Dear Sir,

In their article, Lysaght et al provided an insightful discussion regarding the future impact of the Zika virus on the Singapore region.(1) The authors also mentioned the importance of ecology and environmental interactions for emerging diseases. Today, researchers consider ecological impacts, such as those resulting from global warming or climate change, to be one of the major factors influencing the spread, emergence and changing pattern distributions of old and new diseases, with the role of determinants such as social factors, immigration and local animal populations (as reservoirs) likely to be magnified by environmental change.(2) Global climate change has been identified as an indirect ‘primary’ factor in modifying the capabilities of vectors for various diseases.(2) A change in characteristics relating to vectors was likely a major factor in the emergence of the Zika virus in Singapore.(3) Hence, even with a greater emphasis on public health controls, there will still be an increase in emerging disease events. What is of greater concern is that this may be only the beginning of observed climate-related diseases in this region and other locations.(4)

Lysaght et al’s editorial should serve as an international warning about poorly recognised infectious disease trends. Like many other countries, Singapore could soon begin to observe more diseases that were traditionally considered rare disease events as they become commonplace, especially in populations that are already marginalised in receiving preventative care (e.g. migrant workers and socioeconomically stressed populations).(4)

The issue of climate change is bigger than the worldwide spread of the Zika virus. It has been stated: “What were those of the past thinking and doing to put us in this environmental situation?”(5) This question may now be at the forefront of medicine.

Yours sincerely,

Lysaght T, Lee TL, Watson S, et al. Zika in Singapore: insights from One Health and social medicine. Singapore Med J. 2016;57:528-9.
Kurane I. The effect of global warming on infectious diseases. Osong Public Health Res Perspect. 2010;1:4-9.
Ebi KL, Nealon J. Dengue in a changing climate. Environ Res. 2016;151:115-23.
McIver L, Kim R, Woodward A, et al. Health impacts of climate change in Pacific Island countries: a regional assessment of vulnerabilities and adaptation priorities. Environ Health Perspect. 2016;124:1707-14.
Lange JH. Has the indoor and built environment started changing modern health?. Indoor and Built Environment. 2002;11:119-22.