Research Mapping Climate Change Vulnerabilities to Infectious Diseases in Europe Jan C. Semenza,1 Jonathan E. Suk,1 Virginia Estevez,1 Kristie L. Ebi,2 and Elisabet Lindgren3 1Office of the Chief Scientist, European Centre for Disease Prevention and Control, Stockholm, Sweden; 2Department of Medicine, Stanford University, Stanford, California, USA; 3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden Background : hTe incidence, outbreak frequency, and distribution of many infectious diseases are generally expected to change as a consequence of climate change, yet there is limited regional infor- mation available to guide decision making. o Bjectiv : We surveyed government officials designated as Competent Bodies for Scientific Advice concerning infectious diseases to examine the degree to which they are concerned about potential effects of climate change on infectious diseases, as well as their perceptions of institutional capacities in their respective countries. Methods : In 2007 and 2009/2010, national infectious disease experts from 30 European Economic Area countries were surveyed about recent and projected infectious disease patterns in relation to climate change in their countries and the national capacity to cope with them. r esult : A large majority of respondents agreed that climate change would affect vector-borne (86% of country representatives), food-borne (70%), water-borne (68%), and rodent-borne (68%) diseases in their countries. In addition, most indicated that institutional improvements are needed for ongoing surveillance programs (83%), collaboration with the veterinary sector (69%), manage- ment of animal disease outbreaks (66%), national monitoring and control of climate-sensitive infec- tious diseases (64%), health services during an infectious disease outbreak (61%), and diagnostic support during an epidemic (54%). c onclusi : Expert responses were generally consistent with the peer-reviewed literature regard- ing the relationship between climate change and vector- and water-borne diseases, but were less so for food-borne diseases. Shortcomings in institutional capacity to manage climate change vulnerability, identified in this assessment, should be addressed in impact, vulnerability, and adaptation assessments. k ey words : adaptation, climate change, infectious diseases, surveillance, vulnerability. Environ Health Perspect 120:385–392 (2012). http://dx.doi.org/10.1289/ehp.1103805 [Online 23 November 2011] Europe will experience differential impacts from climate change (Intergovernmental Panel on Climate Change 2007). Differences in geographic, ecological, demographic, and socioeconomic conditions affect the region’s differences in vulnerability to chang‑ ing environmental and climatic conditions. Projections of annual average temperature and mean precipitation predict significant changes overall, with disproportionally warmer win‑ ters in the north and warmer summers in the south (Giorgi et al. 2004). Ambient tempera‑ ture and precipitation patterns influence food‑ and water‑ borne diseases through effects on environmental exposure pathways (Semenza et al. 2011a, 2011b). In addition, changes in seasonal precipitation and temperature influ‑ ence vector‑borne diseases through a) effects on vector survival, reproduction rates, habi‑ tat suitability, distribution, and abundance; b) the intensity and temporal pattern of vec‑ tor activity (particularly biting rates); and c) rates of pathogen development, survival, and reproduction within vectors (Semenza and Menne 2009). Thus, projected climate changes may shift the distributional ranges of vectorb‑orne diseases. There are, however, significant uncertain‑ ties in climate change projections, particularly with regard to changes in weather patterns over time and consequences on smaller‑ scale biogeographic regions. Moreover, complex transmission pathways interact with climatic and environmental factors and are thus often insufficiently understood (McMichael et al. 2006; Patz et al. 2005). It is unlikely that the effect of climate change on a specific patho‑ gen will be idiosyncratic; rather, a multitude of effects are likely to occur because pathogen dispersion, transport, fate, and environmen‑ tal exposure pathways can all be altered by local climate and weather conditions (Boxall et al. 2009). Although infectious disease out‑ breaks have been linked to individual weather events, there have been few attempts to detect and attribute temporal trends in infectious diseases to climate change (Semenza et al. 2011b). Many studies have projected future levels of disease spread in response to climate change, but there are currently no means for verifying the accuracy of these models. Capturing local expert opinion has proven valuable when information is uncertain. Expert assessment and judgment can inform regulators and guide the policy decisionm‑aking process (Habegger 2010; Riedy 2009) by identifying climate‑related diseases of current or future public health concern as a function of specific vulnerabilities and adaptive capacities (Alberini et al. 2006; Anderegg et al. 2010; King et al. 2006). Therefore, we surveyed national infectious disease experts responsible for Environmental Health Perspectives • volume 120 | number 3 | March 2012 climate change activities in their country to evaluate potential impacts of climate change on infectious diseases in Europe and capture information on national assessment plans, the extent to which infectious diseases are covered by those plans, and institutional capacities for managing climate change vulnerabilities. Methods The geographic scope of the survey was defined as the European Economic Area (EEA), which includes all 27 member states of the European Union (EU) plus Norway, Iceland, and Lichtenstein. Governments of these countries designate institutions or scientific bodies to serve as official sources of independent scientific and technical advice and/or capacity for the prevention and control of infectious diseases for the European Centre for Disease Prevention and Control (ECDC). In 2007 and 2009/2010, questionnaires were administered to officials representing these Competent Bodies for Scientific Advice in each member state (ECDC 2011), including representatives from governmental health protection agencies (52%), ministries of health (24%), and governmental infectious disease surveillance centers (24%). Several of the representatives also provided an academic affiliation (14%). A different set of experts was queried in each survey. The questionnaire asked respondents to indicate which infectious diseases (from lists of 18 and 29 specific diseases in 2007 and 2009/2010, respectively) or groups of infectious diseases (food‑borne, water‑borne, vector‑ borne, rodent‑ borne, parasitic, viral, or other) would most likely be affected by climate change in their respective countries, according to a five‑item Likert scale (agree strongly, agree somewhat, neither agree nor disagree, disagree somewhat, disagree strongly). In addition, respondents were asked Address correspondence to J.C. Semenza, Office of the Chief Scientist, European Centre for Disease Prevention and Control, Tomtebbodavagen 11A, SE‑ 171 83 Stockholm, Sweden. Telephone: 467‑61‑010‑711. Fax: 468‑5‑8601‑296. Em‑ail: jan. semenza@ecdc.europa.eu We thank F. Apfel and B. Menne for feedback on the 2007 survey instruments, B. Sudre for statisti‑ cal advice, and S. Alves for data entry. We are par‑ ticularly grateful for member state representatives for taking the time to complete the survey. The authors declare they have no actual or potential competing financial interests. Received 11 April 2011; accepted 23 November 2011. 385