While Bhutan is going all out to eliminate malaria by 2025, the fight is going to be more difficult because of climate change.
Bhutan witnessed a northward movement of insects, pests, and vectors. While the snow cover has retreated, mosquitoes have now been sighted in Lunana – 4,800m above sea level.
This unchecked spread of mosquitoes is a concern not only for outbreaks of dengue and chikungunya at high altitudes, but it would seriously compromise malaria elimination efforts in the country.
A medical specialist of Gelephu Central Region Hospital, Dr Thinley Dorji highlighted this in the latest Bhutan health journal on climate change and its implication on health in Bhutan.
While Bhutan enjoys a relatively better state of environment compared to the neighboring countries, he said, the consequences of climate change transcend national boundaries. “There are crossover effects and spillover as the world shares one ecosphere.”
He highlighted that the warming of the climate is one pervasive phenomenon that has particular consequences on the emergence or re-emergence of infectious diseases.
Given that dengue was reported in new places during the dengue epidemic in 2019, he said, it is possible that climate change lengthened the transmission season of Aedes mosquitoes during the epidemic.
Phlebotomus sand fly has been reported at an altitude of 2,000m above sea level in the country.
In 2022, July was reported as the hottest month in the last 25 years with temperatures 2.5 degrees Celsius higher than the average. This was associated with an outbreak of the Nairobi fly in the Himalayan foothills in northeastern India, Nepal, and Bhutan, he says.
He stated that warmer climates are linked to water-borne illnesses. The summer months are prone to other gastrointestinal illnesses.
Eliminating malaria already faces many challenges in the country. Bhutan revised its deadline to eliminate the disease a few times: in 2018 and 2020.
Climate change and climatic variation have contributed to localised drought conditions leading to water shortages in many pockets of the country.
This, he said, is a concern not only for the deterioration of health and hygiene practices but also contributes to shortages in crop production and increasing migration of people from rural to urban areas.
“One result of such migrations is overcrowding in hospitals in urban centers while some health facilities in rural areas remain underutilized leading to worsening health inequities,” he said.
The other health implications include an increasing burden on non-communicable diseases and mental health problems. Exposure to increasing temperature is linked to increasing cardiopulmonary mortality through multiple mechanisms.
“It remains important to keep the efforts focused, timely, and sustained to keep on developing vigilant, responsive, and resilient health-specific strategies within the health system of Bhutan,” he stated.
His article shows that under high emissions scenario, it is projected that by 2030, an additional 7,600 people may be at risk of river floods annually because of climate change and 2,400 because of socio-economic changes.