When the organizers of the 2024 Paris Olympic Games were planning their health preparations, they faced an unprecedented challenge. Alongside the familiar threat of Covid-19, they found themselves developing contingency plans for dengue fever—a “tropical” disease that mosquitoes were now capable of spreading in France’s increasingly warm climate. This scenario perfectly encapsulates the world that Dr. Madeleine Thomson has spent decades preparing for: one where climate change fundamentally reshapes global health threats and where traditional disease boundaries dissolve under the pressure of a warming planet.

As Head of Impacts and Adaptation at Wellcome, Thomson has emerged as one of the world’s most influential voices on climate preparedness and health policy. Her vision extends far beyond responding to individual disease outbreaks or heat waves; she advocates for a comprehensive transformation of how health systems understand, predict, and respond to the cascading effects of climate change. Her approach represents a fundamental shift from reactive crisis management to proactive, science-informed health policy that treats climate change as the defining health challenge of our time.

Redefining Disease Geography

Thomson’s work has been instrumental in expanding understanding of climate-sensitive infectious diseases (CSIDs)—any infectious disease whose transmission and spread are influenced by changes and variations in climate and weather. Her research demonstrates that climate change is not simply making existing health problems worse; it’s creating entirely new patterns of disease transmission that challenge basic assumptions about global health geography.

The example of dengue fever illustrates this transformation perfectly. Traditionally considered a tropical disease confined to warm, humid regions, dengue-carrying mosquitoes are now establishing themselves in European countries due to warming temperatures. Thomson’s analysis shows that vector-borne diseases like dengue, Zika virus, malaria, chikungunya, and yellow fever all have significant climate dimensions, with both pathogens and their insect carriers being highly sensitive to environmental conditions.

“Almost all vector-borne diseases have a climate dimension,” Thomson explains. “Temperature drives the rate at which vectors and pathogens develop, while rainfall often supports the creation of sites for the vectors to breed.” This insight has profound implications for health policy, suggesting that disease surveillance and prevention strategies must incorporate climate data and projections to remain effective.

Her work reveals that global temperature records in 2024 contributed directly to a worldwide surge in dengue cases, demonstrating the immediate connection between climate extremes and disease outbreaks. But Thomson’s analysis goes deeper, showing how warming temperatures change vector behavior—adult mosquitoes reproduce more quickly and bite more frequently in warmer weather, while pathogens multiply faster within vectors, creating higher concentrations of disease-causing organisms in each bite.

The Policy Challenge: Timeframes and Decision-Making

One of Thomson’s most significant contributions to climate-health policy thinking concerns the fundamental mismatch between climate science timescales and public health decision-making needs. Her analysis reveals a critical gap: while climate scientists can predict likely changes 50 to 100 years in the future with reasonable confidence, public health officials need actionable information for the next 5 to 15 years—precisely the timeframe that’s most difficult to predict accurately.

This temporal disconnect has profound policy implications. “Climate variability, which includes the impact of El Niño and La Niña, has a significant short-term impact on global temperatures and regional rainfall,” Thomson notes. “Longer-term trends in climate interact with this variability, meaning that making predictions for the next 5 to 15 years is very difficult. And this is the timeframe often requested by decision makers.”

Thomson’s solution involves bridging this gap through improved integration of climate science with health surveillance systems. Her work emphasizes that health officials dealing with malaria, dengue, or Zika control programs operate primarily within the timeframe of climate variability—what’s happening now, what happened last year, what might happen next year in specific localities. However, she argues that policy makers must simultaneously maintain awareness of longer-term climate trends to build the institutional capacity needed for future challenges.

This nuanced understanding of temporal scales has led Thomson to advocate for climate scientists who can “support decision makers across a range of time and spatial scales.” Her vision requires a new generation of interdisciplinary experts who can translate long-term climate projections into actionable short-term health guidance.

Building Predictive Capacity

Central to Thomson’s policy vision is the development of sophisticated early warning systems that integrate climate data with health surveillance. Her work at Columbia University’s WHO Collaborating Centre established global standards for malaria early warning systems, but her current role at Wellcome allows her to expand this approach to a broader range of climate-sensitive health threats.

Thomson’s team is currently funding 24 research teams from both climate and health backgrounds in 12 countries to develop new digital tools for responding to emerging CSID threats. This international network represents her vision of collaborative, technology-enabled health preparedness that can provide early warnings before disease outbreaks reach crisis levels.

One particularly innovative example comes from Vietnam, where researchers are developing E-DENGUE, a digital tool designed to predict dengue outbreaks as early as two months in advance. Tailored specifically for the Mekong Delta region, this system exemplifies Thomson’s approach to localized, climate-informed health interventions that give public health practitioners time to mobilize resources and concentrate interventions in the most affected areas.

This predictive approach represents a fundamental shift from reactive to proactive health policy. Rather than responding to disease outbreaks after they occur, Thomson’s vision involves health systems that can anticipate and prepare for climate-driven health threats before they manifest as public health emergencies.

Educational Infrastructure and Workforce Development

Perhaps Thomson’s most transformative policy recommendation involves fundamental changes to global health education and training. Her analysis reveals a critical gap: outbreak response teams may have access to excellent climate data, but if the health sector doesn’t understand how to interpret and use climate information effectively, even the best early warning systems will fail.

“I would incorporate some fairly straightforward information on climate and environmental disease drivers in all epidemiological training that happens around the world,” Thomson states. This seemingly simple recommendation represents a radical restructuring of public health education, requiring every epidemiologist to understand climate science basics and every climate scientist working in health applications to understand disease surveillance and outbreak response.

Her vision extends beyond formal education to ongoing professional development for current health workers. Thomson’s approach recognizes that the climate-health challenge cannot wait for a new generation of appropriately trained professionals; existing health systems must rapidly develop climate literacy to address current and emerging threats.

This educational transformation reflects Thomson’s understanding that effective climate-health policy requires cultural change within health institutions, not just new technologies or additional resources. Her work suggests that the most sophisticated early warning systems will fail if health professionals lack the conceptual framework to understand and act on climate-informed health guidance.

Global Equity and Resource Distribution

Thomson’s policy vision is deeply informed by her recognition that climate change’s health impacts are fundamentally unequal. Her analysis shows that countries making the smallest contributions to greenhouse gas emissions often face the most severe climate-health consequences while having the least capacity to respond effectively.

“Currently, lower-income countries—particularly those in tropical regions—bear the higher burden of CSIDs,” Thomson notes. This inequality stems from multiple factors: warm and humid climates that favor disease vectors, inadequate housing and infrastructure, limited healthcare capacity, and reduced resources for surveillance and response. Her work reveals that this combination creates heightened risk and reduced resilience in precisely the regions least responsible for the climate change driving these health threats.

However, Thomson’s analysis also shows that climate change is democratizing health risks in unexpected ways. As temperatures rise, cooler regions like Europe are becoming vulnerable to climate-sensitive diseases that were previously confined to tropical areas. Lyme disease, transmitted by ticks, exemplifies this pattern—it’s now spreading into northern Canada and Arctic regions where ticks previously couldn’t survive, and could lead to year-round tick seasons in areas of Scotland and elsewhere.

This shifting geography of health risks creates both challenges and opportunities for global health policy. Thomson’s vision involves leveraging the growing climate-health risks in wealthy countries to build political support for global climate-health preparedness that benefits all populations, not just those in the most privileged regions.

Innovation and Technological Solutions

Thomson’s policy framework emphasizes the critical role of innovation in addressing climate-health challenges. Her current work at Wellcome involves funding cutting-edge approaches to disease control that adapt to changing climate conditions. One promising example is the World Mosquito Program, which releases mosquitoes infected with Wolbachia, a naturally occurring bacterium that reduces mosquitoes’ ability to transmit viruses like dengue and Zika.

However, Thomson’s analysis reveals the complexity of climate-adapted interventions. Extreme heat can reduce the effectiveness of Wolbachia-based mosquito control, highlighting the need for heat-resistant strains in future control programs. This example illustrates her broader point about the dynamic nature of climate-health challenges: solutions must be designed to remain effective as climate conditions continue to change.

Her support for vaccine development represents another dimension of her innovation strategy. Recent advances in dengue and malaria vaccines offer hope, but Thomson’s approach recognizes that even breakthrough technologies must be integrated with climate-informed deployment strategies to achieve maximum effectiveness.

The Integration Imperative

Throughout her policy recommendations, Thomson emphasizes the need for fundamental integration between climate science and health systems. This goes beyond simply adding climate data to existing health surveillance systems; it requires reconceptualizing health as a climate-sensitive system that must be understood and managed within planetary boundaries.

Her vision involves health systems that routinely incorporate weather forecasts and climate projections into disease surveillance, outbreak response, and long-term planning. It requires urban planners to consider heat stress and vector breeding sites when designing cities, healthcare facilities to prepare for climate-driven surge capacity needs, and health professional education to treat climate literacy as essential rather than optional.

This integration imperative extends to international cooperation and governance. Thomson’s work suggests that effective climate-health policy cannot be developed by individual countries acting alone; it requires coordinated global action that recognizes climate change as a shared threat requiring shared solutions.

A Call for Systemic Transformation

Thomson’s vision for climate-prepared global health ultimately calls for systemic transformation rather than incremental improvement. Her analysis suggests that existing health systems, designed for stable climate conditions and predictable disease patterns, are fundamentally inadequate for the climate-changed world we now inhabit.

The path forward, according to Thomson, requires unprecedented integration of climate science and health policy, massive investments in predictive capacity and early warning systems, fundamental changes to health professional education, and global cooperation to address the unequal distribution of climate-health risks. Most importantly, it requires recognizing climate change not as a future threat to be managed, but as a present reality that is already reshaping global health in profound and irreversible ways.

Her work represents more than scientific research or policy analysis—it’s a blueprint for reimagining global health in an era of planetary change, where the boundaries between climate science and medical practice dissolve in the face of shared challenges that demand integrated solutions.

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