Prioritizing climate-sensitive zoonotic diseases in Bangladesh: integrating climate hazards, pathogen transmissibility and potential health outcomes.

Introduction: Zoonotic diseases, originating in animals and transmissible to humans, pose significant public health challenges globally. Many of these diseases are strongly influenced by climatic variations and extreme weather events, creating a compounded hazard. Bangladesh, a South Asian country highly vulnerable to climate hazards, is particularly at risk given the diversity of disease vectors and the vulnerability of livestock and human populations. Traditional decision-making frameworks often fail to address the complexities and uncertainties of these interactions, resulting in suboptimal disease prioritization for control interventions. Methods: We present the application of a prioritization protocol for climate-sensitive zoonotic diseases in Bangladesh. Using fuzzy analytical hierarchy process methodology, the prioritization protocol was tailored to the Bangladesh context, leveraging national expert knowledge while accounting for uncertainty in the expert elicitation process. Results: Our findings highlight that warming, precipitation, and floods were the critical climatic hazards, with pathogen evolution and vector population changes as key transmission mechanisms impacted by the identified climate hazards in Bangladesh. Mortality and transmissibility were deemed to be the most significant health outcomes resulting from the transmission mechanisms affected by the key climate hazards. The prioritization process identified Japanese encephalitis, visceral leishmaniasis, Chikungunya, anthrax and dengue as the most climate-sensitive zoonoses. Conclusions: Our findings contribute to Bangladesh's risk management processes against climate change in the context of zoonotic infectious threats. The results of the structured expert elicitation process emphasize the value of considering uncertainty in expert responses for improving the reliability, credibility, and usefulness of the elicitation outcomes.