South of the United States and the heat is going way, way up and people can’t show up to work or it’s putting stress on generators and systems everything gets imperiled.

I just heard a story earlier today about the fact that, you know, apparently some of our nuclear system, you know, alarm or watch systems are in places where wildfires are now threatening it. So this is – you know, the threat to our security or our biosecurity is in any number of different ways.

I think it’s about – and so to me, again, this is an example of where all the arguments can come together and we can solve multiple problems through a similar solution.

Dr. Gerberding: I guess part of the question, and I do want to hear from the minister, but is how do you bring them together. You know, we have a parallel policy framework over here and we have a parallel policy framework over here but they really are part of the same overall situation.

So from, you know, policy, legislation, implementation, appropriation, how do you bring these things together? Because we want to help you. (Laughter.) We have a strong motivation to figure out how we might be able to be useful in that.

Dr. Kerry: I think part of it is creating that data and that argument that demonstrates those linkages. And then I think it becomes real door-to-door diplomacy, right, really engaging people who are in the positions who need to hear the perspective that is different from what they’ve understood, to see that opportunity and to convene those different groups together to find the common solution or to think of ways that they could bring this investment forth.

But I think it’s about framing the arguments in a way that brings together those different sectors. There’s a start bringing that data together and then make sure that those who need to hear the data who don’t know it, right, who maybe live in a security realm but don’t understand the health realm –

Dr. Gerberding: Or the vocabulary.

Dr. Kerry: – hear the health arguments and the vocabulary and kind of vice versa and to see if you can find someone who can be the real interlocutor to bring them together and to be the translator of those different languages.

You know, we’ve done this successfully. You know, we taught a course at Harvard Medical School and the Kennedy School for Government that brought together different partners – governments, pharma, private sector, and foundations and implementers – to sit in a room together and to understand the health security threat of disrupted health systems and how to protect them appropriately and that led to a number of totally novel partnerships to solve problems.

So sometimes it’s also about convening different groups and creating the opportunity for them to come together and discover they have the same problem. It’s just viewed in a different way, right?

This is my right hand. If you’re looking at the palm and I’m looking at the back we have incredibly different views but it’s the same hand, and I think it’s a little bit of helping people to flip the hand to understand it’s the same problem.

Dr. Gerberding: Do you agree with that, Austin?

Dr. Demby: Well, it’s just like music to my ears listening to you.

I’ll just – I want to invite you all to come to Sierra Leone and see what we’re doing there. We are looking at ways of addressing the adaptation and resilience issues. You know, we’ve had Ebola outbreaks. We’ve got COVID-19 that we managed really well. We’ve got Lassa fever. We’ve got multiple outbreaks here.

And so we have a wealth of experience in Sierra Leone. What has just happened recently is that we stood up a new national public health agency that’s focusing on power security.

Now, what we’re seeing is power security is not an island. Our posture on health security is overlain on public – with primary health care. Outbreaks start in the community; they end in the community. And so having a national public health agency that is completely interwoven with the primary health care – has FETP-trained staff who are out in the field, who are working on the malarias and the typhoids and all of the different infections out there, helping to analyze data, looking at the analytics, and looking at what’s unusual, what triggers an early response, that will allow us to contain the outbreak very, very quickly, a rapid response – it’s all being at play here.

What we also are doing is not only setting up these systems to collect the data; we’re looking at what do we do during quiet periods. When we have hot periods we are able to pull – CDC was able to mobilize about 1,500 staff to come to West Africa during the ’14-’15 outbreak. You don’t have 1,500 staff sitting there waiting for the next outbreak; they’re working on things. So what we want to do is to have this agency really be interwoven into the health-care system especially during the quiet periods to understand these things, to generate the data, to look at the analysis and look at attributions and look at causal factors and be able to bring that out and collate that information and increase the knowledge base around it.

So it’s incredible what’s going on. I think we’re putting into play the 42 years of experience working with CDC and working in this global space and really breaking the walls between health security and primary health care and I think we are really waiting to see when all this comes together. Actually, we’re coming to Washington in the next couple of weeks to talk to people around it.

But I think we have a really good model here that will start to generate the data, that will start to do the analytics, that will help us better understand these outbreaks even before they occur, and when they occur to detect them early and respond to them fast.

Dr. Gerberding: Well, that –

Dr. Demby: It is climate related – (inaudible) – we are anticipating that as well.

Dr. Gerberding: We are very fortunate to have your leadership in West Africa and we’ll do whatever we can to help relay your story and your example to other people who will be watching.

We just have a couple of minutes left, literally, so I’m going to ask you a closing question – you know, lightning round, so to speak.

What is the most important thing you want to do first, Vanessa?

Dr. Kerry: I don’t know if I can say a first because I feel like I’ve already been doing it, and I guess specific to the special envoy role the most important thing I want to do is to tackle the reframing of the argument in a way that spurs action and to help drive that momentum.

The reason I hesitated, though, is that what I also want to do is to challenge our leaders to rise to this moment through bold, ambitious action and to not just settle for incremental change. And I think that one of the things we suffer from is a pandemic of poor and expedient choices to serve election cycles, to serve next year’s returns, and the reality is we’re dying because of it. And the chaos that is being created through the way we communicate – the distrust, the false information – is killing us.

We have a really real problem. We are dying from climate change, we are dying from lack of investment in health, we are dying from growing inequity in this world, and we’re not doing what we need to do to address it.

That has been what we have done through Seed for 10-plus years and has been what my career has been devoted to. So, to me, it’s a continuation but the urgency of it is just growing.

Specific to this role, though, it’s about really making sure that we reframe the argument in a way that spurs the action to solve that first problem.

Dr. Gerberding: Thank you for that.

And, Minister of Health, you have the last word. I’m struggling to call you health minister because you’ve been Austin to me for so many years. (Laughter.) But we are truly blessed that you are in this position of leadership, really, global leadership at this point.

What is the most important thing that you’re going to do next?

Dr. Demby: Well, thank you, Julie.

I think for me the most important thing is we have an opportunity. For once in a lifetime, there has been some attention to climate change and health. We should not let this opportunity slip.

And so, for me, my focus is on energy and health as a model for what it’ll take to be able to radically change health-care delivery, build resilience, build adaptation that is long term, and as we do this have an institution like a national public health agency to help drive that going forward. That’s my mission.

Dr. Gerberding: Well, I’m confident both of you will be successful. You’re incredibly strategic thinkers, incredibly passionate people who obviously care a great deal about your mission and we will give you our full support.

So thank you so much for joining us here at CommonHealth Live! We’ve learned a lot today and we’re inspired.

Dr. Kerry: Thank you.

Dr. Gerberding: So thank you also to CSIS for hosting this and for all of the important policy work that happens here that, hopefully, will be translated into good policy decisions by those who are in a position to really make a difference.

I can’t think of anything much more important than climate change and health as we look into the future. Thank you.