Tuberculosis remains a critical infectious disease of risk, with reported notifications in England increasing by 11% in 2023 compared to the previous year. Meanwhile, climate change acts as a threat multiplier to nearly all sustainable development goals, including health. A wide body of evidence exists revealing a concerning association between TB burden and key risk factors likely to be affected by climate change. However, the potential scale of the effect of the climate crisis on TB burden via these pathways is still unclear. This project will generate evidence on the potential impact of climate change on TB, using innovative TB models to capture climate-sensitive TB risk factors for migrants from countries most likely to be affected.

Questions to be addressed:
We need to know how migration, particularly forced displacement, could drive TB transmission in order to understand how climate-induced displacement could increase risk of new TB infections.
We also need to know how changes in undernutrition and other key risk factors in migrants could affect progression from TB infection to disease, in order to understand how climate-mediated stress could increase TB burden.
Finally, we need to know how disrupted access to healthcare and increased vulnerability to TB could affect TB diagnosis and cure, in order to understand how climate-driven crises could increase unsuccessful TB treatment and death in migrant populations.

To achieve this, the project will develop TB models linking climate change to key risk factors, mapping the pathways from climate change to TB burden. The objectives will cover 3 broad areas:
i) The student will integrate models of climate-vulnerable populations and known migration routes with TB burden estimates, in order to estimate how migration could drive TB transmission;
ii) The student will develop risk-explicit TB transmission models linked to projections in risk factors (such as BMI), in order to estimate how changes in undernutrition could affect progression from TB infection to disease in populations;
iii) Finally, the student will generate cohort models of TB diagnosis and treatment linked to risk factors, in order to estimate how disrupted access to healthcare and increased vulnerability to TB could affect TB diagnosis and cure.

This will allow the student to quantitate and project key potential effects of climate change on TB, and model the potential effect of different intervention adaptation and mitigation measures, which will be used to support decision-making for the development of a climate-resilient TB programme.