Statement by dengue fever

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Conference on Climate Variability and Change and their Health Effects
                         in the Caribbean
                Bridgetown, Barbados, 21 May 2002

         Adddress by H.E. Ambassador Tuiloma Neroni Slade
        Chairman of the Alliance of Small Island States (AOSIS)

Mr Chairman,

It is something of a pilgrimage to be in this country, for Barbados holds a place
of special significance in the affairs of small island States, indeed, in the
endeavors of all States. This was the place, following the great conference of
Rio de Janeiro, that inspired the world community to set into concrete action the
high principles of the Rio Declaration and of Agenda 21. That, of course, was
done through the Programme of Action for the Sustainable Development of
Small Island Developing States agreed in Bridgetown in 1994, the first global
effort to translate vision and principle into practical results.

I feel particularly privileged to be here, and on behalf of the Alliance of
Small Island States (AOSIS) let me say that we are most grateful for the
generosity of the invitation that allows the representation of our group in this
important conference.

Coinciding with the final steps being taken for the tenth anniversary review
of Agenda 21, this conference could not have come at a more propitious
moment. As you will know, there is determination to make the World
Summit in Johannesburg very practical in orientation and its outcomes, so
that real and practical actions are actually taken to tackle the social,
economic and environmental issues of the type that you will be addressing at
this conference. I should like to offer to the Government of Barbados, to
you Mr Chairman and to all the conference co-sponsors and organisers our
warmest compliments and felicitations.

Barbados Programme of Action

The Barbados Programme of Action (BPOA) provides the requisite
background to the consideration of climate change and health issues in small
island States. I want to draw on aspects that would seem to be especially
relevant to the issues that you will be discussing.

First, the BPOA is the global affirmation of small islands as a special case
for both environment and development, because of their ecological fragility
and their situation of vulnerability. There is wide acknowledgement that
small island States are particularly vulnerable to global climate change,
climate variability and sea-level rise.

The Programme of Action acknowledges the fact, straightforward enough
though hitherto not well appreciated, that sustainable development
programmes must seek to enhance the quality of life of peoples, their health
and well-being and safety. It underscores the close dependency of human
health on a healthy environment, as it does the inter-linkages of factors and
the need for fully integrated approaches. It is now much clearer, and we
know from reports such as that presented to the WHO by the Commission on
Macroeconomics and Health that the linkages of health to poverty reduction
and to long-term economic growth are powerful, and much stronger than is
generally understood.

The BPOA notes that smallness and vulnerability of island States
necessitates special attention being paid to population issues, education and
health to ensure effective human resource development. Part of this was due
to the fact that, as noted in the Programme, overall improvement in the
health of island populations had continued to slow down as assessed around
1994 and, furthermore, that in many cases the health conditions of
vulnerable groups, such as poor women and children, had actually
deteriorated. This was borne out in the years subsequent to 1994 by the
significant environmental degradation reported by UNEP in the
Environment Outlooks of all SIDS regions, a situation exacerbated by
problems created by population pressures, urbanisation, disease and climate
change effects.

I should emphasise that there is a clear sense of island-ownership of the
BPOA, and that all AOSIS countries are committed to its effective
implementation. It is commitment derived through the island States
themselves having determined the issues and priorities of the Programme,
issues that remain today substantially as valid if not, as with climate change,
more urgently so.

The global programme fashioned in Barbados in 1994, dedicated to SIDS,
might then be the pertinent background and natural setting to your work.

Climate change

Human health, settlements and economic activities among island
communities are likely to be significantly affected by projected changes in
climate and sea-levels. Human health is a major concern in tropical islands,
many of which are currently experiencing a high incidence of vector-borne
and water-borne diseases. This is due in part to changes in temperature and
rainfall occurring worldwide, and partly also to changes in the pattern of
droughts and floods.

As population, agricultural land and Government and commercial centers
tend to be concentrated in the coastal zone, any rise in sea-level will have
significant effect on infrastructure and living conditions. Indeed, we know
from the almost annual catalogue of storms and hurricanes, in the Caribbean
region as in other small island regions, how disastrous the consequences can
be. The great uncertainty for the future is that climate extremes are more
likely to be the norm. Such an eventuality will impose a huge additional
burden on the sustainability of islands and the health of their populations.

Tourism and agriculture are both major employers and revenue earners in
many small island countries. Changes in temperature and rainfall regimes
and resulting damage to crops, or loss of beaches, could be quite devastating
especially for economies dependent on these sectors.

The dangers and threats to the very survival of atolls and other low-lying
islands are real and widely acknowledged. Inundation of outlying islands
and loss of land above the high-tide mark, quite apart from the destruction of
infrastructure and human settlements, may result in loss of exclusive
economic rights over extensive marine areas. As it is, natural water tables
and reserves have suffered from saline intrusion, and a number of low-lying
islands have had to adapt through desalination or rain-water catchment for
their needs. We need to understand more, and do more to anticipate the
potentially disastrous climate change impacts on water quality and water

Global climate change and temperature changes will also impact adversely
against coral reefs and coral reserves, and will have potential to alter the

distribution of zones of upwelling likely to affect both subsistence and
commercial fisheries production. A number of countries in the Pacific
experienced the temporary "loss" or, in reverse circumstances, temporary
"gains" over several months of highly migratory tuna stocks in their waters
during a particularly active phase of the 1997/1998 El Nino.

Better understanding

While there are provisions in the Climate Change Convention concerning
health aspects, it is probably the case that health issues were not fully or
properly understood. For the AOSIS negotiators, the focus was really more
on the dangers of sea level rise and the impacts of frequent and damaging

Much more is now known of the science and the impacts of climate change.
The findings of the IPCC and the emerging evidence from the work of WHO
and others of the likely health implications raise issues of immediate
concern. Studies of vector-borne diseases such as malaria and dengue fever,
including studies carried out at the regional level, confirm the fears that the
dangers for small island communities, especially among the young and the
elderly, could be widespread and serious.

Indications are that these diseases are emerging or re-emerging in parts of
the Caribbean. For the Pacific, there is prediction that with warming
temperatures there could be migration of malaria-carrying mosquitoes to
higher altitudes in Papua New Guinea, for instance; and there is expectation
of increases in dengue fever outbreaks in the Cook Islands and Samoa.
There is also the possibility, it seems, of malaria re-appearing in islands
where once it was supposed to have been eradicated.

The significance of all this is, if you know the Pacific area, that whereas
malaria had previously tended to be largely confined to Papua New Guinea
and other islands of the western and central Pacific, it now appears to be
extending further east as far as Fiji. Such a trend would be a very serious
turn of events for any island community, and would add considerably to the
constraints against health prospects and in achieving sustainable
development. We know from the studies of WHO and others that malaria is
second only to HIV/AIDS as amongst the main causes of avoidable deaths,
alone taking two lives every minute of every day among developing
countries, mainly amongst children under five and pregnant women.

Public awareness and prevention

Like other developing countries, there are severe limitations in the ability of
small island States to mount a full response to health risks of this magnitude.
However, there are practical options that could be taken. Public education
and outreach is a key step and, in fact, considerable efforts are being taken in
the Caribbean, and in other small island countries. In the Pacific experience,
for instance, public awareness programmes related to malaria, dengue fever
and other diseases are an essential, low-cost method for reducing the public
health risk. Such programmes have already been initiated in a number of
countries and are considered to be relatively effective, as are village or
community projects to reduce or eliminate mosquito-breeding sites, and the
use in households of simple protective measures like bednets and mosquito

Water-borne diseases notably can add to the difficulties and complications
of health problems, especially in high population-density areas infested with
inadequate sewage and drainage systems.

Gastroenteritis and diarrhoea normally associated with poor water quality
and flooding during rainy seasons are likely to increase with worsening
climate-related conditions. These, too, as probably others, will need to be
followed through with much more detailed research and study, and a
concerted effort to find practical solutions.

Policy options and strategies

The range of options available to small island States is largely measurable
by their capacity and resources. That sustainable development cannot be
achieved without a healthy population is true enough. But having a national
strategy informed by sound science and policy would also be essential. It is
critical that such policy should focus on the national situation, and the need
for research to collate or clarify data and be forward-looking to provide for
preventive and early warning systems.

There are, unfortunately, many "unknowns". The IPCC Third Assessment
Report seems to be of the clear view that health impacts will get worse.
Vector borne diseases such as malaria and dengue, within “their present
ranges", and "many other diseases", would tend to increase in incidence and

seasonality. The impacts on human health of heat waves and of flooding,
storms and droughts is under study, but is perhaps not that well understood.
Certainly, there is need to have more detailed information and understanding
of island-specific circumstances and from the perspective small island

Uncertainties associated with the projection of future climate change
impacts, at scales appropriate to SIDS, is one of the obstacles for SIDS, in
terms of policy formulation and implementation. Moreover, it is not always
clear, given the many competing priorities confronting SIDS, that climate
change impacts are upper-most in the minds of the authorities.

Health care facilities

Vulnerability to health risks will, of course, vary according to such factors as
availability of quality health care, present health status of the population, and
availability of technical and other resources. Not all small islands can lay
claim to quality services that can respond adequately to health emergencies
or major natural disasters. Hence, the resilience of island States and their
capacity to respond effectively to increasing health threats posed by climate
change is likely to be quite low.

Natural disasters

Small island States are exposed and susceptible to the impacts of a wide
range of climate extremes and natural disasters. In the Pacific region alone
during the 1990s, small island countries suffered a total of 79 tropical
cyclones, 95 storm surges, 12 floods, 31 droughts, 4 earthquakes, 5
landslides, 2 tsunamis and 4 volcanic eruptions. Clearly, it is beyond their
power to respond in any manner likely to be adequate.

However, given the high vulnerability, it is generally accepted that a pro-
active approach to adaptation planning is essential, in order to minimise the
effects of climate change and sea-level rise. Sound policy, with full support
at all levels of society would obviously be ideal. It means an active
programme of public understanding and awareness, with community-based


Constantly, island States are attempting to fathom out the mysteries of
adaptation and the cost implications, including the health aspects. In 1998 a
study sponsored by the World Bank looked at the costs of adaptation for Fiji
if no action was taken internationally or locally. It was found that the annual
costs of dengue fever could be US$1 million to $6 million in annual
damages and US$ 30 million if a large epidemic occurred. The latter would
probably result in a total collapse of tourism during and after the epidemic.
It did not seek to include the costs of any deaths, nor was it able to capture
the full social costs. The figures are therefore really only estimates and give
a snapshot of how the costs could be forced on our countries. The study
indicated a number of additional issues that should be looked at for the
future, such as the impact of a major health disaster on the country’s foreign
reserves in case large amounts of medicines have to be imported. It would
be clear that the economic costs of such a health disaster could be alleviated
if mitigation measures were in place now. The bigger picture would show
that all the efforts that SIDS have made in striving for sustainable tourism
development could come to naught through a major dengue epidemic. Who,
in other words, would want to visit an island where there is a near certainty
of catching breakbone fever? A similar study for Kiribati was not able to
quantify a likely cost scenario, mainly because of the lack of basic health
services capacity in that country to cope with a major epidemic. The verdict,
not surprisingly at all, is that Kiribati would simply not be able to handle a
major outbreak or epidemic. These studies only looked at these costs in a
simple manner, and did not consider the overall costs of climate change
impacts on the health budget. That, clearly, would be an issue for further
work. Small island States must therefore be prepared for the eventualities
that climate change will bring. And there is no question that there will be
major additional costs.

Capacity building

The need for the creation and development of island capacity to cope with
the problem of climate change as a whole is, of course, very clear. Very
serious and wide-ranging programmes of training are under way in all SIDS

Within its own powers AOSIS is playing a role, especially within the
processes of the ongoing international negotiations on the Convention and
the Kyoto Protocol; and also in the elucidation of various aspects of the

climate change issues among AOSIS members in inter-regional workshops
and meetings.

The pooling of knowledge and information exchange among SIDS regions
and their Universities and research organisations is a rewarding and cost-
effective approach, and this also is being utililised. The burden of global
climate change, no less than the associated health issues, calls for the widest
possible measure of collaboration and cooperation.

Mr Chairman,

It seems beyond doubt that the planet is committed to a warmer climate
regime. Small island States have played no part in the causes. But they are
highly exposed and vulnerable to the consequences, and must adapt. They
need to carry out their own internationally agreed commitments, along with
the rest of the international community. From the perspective of AOSIS, I
know that they are serious and conscientious about what they need to do.

This conference would be an important occasion to share information on
what needs to be done about the climate-related health issues in the
Caribbean. I am sure the picture will mirror what is happening elsewhere
among small island countries. In doing so, I should like to think that you
would be guided by the need to find real and practical solutions. As I say, it
is the resolve and ambition of the World Summit to do just that about
implementing the promises of Agenda 21.

I hope also that your work will result in greater understanding, perhaps
renewed and greater commitment from our international partners to assist
small island States in confronting climate change and its effects. Perhaps
when the human health costs of climate change is appreciated and added to
the material costs and environmental damages faced by small island States a
strengthened spirit of partnership and cooperation will emerge.

May I wish you every success with your deliberations.

Thank you.