If more aggressive action is not taken to slow climate change, the frequency and severity of allergic illnesses, including asthma and hay fever, are expected to increase in the U.S., as are diseases caused by mosquitoes, like the Zika and West Nile viruses, government scientists said in a new report.
Rising air and water temperatures and more intense extreme events as a result of climate change are also expected to increase exposure to waterborne diseases, like leptospirosis and cryptosporidiosis, and foodborne infections, such as salmonella, the authors of the congressionally mandated report said.
In addition, the rates of mental illnesses, such as anxiety, depression, post-traumatic stress and suicidality, will rise, according to the report, the Fourth National Climate Assessment, Volume II.
"Climate change affects the health of all Americans," the report's authors wrote.
The report was compiled by scientists and others at the U.S. Global Change Research Program, or USGCRP, which consists of 13 federal agencies, including Health and Human Services and the National Science Foundation. It was mandated by Congress under the Global Change Research Act of 1990.
The assessment relied on the expertise of more than 300 authors from federal, state and local governments; industry; academia; tribal organizations and non-government organizations and its findings were the result of over 6,000 references, including from the report's first volume, released last year.
The scientists estimated the U.S. economy could lose hundreds of billions of dollars by the end of the century, with the nation's gross domestic product dropping by as much as 10% or more under the worst-case scenarios.
The Trump administration quietly released the new report late in the afternoon on Nov. 23, while most Americans were celebrating the long Thanksgiving holiday weekend — the timing of which was criticized as an attempt to bury the results.
"The president may try to hide the truth, but his own scientists and experts have made it as stark and clear as possible," former Vice President and environmentalist Al Gore said in a statement.
If the administration's plan was to ensure the report got little attention, "it backfired," because there was little other news that day and so it got more interest than it might otherwise have done, Sen. Amy Klobuchar, D-Minn., said during a Nov. 25 appearance on ABC's This Week.
"This is a very alarming report and we've got to wake up and address these issues," Sen. Bernie Sanders, I-Vt., said on CBS' Face the Nation. "It is amazing to me that we have an administration right now that still considers climate change to be a hoax, who is not sure about whether it is manmade."
HHS Secretary Alex Azar, U.S. Food and Drug Administration Commissioner Scott Gottlieb and Centers for Disease Control and Prevention Director Robert Redfield — who were in the midst of dealing with yet another nationwide E. coli outbreak linked to romaine lettuce — were mum about the climate change report and did not issue any public statements about it, despite their congressionally mandated duty to protect the nation's public health.
People and communities are differentially exposed to climate-related hazards and health risks and certain groups, like children, older adults, poor Americans and some communities of color, are disproportionately affected, the authors said.
Pregnant women also are among those particularly vulnerable to the effects of climate change, they added.
Vaccines and treatments
Climate change is expected to alter the geographic range, seasonal distribution and abundance of disease vectors, exposing more Americans to ticks that carry Lyme disease or other bacterial and viral agents and to mosquitoes that transmit the West Nile, chikungunya, dengue and Zika viruses — diseases for which there currently are no vaccines approved in the U.S.
Sanofi, however, secured an expedited review from the FDA last month on the company's application for its dengue vaccine Dengvaxia. The agency is expected to make a decision by May 2019.
But Sanofi decided last year to discontinue its partnership with the Walter Reed Army Institute of Research on a Zika vaccine, though the military organization has continued developing its purified inactivated product, called ZPIV.
The National Institutes of Health and a handful of biopharmaceutical companies, including GlaxoSmithKline PLC and Moderna Therapeutics Inc., also are pursuing vaccines against Zika, which has minimal effects for most people but has devastating consequences for unborn babies, causing them to potentially develop microcephaly, a rare neonatal malformation in which a baby's head is much smaller than normal, resulting in developmental and other disabilities.
The NIH also has been working on a vaccine and treatments for chikungunya, which can cause fever and debilitating joint pain and arthritis. The agency has partnered with Themis Bioscience NV on the vaccine.
Valneva SE also has chikungunya vaccine candidates in its development pipeline.
While the NIH has developed a West Nile vaccine candidate — which uses a DNA strategy similar to the one the agency is employing for its experimental Zika product — no biopharmaceutical partner has stepped up to take it into late-stage development and to the marketplace.
Annual national cases of West Nile neuroinvasive disease could more than double by 2050 due to increasing temperatures, among other factors, resulting in about $1 billion per year in hospitalization costs and premature deaths, the authors of the USGCRP report said.
The number of yearly cases could reach as high as 3,300, at an annual cost of $3.3 billion by the end of the century, they added.
Another mosquito-borne disease the USGCRP report authors warned may spread faster if action lags to rein in climate change is yellow fever, which can result in bleeding, shock, organ failure and sometimes death in severe cases.
While there is an FDA-approved vaccine against the disease from Sanofi, known as YF-Vax, the product has been out of stock in the U.S. since last year. The company is anticipating having more YF-Vax available for Americans by mid-2019.
In the meantime, Sanofi has made an alternative yellow fever vaccine, Stamaril, available at certain locations under an expanded access investigational new drug application from the FDA. Stamaril is approved in 70 other nations.
Healthcare sector a contributing factor
While healthcare facilities are a critical component of communities' emergency response system and resilience to climate change, they also are a significant contributor to the problem, accounting for about 10% of total U.S. greenhouse gas emissions, the authors of the USGCRP report said.
Hospitals and other facilities could take steps to decrease greenhouse gas emissions, while also significantly reducing their operating costs and contributing to greater resilience of the healthcare infrastructure, they said.
They noted the nonprofit Commonwealth Fund estimated that U.S. hospitals could save roughly $15 billion over 10 years by adopting certain basic energy efficiency and waste-reduction measures.
Hospitals also are at risk from certain outcomes of climate change, like being inundated because of storm surges from hurricanes, the USGCRP authors said.
ACA enrollment down
Meanwhile, in Washington, HHS officials have done little in the last month to urge Americans to sign up for health plans offered under the Affordable Care Act, whose enrollment was significantly down in the first three weeks from last year's figures.
The administration on Nov. 21 reported 1.92 million Americans had enrolled in plans offered by the federal health exchange, Healthcare.gov, since Nov. 1 — a drop of more than 350,000 from the same week in 2017.
Last year, the Trump administration slashed in half the ACA marketplace's annual open enrollment period — shortening it from three months to six weeks. It now runs from Nov. 1 through Dec. 15.
HHS also substantially cut grants for navigators — people who help enrollees understand their options and assists them with paperwork for obtaining financial help and in assessing provider networks.
HHS also sharply cut funds for advertising about the enrollment period.
While Centers for Medicare and Medicaid Services Administrator Seema Verma reminded her followers on Twitter on Nov. 1 that enrollment had opened, she tweeted later that day that "skyrocketing premiums are destroying affordable options for the unsubsidized, including people with pre-existing conditions, resulting in 20% drop in unsubsidized enrollment in 2017."
But the nonpartisan Kaiser Family Foundation reported on Nov. 20 that the premiums for unsubsidized plans are actually decreasing, not rising.
The ACA plans are sold in four so-called "metal" categories — bronze, silver, gold and platinum.
Nationally, the average unsubsidized premium for the lowest-cost bronze plan has decreased by 0.3% from 2018 to 2019, while the average unsubsidized lowest-cost silver premium has dropped by 1%. The average unsubsidized lowest-cost gold plan has declined by 2%.
In addition, premiums for ACA marketplace benchmark silver plans — the most popular of the plans — are decreasing on average across the U.S. in 2019, Kaiser reported.
Verma waited three more weeks before tweeting again about open enrollment.
HHS' Azar, however, has sent no tweets about open enrollment from his account, though he retweeted Verma's Nov. 1 tweet and another that day from his agency. He also has made no trips around the country or made public speeches to promote open enrollment, unlike his predecessors in the Obama administration.