Playing Our Part in Addressing the Impact of Climate Change on Health

The year 2015 marked a turning point in the fight against climate change. The signing of the Paris Agreement during COP 21 in December marked an important step in the move toward limiting an increase in global temperatures. This agreement is not just a climate agreement; it is also a major health agreement. Indeed, as the World Health Organization (WHO) points out: “Between 2030 and 2050, climate change is expected to cause approximately 250,000 additional deaths per year, from malnutrition, malaria, and diarrhea to heat stress.”

In its report published in June 2015, the Lancet Commission on health and climate change warned about the threat that climate change represents for health: “The effects of climate change are being felt today, and future projections represent an unacceptably high and potentially catastrophic risk to human health. The implications of climate change for a global population of 9 billion people threatens to undermine the last half century of gains in development and global health.”

There is therefore a need for the international health community – public and private – to get mobilized to address this health challenge – and Sanofi is ready to play its part.
Climate change directly and indirectly affects social and environmental determinants of health, such as clean air, safe drinking water, nutrition, etc. Although global warming may bring some localized benefits, such as fewer winter deaths in temperate climates and increases in food production in certain areas, the health effects of a changing climate are likely to be overwhelmingly negative. Climate change is expected to lead to increases in ill health in many regions, and especially in low-income countries. Direct effects include temperature-related illnesses and death during extreme weather events. Indirect impacts include the influence of climate on microbial populations, the distribution of vector-borne diseases, host resistance to infectious agents, food and water shortages, food-borne diseases, and the consequences on non-communicable diseases such as cardiovascular and respiratory diseases.

Areas with weak health infrastructure – mostly in developing countries – will be the least able to cope with the negative health effects of a fossil fuel-based energy system or the indirect effects of climate change on their communities without assistance in preparing for, and responding to, the impacts of climate change.

In this context, in addition to the mitigation efforts already being carried out by Sanofi and its commitment to reducing greenhouse gas emissions, Sanofi brings its value by raising awareness about the consequences of climate change on health and by providing health solutions for climate-sensitive diseases.

Raising awareness about the impacts of climate change on health

Sanofi began addressing the climate change and health nexus a few years back. We set up an internal working group whose mission was to define the role that we should play on this issue – as a global health leader, Sanofi has a responsibility to address the threats posed by climate change. We developed a dedicated advisory board with external experts from the climate and health fields. This enabled us to better understand the stakes related to the impacts of climate change on health and identify areas in which we would have the greatest added value.
Our Chief Executive Officer, Olivier Brandicourt, embodies our commitment to tackle the impacts of climate change on health. In June 2015, he was one of many CEOs from the pharmaceutical sector who signed a statement to support the publication of the Lancet Commission’s report on climate change and health. On 27 November 2015, on the eve of COP 21, Brandicourt published an op-ed in the French newspaper Le Monde. This op-ed called for integrating health into the official negotiations of COP 21. It was translated into several languages and published in major newspapers in Brazil, Germany, India, Spain, and the United States.

This strong commitment also materialized through our involvement in COP 21. We were the only pharmaceutical company to be an official partner of COP 21. We also organized a series of events in December in Paris to raise awareness about the impacts of climate change on health, including a roundtable with representatives from international organizations (WHO, UN Foundation), a public conference with non-profit organizations (Drugs for Neglected Diseases initiative – DNDi), and discussions with climate and health experts.

Offering health solutions for climate-sensitive diseases

Over the years, we have developed expertise in many disease areas most likely to be affected by climate change. We work to provide solutions to prevent and respond to the direct and indirect impacts of climate change on health. This includes the development of medicines and vaccines to address the health risks of diseases such as dengue and malaria. Beyond the treatment or cure, Sanofi takes action in the field alongside its partners, working with local stakeholders to help individuals protect themselves against these diseases, including by increasing awareness.

Launching a new vaccine to combat dengue

Dengue is a viral disease transmitted to humans by mosquitoes, mainly in the intertropical zone (Southeast Asia, Indian Ocean, South Pacific, Latin America, West Indies). WHO estimates 50 million cases annually, including 500,000 cases of dengue hemorrhagic fever, which is fatal in 20 percent of cases. There are 2.5 billion people who live in at-risk areas.

Climate change may extend the transmission season and alter the geographical distribution of dengue, particularly due to weather variations (increased temperatures or tropical rains). This could lead to:

• increased number of mosquitoes as environmental conditions become more favorable; for example, it was recently demonstrated that high temperatures during El Niño periods were associated with dengue epidemics in Asia;
• the expansion of the vectors and virus to previously unaffected areas (e.g., in temperate regions such as North America and Europe);
• shorter incubation of the virus in the vector, leading to more explosive outbreaks;
• changes in vector biology and biting habits, facilitating increased transmission; and
• changes in human behavior, in response to climate change, that place them at elevated risk of dengue.

After 20 years of research and development, Sanofi Pasteur launched the first dengue vaccine. On December 9, 2015, Mexico was the first country to grant marketing authorization to Dengvaxia®, our tetravalent vaccine for the prevention of diseases caused by all four dengue virus serotypes in preadolescents, adolescents, and adults (aged 9 to 45) living in endemic areas. The marketing authorization of Dengvaxia® in Mexico was followed by approvals in the Philippines and Brazil in 2015 and El Salvador in 2016. We are introducing Dengvaxia® first in these countries where the vaccine has the greatest potential to reduce dengue burden globally and help achieve the WHO’s goal of reducing dengue mortality by 50 percent and morbidity by 25 percent by 2020 in endemic countries. Regulatory review processes for Dengvaxia® continue in other endemic countries, and Sanofi Pasteur remains committed to introducing the vaccine first in countries where the disease is a major public health priority.

Our integrated approach to fight malaria

Malaria is one of the most deadly infectious diseases in the world. According to WHO estimates, there were 214 million cases and 438,000 deaths from malaria in 2015, mostly among African children. In Africa, a child dies of malaria almost every minute.

Heavy rains and high humidity are identified as important factors for the reproduction and survival of infected mosquitoes responsible for transmitting the disease. Climate strongly influences the conditions for transmission of the disease. In warmer weather, mosquitoes carrying the parasites responsible for the disease multiply and quickly develop their infectious capacity. Africa and South America are especially at risk.

Sanofi promotes access to treatment at affordable prices in the areas most affected by malaria. In 2007, Sanofi developed Artesunate Amodiaquine Winthrop (ASAQ Winthrop®), one of the leading malarial drugs, under a public-private partnership with DNDi. Distributed at tiered prices in 34 countries, particularly in Africa, more than 400 million doses have been produced since 2007. Sanofi did not seek patent protection for that drug. Sanofi has also partnered with Medicines for Malaria Venture to develop new therapies to prevent the risk of resistance to existing treatment in Southeast Asia and the risk of expansion in Africa. Beyond medicines, Sanofi is strongly committed to awareness, education, and prevention programs with local communities. The “Schoolchildren against Malaria” program provides educational tools to help teachers educate children in Africa. Nearly 8 million children in 15 African countries have been sensitized to the fight against malaria. We collaborate with the National Malaria Control Program and local NGOs in a program to train educators, mainly about how to manage malaria. Finally, Sanofi is part of a collective process to develop knowledge about malaria and its treatment. We share data from clinical studies conducted with the Liverpool School of Tropical Medicine, and we develop means of surveillance in the countries most affected by the disease, in partnership with the National Malaria Control Program and DNDi.

Tackling climate-sensitive neglected tropical diseases

As pointed out by WHO, the risk factors around leishmaniasis include poverty, malnutrition, and population mobility but also climate change, as changes in rainfall, temperature, and humidity are factors that may impact the epidemiology of the disease. Sanofi provides glucantime, a treatment on the WHO List of Essential medicines, at a preferential price. In October 2015, Sanofi and the Institut Pasteur de Tunis signed a partnership agreement to launch a program aimed at combating cutaneous leishmaniasis in the school environment. This awareness-raising program is centered on the distribution of 70,000 comics (available in both French and Arabic) to schoolchildren in seven governorates where leishmaniasis is endemic. The program was launched in March 2016.

Asthma and allergies

Allergies are common and some are climate-sensitive. Warmer conditions generally favor the production and release of airborne allergies and, consequently, there may be an effect on asthma and other respiratory diseases. In May 2015, Sanofi and Regeneron announced positive pivotal phase 2b dupilumab data in adult patients with moderate-to-severe asthma who are uncontrolled despite treatment with inhaled corticosteroids and long-acting beta agonists. The companies also announced the initiation of a phase III clinical trial of dupilumab in patients with uncontrolled persistent asthma.

Continuing our efforts in mitigating climate change

We also fully recognize our responsibility to mitigate climate change and are actively seeking to develop innovative solutions to mitigate our impact on the environment. By taking concrete and scalable actions to mitigate climate change, we are contributing to immediate public health and economic co-benefits for the communities where we operate while reducing our impact on the climate. Through partnerships with energy providers, infrastructure developers, and research bodies, we aim to develop groundbreaking solutions that will have positive impacts on the health of the planet and people. For instance, we have installed a natural gas connection at our Swiftwater site in Pennsylvania. The project consisted of piping natural gas to the site and converting existing boilers to burn natural gas. The expected impact of using natural gas instead of light fuel oil represents an annual decrease in CO2 emissions amounting to 10,000 tons/year at this site alone. Moreover, we decreased our CO2 emissions by 24 percent between 2010 and 2015 by using maritime transport. Today, 86 percent of our international shipments are sent by sea. In 2015, we reduced our CO2 emissions by 15.8 percent compared to 2010 (scopes 1 and 2).

The future

Sanofi will continue to commit to tackling climate-sensitive diseases, for which we have a strong expertise. We will endeavor to offer adapted solutions for these diseases that may be impacted by climate change.

According to WHO, climate change may have had a role in the spread of the Zika virus. In February 2016, we announced that – building on our successful history in developing vaccines against similar viruses, including dengue – we are launching a vaccine research and development project targeting the prevention of infections and diseases related to the Zika virus.
We will also assess any opportunities to work with partners to promote awareness about the impacts of climate change on health, as collaborative efforts are needed to tackle what The Lancet calls “the biggest global health threat of the 21st century.”