Climate change has been regarded as the “defining issue” for public health in the 21st century. Rising temperatures bring about the spread of different infectious diseases, both vector-borne and pathogen-based. Additionally, it (climate change and rising temperatures) fuels the emergence and spread of antimicrobial resistance (AMR) in microorganisms, as well as the spread of infectious diseases through zoonoses (infectious diseases jumping species barrier from non-humans to humans).
Bangladesh uniquely stands to be negatively impacted by the rising temperatures and their consequences from a public health perspective. Having been consistently ranked as one of the countries most likely to experience climate change-induced difficulties, the probability and potentiality of the spread of different infectious diseases poses a significant and complex puzzle for us. This essay will not delve into the legal intricacies surrounding infectious disease response mechanisms; rather, it will outline the complexities and shortcomings of our current response mechanisms as well as the dangers these shortcomings pose for us as a nation.
That being said, I would be remiss not to briefly outline the contours of climate change-induced disease outbreaks and their response mechanisms. What happens when temperatures rise? Different weather conditions, consequential rise of sea levels, and incremental incidences of heat waves or other extreme weather events fuel the spread of different infectious diseases. This means more frequent outbreaks of dengue, malaria, different forms of influenza, tick-bite related diseases, Lyme disease, and cholera. It could also mean new or emergent pathogen spread, such as mutated variants of influenza, bird flu, or swine flu with higher infectiousness and lethality. This also includes invasive fungal infections (caused by fungi). The majority of these infections are fatal, and they are spreading rapidly with recorded cases in more than 50 countries (Deutsche Welle, 2025). Cures are currently out of reach for these infections.
Disease control measures form the core of the response mechanism when dealing with communicable diseases, such as pathogen or vector-based infectious diseases. Such measures include early detection, rapid testing, quarantine, isolation, personal hygiene recommendations, addressing spark (when and where a disease flares up) and spread (spread of an infectious disease) risks, risk communication, scaling up existing infrastructure, and vaccination to reduce infectiousness. To operationalize disease control measures in the event of a spark, the origination of the disease, its typology, and infectiousness (also referred to as R0 or R-naught) are required in order to establish a mechanism to tackle it. Scientific guidance and information are crucial in this case to lay down the groundwork for legal and policy-level mechanisms to execute the recommendations. Scientific guidance is also crucial in filtering out the ineffective measures, for example, complete or partial border closures have regularly been used by countries as a measure to stave off infection spread, but scientific studies have conclusively established that even a complete border closure only delays the spread of a disease in that location by a few weeks. Thus, in handling infectious disease outbreaks, law & science play a complementary role in enhancing public health regulation.
Why is climate change, its impact on public health, and the infusion of law and science in public health regulation so crucial for Bangladesh? Well, firstly, Bangladesh is regarded as one of the countries most likely to suffer from climate change-induced hardships by different indices. Secondly, population, we are a country of 170 million (give or take) souls. In a sense, this makes us an incubator for any kind of pathogen to spread. Thirdly, our healthcare system, we invest very little in it. Whatever amount of the national budget we do invest, we tend to focus more on the tertiary level healthcare facilities (i.e., specialized hospitals, medical universities, medical college hospitals), rather than primary (community clinics & upazila hospitals) or secondary (district hospitals) level ones. The tertiary ones are often located in the metropolitan areas, further adding a geographical complexity to the already complicated healthcare infrastructure of Bangladesh.
Now, imagine, temperatures continue to rise globally, causing extreme weather events, sea level rise, emergence of new pathogens, mutation of existing pathogens, and spread of vector-borne and water-borne diseases. How will it impact Bangladesh? Given our dense population and mismanaged healthcare system, how will we be able to prevent, respond, contain, and eradicate this endless slew of diseases that is albeit sure to arrive?
Globally, nation-states recognize and continue to acknowledge the likelihood of climate change impacting public health worldwide. At the multilateral level, facilitated by the United Nations (UN), states have continued to work on legal instruments specifically geared towards handling disease spread or outbreaks. One such example is the International Health Regulations (IHR) 2005. It calls for developing, strengthening, and maintaining public health emergency response mechanisms to address public health risks. Health measures geared towards public health emergencies are to be based on scientific principles, as well as scientific evidence and available guidance or advice from the World Health Organization (WHO). There is also the WHO Pandemic Accord, which has yet to come into force. The Pandemic Accord calls for pandemic preparedness, prevention, surveillance, and capacity building.
At the national level, Bangladesh has a range of legislation governing a public health emergency, including the Infectious Disease (Prevention, Control, and Eradication) Act, 2018, the Animal Diseases Act, 2005, and the Disaster Management Act 2012. However, none of these laws focus on preparedness, capacity building, surveillance, or prevention. The measures outlined by these laws are essentially reactive, broad, not situation-specific, and do not necessarily infuse scientific evidence or advice in their formulation or execution. Rather, the responsibilities of disease control measure implementation under these laws rest solely on the shoulders of local government officials.
A question might be asked that if the disease response mechanism of Bangladesh is in such shambles, how did we even manage to survive the COVID-19 pandemic? An academically intriguing and an indeed valid question. A range of factors played in Bangladesh’s favour when dealing with the COVID-19 pandemic, including capacity building (albeit partially successfully), herd immunity, and mass vaccination. I would also like to state that just because we survived the COVID-19 pandemic with the status quo healthcare system and disease response mechanisms, does not in any way mean that we will see a likewise result the next time there is a disease outbreak in Bangladesh of similar or greater magnitude. We should be acknowledging our shortcomings and focusing on improving them. One study has already confirmed that during the pandemic, healthcare institutions at all levels (primary, secondary, tertiary) suffered from detection, equipment difficulties, as well as surge capabilities (Harun-Ar-Rashid, 2022). Also, Bangladesh had the highest rate of infection and mortality rates in the world among healthcare workers, presumably due to a lack of personal protection equipment (PPE) (Reza 2020). Furthermore, despite the existence of legislation dealing with disease outbreaks, Bangladesh reneges and has reneged on using them. During the COVID-19 pandemic, the Rules of Business 1996 and the Mobile Court Act 2009 were more frequently used than the 2018 Infectious Disease Act.
Preparedness, surveillance, prevention, and capacity building to address a disease outbreak requires the infusion of scientific guidance or advice with a corresponding legal framework, budgetary allocations, and infrastructural arrangements. This is also what is demanded of nation-states under the IHR 2005 and draft WHO Pandemic Accords. However, the domestic laws of Bangladesh, at present, are unable to live up to that standard. They only deal with what happens after a case is identified within our boundaries, not before that. In some cases, a disease or the person it has infected might not show regular symptoms (asymptomatic), making detection even more difficult. Also, by the time a case is detected, the pathogen may have already spread to large swathes of the population, making prevention and surveillance difficult, if not worthless.
Whatever legal framework we have at present is unable to aid us in terms of preparedness, surveillance, capacity building, and prevention of a disease outbreak. What we first need is a coordinated response mechanism. Our legal and infrastructural mechanisms at present are fragmented, and do not communicate nor do they coordinate with each other. In order to ensure a swift, effective, and prepared entity to oversee, administer, and advice the nation in dire circumstances such as an epidemic or infectious disease outbreak, an omnibus legislation that comprehensively addresses the matters of public health & safety have to be implemented establishing a Centre for Disease Control (CDC) or Federal Emergency Management Agency (FEMA) like entity. This is without any prejudice and with complete acknowledgement of the crucial role played by the Directorate General of Health Services (DGHS) and the International Centre for Diarrheal Disease Research (icddr,b) during the COVID-19 pandemic.
Then comes fiscal prudence and responsible budgetary allocation to prepare for, monitor, and eradicate disease outbreaks for a future rife with climate-induced disease outbreaks. We are a developing nation with immense resource constraint issues, which I acknowledge wholeheartedly. However, this is not impossible; Senegal managed to limit the harms caused by the COVID-19 pandemic, showing the world that it is possible to fight pathogens on a budget.
Defence of a nation does not necessarily only mean military might nowadays; it also includes biosafety (protecting humans and the environment from harmful biological agents and biohazards). For us in Bangladesh, being cognizant of the threat climate change and disease outbreaks induced by it pose, we cannot be ignorant of our biosafety any longer. We already cannot afford to deal with dengue or Zika outbreaks every monsoon; what will happen when fungi-based disease or other infectious disease outbreaks become just as frequent? Infusion of our public health laws with established scientific principles is a first important step in better preparing us and our future generations for what is very likely to become the new normal, a disease-prone environment.
