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[Preprint]. 2025 Feb 20:2025.02.18.25322451.
doi: 10.1101/2025.02.18.25322451.

Climate change and tuberculosis: an analytical framework

Matthew J Saunders  1   2 , Delia Boccia  3 , Palwasha Y Khan  4 , Lara Goscè  5 , Antonio Gasparrini  6 , Rebecca A Clark  5 , Julia M Pescarini  3 , Richard G White  5 , Rein Mgj Houben  5 , Matteo Zignol  7 , Nebiat Gebreselassie  7 , C Finn McQuaid  5
Affiliations

Climate change and tuberculosis: an analytical framework

Matthew J Saunders et al. medRxiv. .

Update in

  • Climate change and tuberculosis: an analytical framework.
    Saunders MJ, Boccia D, Khan PY, Goscé L, Gasparrini A, Clark RA, Pescarini JM, Charalambous S, Fekadu L, Dockhorn da Costa Johansen F, Vasilyeva I, Narendran G, Li T, Ndjeka N, White RG, Houben RMGJ, Zignol M, Gebreselassie N, McQuaid CF. Saunders MJ, et al. Lancet Respir Med. 2025 Oct 30:S2213-2600(25)00329-7. doi: 10.1016/S2213-2600(25)00329-7. Online ahead of print. Lancet Respir Med. 2025. PMID: 41177169 Review.

Abstract

Climate change is likely to exacerbate a range of determinants which drive tuberculosis, the world's leading infectious disease killer. However, tuberculosis is often neglected in wider climate health discussions. Commissioned by the World Health Organization, we developed an analytical framework outlining potential causal relationships between climate change and tuberculosis. We drew on existing knowledge of tuberculosis determinants, identified which are likely to be sensitive to the effects of climate change, and conceptualised the mechanistic pathways through which this might occur. We collated evidence for these pathways through literature reviews. Our reviews found no studies directly linking climate change and tuberculosis, warranting research to build evidence for action. The available evidence supports the existence of plausible links between climate change and tuberculosis, and highlights the need to include tuberculosis in climate risk adaptation and mitigation programmes, and climate-resilient funding and response mechanisms. Further evidence is urgently needed to quantify the effects of climate change on tuberculosis.

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Conflict of interest statement

Declaration of interests Members of the funder (MZ, NG) participated as authors on the study and critically reviewed the framework, reviewed and revised the manuscript, and approved the final manuscript as submitted. All other authors declare no competing interests.

Figures

Figure 1.
Figure 1.
Comparison of TB burden and vulnerability to climate change across 215 countries and territories for different indices. A higher index value represents a poorer performance, where indices include (a) INFORM, measuring the risk of humanitarian crises that could require international assistance, (b) World Risk Index, assessing the risk of humanitarian disaster caused by extreme natural events and the negative effects of climate change, and (c) ND-GAIN, combining both readiness and vulnerability to climate change. Colors indicate World Health Organization regions; blue= African Region, light green= Region of the Americas, dark green= Eastern Mediterranean Region, yellow= European Region, orange= South-East Asian Region, gray= Western Pacific Region. ISO3 codes indicate the top 10 TB burden countries by number of incident TB cases.
Figure 1.
Figure 1.
Comparison of TB burden and vulnerability to climate change across 215 countries and territories for different indices. A higher index value represents a poorer performance, where indices include (a) INFORM, measuring the risk of humanitarian crises that could require international assistance, (b) World Risk Index, assessing the risk of humanitarian disaster caused by extreme natural events and the negative effects of climate change, and (c) ND-GAIN, combining both readiness and vulnerability to climate change. Colors indicate World Health Organization regions; blue= African Region, light green= Region of the Americas, dark green= Eastern Mediterranean Region, yellow= European Region, orange= South-East Asian Region, gray= Western Pacific Region. ISO3 codes indicate the top 10 TB burden countries by number of incident TB cases.
Figure 1.
Figure 1.
Comparison of TB burden and vulnerability to climate change across 215 countries and territories for different indices. A higher index value represents a poorer performance, where indices include (a) INFORM, measuring the risk of humanitarian crises that could require international assistance, (b) World Risk Index, assessing the risk of humanitarian disaster caused by extreme natural events and the negative effects of climate change, and (c) ND-GAIN, combining both readiness and vulnerability to climate change. Colors indicate World Health Organization regions; blue= African Region, light green= Region of the Americas, dark green= Eastern Mediterranean Region, yellow= European Region, orange= South-East Asian Region, gray= Western Pacific Region. ISO3 codes indicate the top 10 TB burden countries by number of incident TB cases.
Figure 2.
Figure 2.
(a) Analytical framework linking climate change to consequences for TB via a range of climate/health links. Example climate/health links considered here include (b) migration and displacement, (c) food and water insecurity, and (d) health system disruptions. Blue arrows indicate pathways included in literature reviews.
Figure 2.
Figure 2.
(a) Analytical framework linking climate change to consequences for TB via a range of climate/health links. Example climate/health links considered here include (b) migration and displacement, (c) food and water insecurity, and (d) health system disruptions. Blue arrows indicate pathways included in literature reviews.
Figure 2.
Figure 2.
(a) Analytical framework linking climate change to consequences for TB via a range of climate/health links. Example climate/health links considered here include (b) migration and displacement, (c) food and water insecurity, and (d) health system disruptions. Blue arrows indicate pathways included in literature reviews.
Figure 2.
Figure 2.
(a) Analytical framework linking climate change to consequences for TB via a range of climate/health links. Example climate/health links considered here include (b) migration and displacement, (c) food and water insecurity, and (d) health system disruptions. Blue arrows indicate pathways included in literature reviews.
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