Adapting to vector-borne diseases under climate change : an evidence-informed approach

Evidence is accumulating on the ongoing effects of climate change. Given the anticipated health implications, notably vector-borne disease impacts, there is a need to design effective and tailored strategies to adapt to vector-borne disease risk. Climate change is a complex problem, involving multiple stakeholders and many unknowns. As such, approaches that can embrace this complexity are needed to inform adaptation research with evidence -  both scientific and stakeholder-informed. Evidence-informed approaches are being increasingly sought in health policy and decision-making in order to improve population health. Evidence-informed approaches have arisen in reaction to ad-hoc, crisis-driven responses to health problems. They recognize the need to be systematic and transparent, and make use of the best available evidence. Deliberative multicriteria decision aid is one such approach.  The objective of this thesis was to study key decision concerns of importance in adapting to vector-borne disease risk under climate change in two contexts: Quebec, where vector-borne diseases are present but not the main burden of disease, and Burkina Faso, where vector-borne diseases contribute to the primary burden of disease. The theoretical underpinnings of this study are rooted in post-normal science, climate change adaptation, and a multicriteria decision analysis approach. Climate change adaptation research is aimed at informing policies to reduce risks and impacts associated with climate change. Within this framework, and in the context of vector-borne disease adaptation, three key questions arise: 1) what diseases are we concerned about? 2) who is most vulnerable and at risk to these diseases? and 3) what are recommended measures to adapt to these diseases? This thesis contributes to these three dimensions to inform adaptation to vector-borne disease. With regards to the first question, we identified concerns of importance for disease prioritization under climate change in both Quebec and Burkina Faso using a deliberative multi-criteria decision aid approach. The results showed that general concerns are shared among these contrasting contexts while specific disease priorities differ as a result of context-informed evidence – both scientific and stakeholder-shared.  With regards to the second question, current knowledge and readiness of the Quebec population relative to West Nile virus was explored as a preliminary and integral step to assessing adaptive capacity to mosquito-borne disease risk. Here, response to perceived mosquito-borne disease risk constitutes a form of adaptation. The results showed that overall knowledge and behavioural adoption levels are good though at least four different subgroups exist within the population with different factors associated with preventive behaviour adoption.  Finally, with respect to the third question, a deliberative multi-criteria approach was used to examine management strategies for West Nile virus in Quebec and malaria in Burkina Faso. West Nile virus strategies under current and theoretical increased transmission were explored in Quebec, and malaria management strategies under current transmission were explored in Burkina Faso. Analogously to the model developed for disease prioritization, shared general concerns were found between the contrasting country and disease contexts lending support to the practical applications of decision-aid approaches for exploring effective management strategies informed by stakeholder experience and the best available scientific evidence.

Keyphrases: Burkina Faso, Vector-borne disease adaptation, Climate change, West Nile virus, malaria, evidence-informed approaches, multi-criteria decision analysis