Climate change presents complex and wide‐reaching threats to human health. A variable and changing climate can amplify and unmask ecological and socio‐political weaknesses and increase the risk of adverse health outcomes in socially vulnerable regions. When natural disasters occur in such areas, underlying climatic conditions may amplify the public health crisis. We describe an emerging epidemic of Zika virus (ZIKV) in Ecuador following the 2016 earthquake, which coincided with an exceptionally strong El Niño event. We hypothesize that the trigger of a natural disaster during anomalous climate conditions and underlying social vulnerabilities were force multipliers contributing to a dramatic increase in ZIKV cases postearthquake.

On 16 April 2016, a 7.8 magnitude earthquake struck coastal Ecuador, resulting in significant mortality and morbidity, damages to infrastructure, and psychological trauma. This event coincided with the first outbreak of Zika virus (ZIKV) and co-circulation with dengue virus (DENV) and chikungunya virus (CHIKV). We tested whether the degree of psychological distress was associated with the presence of suspected DENV, CHIKV, ZIKV (DCZ) infections three months after the earthquake. In July 2016, 601 household members from four communities in Bahía de Caráquez, Manabí Province, Ecuador, were surveyed in a post-disaster health evaluation. Information was collected on demographics, physical damages and injuries, chronic diseases, self-reported psychological distress, and DCZ symptoms. We calculated the prevalence of arbovirus and distress symptoms by community. ANOVA was used to compare the mean number of psychological distress symptoms between people with versus without suspected DCZ infections by age, gender, community and the need to sleep outside of the home due to damages. The prevalence of suspected DCZ infections was 9.7% and the prevalence of psychological distress was 58.1%. The average number of psychological distress symptoms was significantly higher among people with suspected DCZ infections in the periurban community of Bella Vista, in women, in adults 40–64 years of age and in individuals not sleeping at home (p < 0.05). The results of this study highlight the need to investigate the interactions between psychological distress and arboviral infections following natural disasters.

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Over the past decade, the Caribbean region has been challenged by compound climate and health hazards, including tropical storms, extreme heat and droughts and overlapping epidemics of mosquito-borne diseases, including dengue, chikungunya and Zika. Early warning systems (EWS) are a key climate change adaptation strategy for the health sector. An EWS can integrate climate information in forecasting models to predict the risk of disease outbreaks several weeks or months in advance. In this article, we share our experiences of co-learning during the process of co-creating a dengue EWS for the health sector in Barbados, and we discuss barriers to implementation as well as key opportunities. This process has involved bringing together health and climate practitioners with transdisciplinary researchers to jointly identify needs and priorities, assess available data, co-create an early warning tool, gather feedback via national and regional consultations and conduct trainings. Implementation is ongoing and our team continues to be committed to a long-term process of collaboration. Developing strong partnerships, particularly between the climate and health sectors in Barbados, has been a critical part of the research and development. In many countries, the national climate and health sectors have not worked together in a sustained or formal manner. This collaborative process has purposefully pushed us out of our comfort zone, challenging us to venture beyond our institutional and disciplinary silos. Through the co-creation of the EWS, we anticipate that the Barbados health system will be better able to mainstream climate information into decision-making processes using tailored tools, such as epidemic forecast reports, risk maps and climate-health bulletins, ultimately increasing the resilience of the health system.

Background The COVID-19 pandemic has further challenged the world's most vulnerable populations' access to adequate food. The UN World Food Program estimates that COVID-19 will increase worldwide food insecurity from 135 million to 265 million people by 2021. In March, 2020, Walking Palms Global Health (WPGH) initiated their More than Food Emergency Relief Program in Bahía de Caráquez, Ecuador, working with local government to deliver food and supplies to at-risk households. We aim to assess how WPGH's response affected households early in the 2020 pandemic. Methods Between March and July, 2020, rations were delivered to 225 families in rural, urban, and peri-urban communities within the city of Bahia de Caráquez located in the province of Manabí on Ecuador's west coast. These specific communities face frequent piped water disruptions, power outages, and mosquito-transmitted diseases such as dengue are endemic. In June, 2020, WPGH administered evaluations in the urban and rural communities, which included the World Food Program Food Confidence Score to address food consumption, food accessibility stress, and presence of chronic diseases. Findings Evaluations were conducted in 21 of 45 urban households (47%) and 45 of 50 rural households (90%). Overall, 66 households (69%) completed surveys and 29 (31%) opted out. The association between household income before COVID-19 and food insecurity was significant (p=0•04). Before the first programme delivery, 59 participants (92%) worried that their household would experience food insecurity and most often felt nervous or stressed about possible food insecurity (n=55 [85%]). Insufficient access to food led to 55 respondents (85%) skipping meals. Food confidence scores remained stable over the pandemic's most challenging period (Food confidence score=37•68% before deliveries and 38•11% during deliveries). Respondents (n=61 [95%]) reported that boxes allowed them to prepare enjoyable and culturally appropriate meals. The most common combination of meals cooked with box items was rice and beans, stews, corviche, empanadas, and plantains with 98% of participants finding every box item useful. There was no relation between food insecurity and number of children (p=0•26) or number of people in households (p=1•00). There was no significant association between chronic disease and pre-COVID-19 household income (p=0•24) or respondents' food security (p=0•82). Interpretation In communities that had high food insecurity before the pandemic, WPGH's response allowed households to maintain overall food consumption throughout the most challenging lockdown period. WPGH is currently working to innovatively and sustainably increase food security in the communities where they work. Limitations include programme administration relying on donor participation for financial support.