https://orcid.org/0009-0003-6060-9782
Figures
Abstract
Climate change is expected to increase the risks associated with vector-borne diseases, and its implications for human health are already being observed across Canada. The objective of this review was to investigate the recommended adaptation strategies related to the risks associated with vector-borne diseases and examine how various levels of government in Canada are executing these recommended actions in their climate change adaptation plans. A combined methodology was employed, consisting of two distinct searches to examine both the recommended adaptation strategies in the peer-reviewed literature and the adaptation actions from governmental sources in the grey literature. Relevant sources were identified across four databases (Embase, Medline, Scopus, Global Health), as well as national, subnational, and municipal governmental websites across Canada. Data were categorized into eight (8) specific adaptation categories based on previously established frameworks. Data were also collected on which vector-borne diseases were referenced, the vulnerable population groups considered, and the inclusion of a One Health focus. A total of 198 peer-reviewed articles and 89 grey literature sources were reviewed, which contained a total of 591 groups of adaptation recommendations and 184 groups of adaptation actions. The categories of ‘Information and Research’, ‘Capacity Building’, and ‘Warning and Observation Systems’ demonstrated the greatest consistency between proposed recommendations and implemented actions. Our findings revealed a strong alignment between the recommended strategies and the adaptation measures being implemented. However, notable discrepancies were present among the categories of ‘Management, Planning, and Policy’, ‘Practice and Behaviour’, and ‘Laboratory Methods and Other Tools’, revealing gaps across the literature and potential opportunities for further action. While many recommended strategies are being incorporated into actions across Canada, significant regional variability and gaps remain. We advocate for an increased investment in adaptation measures targeting vector-borne diseases and a greater integration of the One Health approach in subnational and municipal plans.
Citation: Schryer R, Norman M, Kulkarni MA (2025) Investigating the recommendations and governmental actions to address the emerging risks of vector-borne diseases in Canada’s changing climate: A scoping review. PLOS Clim 4(9): e0000546. https://doi.org/10.1371/journal.pclm.0000546
Editor: Oscar Brousse,, University College London The Bartlett Faculty of the Built Environment, UNITED KINGDOM OF GREAT BRITAIN AND NORTHERN IRELAND
Received: December 16, 2024; Accepted: August 20, 2025; Published: September 29, 2025
Copyright: © 2025 Schryer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: This work was supported by the Natural Sciences and Engineering Research Council of Canada (NSERC; RGPIN-2019-04730 to MAK) and the Canadian Institutes for Health Research (CIHR; FRN#166112 to MAK). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing interests: The authors have declared that no competing interests exist.
Introduction
The effects of climate change on human and natural systems are predicted to have a significant impact on human health globally, including in North America [1,2]. One of the projected health impacts is the emergence and increase in incidence of vector-borne diseases (VBDs). Substantial evidence has underscored the role of rising temperatures, altered precipitation patterns, and extreme weather events in influencing vector distributions [1,2]. These changing conditions are expanding habitable areas for vectors such as ticks and mosquitoes, among other changes, further accentuating the potential impact on public health [1,2].
In Canada, these climate impacts are already being observed, with data linking the northward expansion of tick vector species to rising temperatures, and the subsequent rise in the incidence of Lyme disease [3,4]. Since becoming a nationally notifiable disease in 2009, surveillance data from the Public Health Agency of Canada (PHAC) has indicated an upward trend in reported Lyme disease cases, from 0.8 cases per 100,000 population in 2011 to a record high of 8.2 per 100,000 in 2021, with a majority of these cases (95.6% in 2020) reported in Ontario, Nova Scotia, and Quebec [5]. While other endemic mosquito-borne diseases, such as West Nile virus, Eastern equine encephalitis virus, and members of the California serogroup, are also endemic in parts of Canada, Lyme disease remains the most frequently reported vector-borne disease [6]. These trends highlight the urgent need for continued public health efforts focused on prevention, surveillance, and public awareness [4,5].
Scientific findings from the Synthesis Report (SYR) of the Intergovernmental Panel on Climate Change (IPCC) Sixth Assessment Report (AR6) show that the global surface temperature has increased by approximately 1.1oC during 2011–2020 in comparison to 1850–1900 [7]. Based on the historic and current data on greenhouse gas (GHG) emissions, these global warming changes have been primarily influenced by human activities [7]. Global responses to reduce the impacts of climate change on health include mitigation actions to reduce GHG emissions and adaptation actions to reduce health risks by reducing population exposures and enhancing resilience [8]. Despite advancements in adaptation planning and implementation across various sectors and regions, the success of these efforts is largely dependent on the capacity and efficiency of governance and decision-making processes, as emphasized by the IPCC [8].
Trends have indicated that Canada is warming at a rate that exceeds the global average [9]. As the world’s second-largest country (by geographical land area), Canada encompasses a vast array of geographies and environments [9]. Consequently, the impacts of climate change and the associated risks of VBDs are expected to vary significantly across its diverse regions [9]. While recognizing the inequities in health system access and outcomes across provinces and territories in Canada, it is crucial to understand the various adaptation measures designed to mitigate climate risks and reduce vulnerability [8]. Identifying key populations at risk remains complex, compounded by the multi-jurisdictional nature of government, presenting an opportunity to develop targeted responses that address specific regional needs and vulnerabilities [8,9].
To address these areas of interest, we conducted a scoping review to investigate the recommended adaptation strategies to address the emerging risks of VBDs in the context of climate change and examine how various levels of government across Canada are incorporating these strategies into their climate change adaptation plans. The question guiding this scoping review was, “What adaptation strategies are being recommended to effectively mitigate the emerging risks associated with VBDs in Canada, and how are governments incorporating these recommendations into their climate change adaptation plans?”. As climate change is anticipated to exacerbate existing inequities, and with growing recognition of the One Health approach, which underscores the interconnectedness of human, animal, and environmental health, we further sought to investigate how this framework is currently being integrated to support holistic response strategies, while also considering the needs of vulnerable populations, as outlined in the following sub-questions:
- How are governmental adaptation plans strengthening efforts in a multisectoral and interdisciplinary approach through the emerging paradigm, One Health?
- Are governmental adaptation plans specifically including a consideration for health equity or populations who may be at increased risk for VBDs?
Methods
We conducted a comprehensive scoping review employing a combined methodology of two distinct searches to examine both the peer-reviewed and grey literature, with an aim to meet our outlined research objectives. We adhered to the methodology outlined in the PRISMA-ScR extension for scoping reviews (PRISMA-ScR) [10]. The protocol for this review was registered on OSF Registries on July 10, 2024 (https://osf.io/9dbjg).
Eligibility criteria and search strategy
The peer-reviewed literature search identified recommended climate change adaptation strategies specifically related to VBDs. These recommendations were derived from both qualitative and intervention studies, consisting of plans, strategies, or actions suggested or proposed from a subject matter expert perspective. A search was conducted on July 18, 2023, across the following databases to identify relevant sources: Embase, Medline, Scopus, and Global Health. Access to non-open access sources was obtained through the University of Ottawa’s Omni library database network (available at https://www.uottawa.ca/library/). The search queries for each database were developed in consultation with a librarian from the University of Ottawa, and are shown in S1 Table of the Supplementary Information. Articles were included and excluded based on the criteria outlined in Table 1. Articles with a North American or global focus were included in the review to ensure broad consideration of potentially relevant adaptation recommendations; however, the potential bias due to inclusion of strategies related to non-endemic VBDs in Canada was addressed in the analysis through a two-stage approach.
For the grey literature, searches were conducted to identify current documents and plans from governments across Canada. Climate change adaptation plan documents with a consideration of VBDs were examined across governmental websites based on the inclusion and exclusion criteria in Table 2. Proposed climate change adaptation initiatives from multiple levels of government were investigated, including national, subnational, and the ten largest population municipalities (see Table 3 for a summary of the specific regions and corresponding two-letter abbreviations). A Level 1 search, conducted internally through the governmental website, or a Level 2 search, conducted through Advanced Google, was employed and recorded for each region shown in S2 Table of the Supplementary Information. Search terms were relevant to the concepts of climate change, adaptation, and VBDs.
Extracted data included adaptation strategies classified by a recommendation or an action, as referenced in the peer-reviewed and grey literature, respectively. These were organized into eight discrete categories. These categories were initially established using the existing titles outlined in the original framework by Austin et al. (2015); to these, the categories ‘Laboratory Methods and Tools’ and ‘Physical Infrastructure’, were constructed based on the analysis by Biagini et al. (2014). Lastly, ‘Other Strategies’ were incorporated as an additional category to capture the full range of adaptation options within the literature [11,12]. See Table 4 for a comprehensive description of each category. To provide an example, recommendations or actions involving the implementation of vector control strategies, use of biological or chemical management techniques, or personal protective measures, were categorized under ‘Practice and Behaviour’. For simplicity of the analysis, each recommendation or action was assigned to an exclusive category which best represented the overarching objective of the recommendation or action, with important consideration to the context within the respective literature source. Additional data on the specific VBDs mentioned, considered vulnerable population groups, and discussions surrounding the concept of One Health were also collected.
Screening and study selection
Peer-reviewed search results were imported into Covidence software (Veritas Health Innovation, Melbourne, Australia; available at www.covidence.org) to screen and manage the results of the search. The titles and abstracts of each article were screened and considered for full-text review by two independent reviewers (RS, MN) to determine their adherence to the inclusion criteria. Any conflicts were resolved through discussions between the two reviewers. A spreadsheet was used to systematically record information from sources identified by the grey literature search. For non-English language sources, files were uploaded and translated using the DeepL software (available at https://www.deepl.com/en/translator).
Data extraction
Information extracted from sources included study characteristics, geographic focus, article type, type of VBDs mentioned, discussion of One Health, and adaptation strategies. For the grey literature search, the data extraction procedure additionally included the respective level of government, the webpage searched to locate the source or document, and the hyperlink (if applicable).
Comparative data analysis
This review employed two independent analyses to assess the extent to which current climate change adaptation plans in Canada align with evidence-based recommendations. Recognizing that the adaptation actions specific to non-endemic VBDs may not be applicable to the Canadian context, the primary analysis examined adaptation strategies proposed in Canadian-specific sources (e.g., peer-reviewed literature with a geographical focus on Canada), while a secondary analysis considered recommendations from the broader body of global peer-reviewed research that met the inclusion criteria. For clarity, the main results for this review will focus on the primary analysis, with additional consideration of the secondary analysis addressed further in the results and presented in the discussion section.
Results
Search results
From the peer-reviewed literature search, 2970 sources were imported for screening, and 1101 duplicates were removed. A total of 1869 studies were screened for title and abstract, and 284 full-text studies were assessed for eligibility. Out of these, 86 studies were removed; most did not include VBDs or recommended adaptation strategies (n = 29) or were outside of the geographic scope (n = 20). A total of 198 peer-reviewed articles were included in the review (Fig 1). Of these, 43 sources were written within a Canadian context and were included in the primary analysis; this included two which also incorporated a global perspective, and one which additionally address North America more broadly. These sources consisted of primary research (34.9%), reviews (27.9%), books or chapters from scholarly literature (4.7%), and other sources (32.6%) such as commentaries, conference proceedings, editorials, reports, essays, and case studies. The other 155 peer-reviewed articles were comprised of global sources and were included in the secondary analysis (Fig 1). Among global literature (secondary analysis), 6 were written in other languages (French, German, Spanish, and Polish). For illustrative purposes, Fig 2 presents a schematic overview of the comparative analysis approach.
From the grey literature search, 89 relevant documents and sources were identified from selected governmental websites. Within these sources, 20 were national (22.5%), 43 were subnational (48.3%), 22 were municipal (24.7%), and 4 were regional (4.6%). A summary of these results is presented below in Fig 3. The review identified a total of 132 sources in the primary analysis and 287 in the secondary analysis.
Percentage distribution by A) Level of government (n = 89) B) Province/territory (n = 43) C) Municipal region (n = 22). Subnational region abbreviations: Alberta (AB), British Columbia (BC), Manitoba (MB), New Brunswick (NB), Newfoundland and Labrador (NL), Northwest Territories (NT), Nova Scotia (NS), Nunavut (NU), Ontario (ON), Prince Edward Island (PE), Quebec (QC), Saskatchewan (SK), and Yukon (YT).
Based on the adaptation classification system within the primary analysis, we extracted 122 recommendations from the peer-reviewed articles and 184 adaptation actions from the sources and documents from the grey literature. These numbers represent groups of recommendations or actions within each adaptation category, rather than individual items. Fig 4 presents a comparison of the proportions of these adaptation strategies across each of the eight adaptation categories previously described based on the results from the primary analysis. See the Supplementary Information for a complete summary of the extracted recommendations (S3 Table and S4 Table) and actions (S5 Table) from the peer-reviewed (primary and secondary analysis) and grey literature, respectively.
Types of VBDs
The types of VBDs referenced in adaptation strategies, compared to Canadian-specific sources (primary analysis), differed greatly between peer-reviewed and grey literature (see Fig 5). Peer-reviewed sources emphasized a wide range of non-endemic and endemic VBDs (to Canada), addressing both tick- and mosquito-borne diseases including Lyme disease (n = 29), West Nile virus (n = 19), Zika virus (n = 8), Dengue (n = 6), Chikungunya, (n = 6), Malaria (n = 5), mosquito-borne arboviruses causing viral encephalitis (n = 6), among many others (n = 47). In contrast, grey literature focused more broadly on VBDs (n = 61) without a specific reference to a particular disease among the adaptation actions outlined in governmental plans. Notably, the most frequently cited endemic VBDs in grey literature were Lyme disease (n = 34) and West Nile virus (n = 27).
Utilization of a One Health lens
In the peer-reviewed literature, 4 (9.3%) sources recommended adopting a One Health approach. Similarly, in the grey literature, 8 (9.0%) governmental plans emphasized the use of a One Health framework. Of these, the majority (87.5%) were referenced at the federal level (CA), while 1 (12.5%) plan mentioned One Health at the provincial/territorial level (ON).
Consideration for vulnerable populations and health equity
In the primary analysis, discussions highlighting the importance of considering vulnerable populations and health equity in climate change adaptation for VBDs were present in 12 (27.9%) peer-reviewed sources and 40 (44.9%) governmental documents from the grey literature. There was a diverse range of vulnerable groups mentioned across these discussions (see Fig 6). In the peer-reviewed literature, the most frequently cited groups included children and youth (n = 4), older adults and seniors (n = 4), those with low income (n = 3), those living in urban, rural, or remote regions (n = 3), and vulnerable populations in general (n = 3). In contrast, governmental actions from the grey literature focused more on vulnerable populations in general (n = 12), Indigenous communities (n = 11), those with health conditions or disabilities (n = 11), older adults and seniors (n = 10), and children and youth (n = 10).
Primary analysis: Comparison of governmental adaptation plans and actions to Canadian-specific literature
Category #1: Management, Planning and Policy.
Adaptation strategies classified in ‘Management, Planning and Policy’ include those related to management, planning, or policy, such as legislation, funding, or collaborative groups. This category was the most frequently recommended among peer-reviewed articles, representing 23 (18.9%) recommendations from the included sources. The most prevalent recommendations included multi-sectoral collaboration and coordination with an emphasis on partnerships, cooperative effort between stakeholders, networking among public health jurisdictions, seeking input and feedback from multiple sources (including the public), and incorporating a One Health approach [11,13–22]. Also emphasized was the recommendation to focus on the broader contexts affecting health in policy development, such as in concert with environmental factors, health promotion, other diseases affected by climate change, and addressing multiple health impacts at a time [18,23,24]. Planning should incorporate broader contexts, such as biopsychosocial and socioecological approaches, rely on frameworks (e.g., health promotion, public input), and include active consideration of the needs at different geographic and jurisdictional levels [11,18,20,23,25–30]. Governmental and public health institutions should commit to and take responsibility for coordinating and making strides in adaptation planning [11,17,19]. Planning agencies are also recommended to undergo prioritization exercises to determine priority agents and diseases to target in adaptation actions, including emerging and re-emerging VBDs [11,16,31].
This category was also most frequently cited among the grey literature, present in 61 (68.5%) of the included sources. Multisectoral or multidisciplinary collaboration and coordination were largely represented in the proposed and executed plans across all governmental levels [32–44]. National-level initiatives focused on a collaborative approach with respect to targeted investments in Lyme disease initiatives [42]. Provincial and territorial (NB, NT, ON) and municipal (Toronto, Vancouver, Winnipeg) strategies highlighted fostering partnerships with non-governmental organizations, agencies, and institutions in their adaptation actions [32–35,40,45]. Other adaptation plans related to this category involved consultation with diverse stakeholders to address climate change-related risks [37,41,42]. Funding relevant climate change adaptation plans was primarily discussed by the federal government (CA) [44,46–48].
Category #2: Practice and Behaviour.
Recommendations relating to the practices and behaviours to address VBDs, such as direct vector control methods, represented 10 (8.2%) recommendations from the included sources. Recommendations centered on specific interventions to reduce risk for VBDs, at the population, community, and individual levels, including lifestyle changes and preventative behaviours, as well as integrating activities to improve their feasibility and ease of delivery [17,49–51]. Additionally, recommendations emphasized the need to link control efforts with surveillance data to inform public health activities and respond to risks related to VBDs [49,52,53]. Targeting interventions was recommended based on signals from surveillance data, including environmental indicators, in an effort to improve the quality of recommendations for surveillance campaigns as well as direct interventions to where they will have the most impact [49,52,53].
From the grey literature search, this category was discussed in 8 (9.0%) of the included documents and sources. These initiatives involved engaging and partnering with stakeholders to enhance existing policies and practices (Edmonton) and adapting to climate-related threats by identifying risks and assessing vulnerability to VBDs (Pilot Infectious Disease Impact and Response Systems program, CA) [54]. Other activities largely discussed targeted practices to reduce disease transmission, equity-based adaptation strategies, targeted practices for Lyme disease, and promoting risk management [37,55–57].
Category #3: Information and Research.
The category of ‘Information and Research’, defined as any recommendation that centers around the need for specific research or evidence generation, and the creation and dissemination of information, was the second most prevalent category, comprising 29 (23.8%) recommendations from the included sources. The major sub-category in this section was expanding research to improve interventions and understanding of VBDs and related impacts of climate change, including the ecology, epidemiology, public health, and health impacts, perceptions of VBDs, use of new technologies for investigation, and best practices around education strategies [13,15,22–25,28,29,58–62]. Recommendations around communicating risk and information also comprised a large proportion of the results in this category, including strategic communication and education to targeted groups (healthcare professionals, public health, travellers, at-risk populations) [13,17,25,27,28,63,64]. Information should also be more readily shared with clinicians to improve clinical understanding of VBDs and their interventions [29,64]. Specifications around how information should be collected included using multiple sources (e.g., Indigenous populations, nurses, individuals impacted locally) to ensure that impacted and at-risk individuals’ input is included, combining research strategies to inform interventions, and expanding the use of vulnerability/risk assessments and health impact assessments [16,20,62].
This category was also the second most frequently discussed in 42 (47.2%) of the included documents and sources from the grey literature. Assessments of the local health risks of climate change were conducted both on the subnational level (BC, NB, NT) and the municipal level (Toronto, Montreal, Hamilton, Kitchener), and included a primary focus on the understanding of Lyme disease, vulnerable populations, and identifying favourable climate conditions [32,33,65–72]. Establishing priorities for future research was also highlighted by NB and NT [65,73]. NT emphasized investing and committing to interdisciplinary and wildlife-focused research to build an evidence base on the impacts of VBDs in the context of climate change [68,74,75]. Activities to support research activities included building research groups (such as the Canadian Centre for Climate Services, Climate Science 2050, the Infectious Disease and Climate Change Program, and Lyme Disease Research Network), developing research tools, and strengthening research more broadly [36,56]. Many reports also identified the need for future research (CA, NS, YT, Vancouver, Hamilton) in the following areas: best practices for VBDs, climate data, Lyme disease (including genetics, prevention, and control), and impacts of climate change on wildlife [34,36,38,42,43,45,54,56,76–78]. Communication improvements and commitments to sharing information about the issue were reported by CA, NT, Toronto, Hamilton, and focused on communication modalities (such as radio, Service Canada centres, social media, publications, plain-language summaries, online central repositories, and other existing channels) to connect with a wide range of audiences including Indigenous communities, governmental stakeholders, academic partners, and marginalized and racialized groups [69,75,76,79,80]. The federal government (CA) also developed education materials for Lyme disease (Canadian Federal Framework) and made commitments to supporting the generation of similar materials [56].
Category #4: Capacity Building.
Recommendations surrounding ‘Capacity Building’ included education, training, and building healthcare or public health capacity, and consisted of 20 (16.4%) recommendations from the included sources. The most frequent recommendations centered on educating the public, health-care professionals, and those working in public health and municipalities on VBDs and climate change [2,13,18,25,26,29,51,62,63,81]. Specific recommendations for engaging with the public included fostering public trust, strengthening partnerships (e.g., citizen science initiatives), and addressing social barriers to adaptation [28,50,82]. It is also recommended that establishing and acquiring resources for training and interventions be essential for capacity building [11].
This category was also discussed in 26 (29.2%) included grey literature sources. Activities for enhancing education for the public and healthcare professionals were discussed and implemented by both provinces (ON, SK) and municipalities (Toronto, Montreal, Hamilton), with a focus on raising awareness of the health and other impacts of climate change, Lyme disease, and other VBDs [33,40,76,83,84]. Building capacity by empowering youth and engaging them in climate change-related actions was also included in initiatives in subnational level plans (YT) [38,45,85]. Other initiatives at the subnational and municipal level involved commitments to increase public awareness and provide education and outreach materials to communities (NT, YT, Montreal, Ottawa) [47,71,74,85,86].
Category #5: Physical Infrastructure.
The category of ‘Physical Infrastructure’ included any recommendations with a focus on managing, designing, or adapting physical infrastructure, including urban areas or parks. These were present in 1 (0.8%) of the included peer-reviewed articles. The emphasis from Booth et al. included that the design of urban neighbourhoods needs to incorporate the considerations and possibility of vector-borne disease emergence [87].
This category was discussed in 3 (3.4%) of the grey literature sources. These activities involved contributing to climate change-related community land-use planning (Atlantic Region Adaptation Science Activities, NB) and building climate-resilience via investments in infrastructure (NT) [46,65].
Category #6: Warning and Observation Systems.
Recommendations relating to ‘Warning and Observation Systems’ consisted of 20 (16.4%) recommendations from the included sources. These included recommendations to develop and utilize early warning systems for climate-related health phenomena, with an emphasis on disease outbreaks surveillance and enabling rapid response [31,63,64,88]. The majority of recommendations centred on surveillance methods - including expanding efforts, prioritizing and targeting populations and vectors of interest, utilizing novel or alternate methods of surveillance (including new technology and data sources - such as environmental and wildlife data), and investing in long-term surveillance [13,17,18,22,23,25,26,28,31,49,50,53,60,61,81,88–90].
This category was discussed in 36 (40.4%) of the included documents and sources from the grey literature. Activities and plans outlined strategies for enhancing monitoring by detailing improvements, expansions, focus areas, and refinements. CA, NB, and ON discussed how monitoring programs were being improved via increasing accessibility, enhancing activities, and incorporating a One Health lens [6,32,40,54,56,80]. Expanding surveillance programs is being accomplished by focusing on cross-jurisdictional (CA, ON), nationalized (National Microbiology Laboratory, National Notifiable Disease Surveillance System, National Lyme Disease medical surveillance, CA), and expanded surveillance networks (QC) [4,41,57]. Many jurisdictions highlighted the monitoring of specific climate change indicators of VBDs. This included surveillance of specific species of concern (NT), emerging human and wildlife diseases (NT), suitable habitat areas (NT, SK), VBDs and vectors (NL, NT, SK, YT, NL, Toronto), meteorological and climate related factors (CA, QC), sentinel animals (CA), cases of disease (Ottawa, CA), and economic costs associated with VBDs (CA) [4,33,36,56,68,69,75,78,80,83,91–97]. Other reported aspects of surveillance included coordinated approaches and responses in surveillance networks (NB), considering health risks (NB, Kitchener), frequent reporting and alert systems (NT), established annual surveillance activities (SK), and including specific communities (such as Indigenous groups) in monitoring and surveillance efforts (CA, YT, YT/NT/NU) [32,36,65,72,74,91–93,98,99].
Category #7: Laboratory Methods and Other Tools.
Recommendations relating to ‘Laboratory Methods and Other Tools’, which broadly included any methods related to laboratory activities, field research, clinical diagnosis and management, and other tools related to VBDs, consisting of 17 (13.9%) recommendations from the included sources. Recommendations in this category highlighted the need to develop new diagnostic tools for VBDs, new personal protection equipment, and materials [29,58,60]. The development and refinement of tools were also recommended in the contexts of indices for monitoring VBDs, predictive models, and risk maps (including the use of AI and earth observation tools), and decision making at multiple levels of public health intervention [17,20,21,27,31,59,61,100,101].
This category was also discussed in 8 (9.0%) of the included grey literature sources. Identified activities included the provision of resources and tools (from the federal government to local public health professionals), and the development of new diagnostic and laboratory technologies at the national level [4,54]. Additional specific disease interventions included developments in mosquito and larvae trapping methods for West Nile virus and laboratory diagnostics for Lyme disease, both from the national level (CA) [56,80].
Category #8: Other Strategies.
Additional strategies that were not identified under the previous categories consisted of 2 (1.6%) recommendations from the included sources. These included the consideration of equity in adaptation strategies and addressing socio-cultural barriers to adaptation, in addition to the formal recognition of climate change adaptation co-benefits [28].
This category was not recorded in any of the included sources from the grey literature.
Secondary analysis: Comparison of governmental adaptation plans and action to Canadian and global literature
Management, Planning and Policy’ was most frequently cited among peer-reviewed articles (67.7% of sources). Similar to the Canadian-specific literature, most recommendations related to multi-sectoral collaboration and coordination with an emphasis on partnerships, cooperative effort between stakeholders, networking among jurisdictions, and accountability in governmental institutions [13–15,17,18,102–119,120]. Focus was also placed on investing in planning or development, financial incentives or funding, and the allocation of resources to climate change adaptation efforts [2,103,104,111,116,121–126]. Additionally, recommendations included monitoring and evaluating initiatives, adopting a One Health approach, and improving political commitment [13,17,18,108–110,112,113,127–136].
Recommendations under ‘Practice and Behaviour’ were present in 66 (33.3%) of the included peer-reviewed articles, centered on control measures to reduce vector populations and human exposures to VBDs, such as application of pesticides and biological control agents, indoor residual spraying, and the use of insecticide-treated nets [31,105,106,111,130,137–146,147]. Integrated vector management was also highlighted as a strategy [35,80–84,148,149], as well as linking control efforts with surveillance data to inform public health activities and respond to risks related to VBDs [64,66–68,85].
‘Information and Research’ was the second most prevalent category, consisting of 128 (64.6%) peer-reviewed recommendations, focused on developing communication strategies, conducting vulnerability and risk assessments, and improving research to understand the vectors and transmission of VBDs [11,17–19,24,28–30,81,102,105,106,114,115,123,133,136,148,150–168]. Strategies proposed the creation of evidence-based messaging to communicate relevant information about VBDs to the public [16,22,39,47,78,82–84,86,87,92–94,115–118].
Recommendations under ‘Capacity Building’ included 72 (36.4%) from peer-reviewed sources, most frequently centered on educating the public and healthcare professionals on VBDs and climate change while strengthening health systems [2,12,19,24,28–34,81,103,105,109,110,113,124,129,138,139,141,169,170,154–165,171,172]. Strategies were directed towards the general public, which involved educating and raising awareness about VBDs and the general health impacts of climate change [2,19,26,30,71,72,74,94,99,114,136–144]. Education for healthcare professionals additionally included health research engagement and policy evaluation involvement change [2,38,43,70,90,97,106,134,139,142–146,169,173]. Strengthening health systems and public health infrastructure was also recommended to respond to climate change risks and for monitoring VBDs [19,25,28,102,104,110,130,139,156,157,174,175,176].
Recommendations under ‘Physical Infrastructure’ consisted of 15 (7.6%) peer-reviewed recommendations, focusing on environmental water management and urban or housing design [17,20,25,43,51,137,138,143,155,156].
It was suggested that infrastructure should be designed and adapted to respond to flooding and rising sea levels to control mosquito breeding sites [110,136,177,178,179,180]. Housing quality and air conditioning were also a recommended strategy in urban design for preventing exposure from VBDs [181].
Recommendations under ‘Warning and Observation Systems’ included 105 (53.0%) peer-reviewed recommendations, with strong emphasis on recommendations to develop and utilize early warning systems (EWS) [2,30,63,64,105,109,117,145,160,178,182,179,183,184–190]. It was also recommended that surveillance be enhanced through increased investment and improvement, particularly in outbreak investigations. Suggestions involved updating systems, tailoring approaches to specific contexts, and extending the duration of surveillance efforts, with a focus on nationalizing these practices and ensuring actionable results [18,21,23,24,26,36,38,40,43,49,74,90,92,99,101,108,111,113,114,141,169,170,150,164,167,168,171,177,178,191–193,194,195,196]. Areas for enhanced surveillance include animal and wildlife, global, baseline, occupational, entry points, and the effectiveness of interventions [31,45,48,75,78,107,115,165,174,179,182,197]. Suggested methods surrounding surveillance involved passive or citizen-driven, community or population-based, disease-specific approaches, and the use of new technologies [53,198,199]. It was proposed that surveillance efforts should be integrated, combining traditional vector and vector-borne disease monitoring with environmental and veterinary surveillance [28,30,106,108,111,115,121,130,143,145,152,163,183,180,190,200–205].
Recommendations under ‘Laboratory Methods and Other Tools’ included 62 (31.3%) peer-reviewed recommendations, highlighting the need to develop new genetic and laboratory technology, insecticides, vaccines, therapeutics, and diagnostics [2,58,128,170,151,161,162,164,206,207]. There was also emphasis on developing and utilizing tools such as 3D visualization, mapping, GIS, remote sensing, and other methods such as wastewater detection for VBDs [17,27,61,90,105,144,165,208,209,210,211]. Designing and implementing tools for decision making and reporting were also strongly highlighted [2,21,100,127,129,212,213]. Other recommendations included the use of machine learning and artificial intelligence to understand vectors, transmission cycles, and analyze relevant data [2,60,161,167,175,214,215].
Discussion
Concordance and discordance of recommendations and governmental actions
This review highlights the extensive range of existing recommendations for climate change adaptation in response to the emerging risks presented by VBDs in Canada. Notably, it identifies that federal, provincial/territorial, and municipal governments across Canada are actively recognizing and addressing these risks in their climate change adaptation plans. Proposed recommendations and actions were consistently aligned across the categories of ‘Information and Research’, ‘Capacity Building’, and ‘Warning and Observation Systems’. More broadly, there is a strong concordance between the recommended strategies and the adaptation measures being undertaken by Canadian governments at various levels (Fig 4).
The largest discrepancies between the recommendations and the planned actions were found within the categories ‘Management, Planning, and Policy’, ‘Laboratory Methods and Other Tools’, and ‘Practice and Behaviour’. The portion of recommendations in these areas is not reflected equally in the adaptation actions. A notable gap in Canada’s adaptation plans is the lack of detailed environmental control mechanisms and specific targets for VBDs under the ‘Practice and Behaviour’ category. Although specific actions relating to promoting individual measures, particularly in occupational settings, were proposed in the literature, they were absent from adaptation plans. While environmental control activities may be taking place, their integration into outlined climate change adaptation plans was notably absent. Moreover, the reviewed adaptation plans did not address the use of novel technologies for monitoring and predicting the spread of VBDs, another key area emphasized in the literature. Numerous sources recommend employing predictive modeling, remote sensing, GIS, artificial intelligence, machine learning, mapping technologies, and 3D visualizations to better understand and predict the dynamics of VBDs. As these technologies become more widespread, particularly the use of artificial intelligence, it will be worth observing whether their inclusion in adaptation plans increases over time.
The reviewed literature also underscored the need for strong management in climate change adaptation, particularly regarding leadership, advocacy, and collaboration across leadership groups, accountability, and responsibility. While these elements are crucial for driving meaningful action, they were notably absent from the governmental plans examined. Additionally, the literature calls for a range of both targeted and broad research initiatives, including studies on weather and climate, new tool development, and research specific to VBDs. While research may not necessarily be conducted at the governmental level, this area is still underrepresented in the current adaptation plans.
The literature also highlights the importance of robust information gathering to inform effective adaptation strategies. This includes conducting geographic analyses, evaluating adaptation capacity costs, assessing health impacts, and analyzing communication strategies—none of which are explicitly addressed in the existing plans. Although education is featured in many plans, specific recommendations for educating patients and policymakers about the impact of climate change on VBDs are missing, as are recommendations related to capacity building, particularly in vulnerable regions.
In terms of physical environmental controls, the literature advocates for a broader focus on structural elements, such as urban neighbourhood design, but this is not necessarily incorporated into the adaptation plans. Additionally, various surveillance approaches are highlighted in the literature, including combinations of surveillance systems and modalities. For instance, three studies recommended passive or citizen-based surveillance interventions, yet these methods are not explicitly identified in any governmental plans.
Characterizing the landscape of Canadian adaptation actions
Regional differences.
In examining climate change adaptation plans at the national, subnational, and municipal levels, there was an uneven distribution across regions spanning multiple areas. Notably, there was a relative overrepresentation from the territories (YT/NT/NU), which accounted for over 30% of all provincial and territorial documents. This aligns with the well-documented uneven distribution of rising temperatures across Canada, with northern regions, including YT/NT/NU, experiencing the most significant warming [9,216]. These findings, along with the establishment of the Pan-Territorial Adaptation Partnership, provide strong evidence that these regions are taking collective action and are committed to implementing practical adaptation measures in response to emerging climate-related threats [99]. In this context, this overrepresentation of territorial plans may also reflect important regional disparities in the emergence and distribution of VBDs across Canada, particularly in areas undergoing rapid climatic change.
Among other regions, adaptation plans from Atlantic Canada (NB, NL, NS, PE) had the second most recorded sources (20.9%), followed by the Prairie provinces (AB, MB, SK) (18.6%), the Central Canada (ON, QC) (18.6%), and the West Coast (BC) (7.0%).
Endemic vs. non-endemic VBDs in Canada.
Based on current distributions and climate conditions described by Otten et al. (2020), the highest priority endemic VBDs of public health importance in Canada were identified as Lyme disease, West Nile virus, Cache Valley virus, and Babesiosis, while those concerned to become endemic under future climate conditions include Eastern equine encephalitis, Powassan virus, La Crosse virus, Rocky Mountain spotted fever, and Plague, among others [21]. The authors defined endemic VBDs as those with current and constant presence in the human population for at least two or more consecutive years up to 2016 [21].
Interestingly, the majority (56.5%) of VBDs cited in the peer-reviewed literature examined in Canadian-specific sources (primary analysis) were non-endemic. This included references to viruses such as Zika, Dengue, Chikungunya, and La Crosse virus, as well as Eastern equine encephalitis. While Canada’s current climate does not support vectors for many of these diseases and/or suitable temperatures to sustain transmission, this finding may also be a concern for the potential introduction or establishment of non-endemic VBDs as conditions change [21].
In contrast to the peer-reviewed literature, the VBDs highlighted in governmental plans and adaptation strategies primarily reflected those currently endemic to Canada, such as Lyme disease and West Nile virus [217]. However, most governmental plans (46.9%) addressed VBDs in broad or general terms, without specifying which diseases their interventions target. It remains unclear whether these governments are taking a comprehensive, proactive approach to monitoring and preparing for VBDs or if they are inadequately prepared for the emerging threats in their regions. Further examination of these adaptation plans is needed to better understand the level of preparedness across different regions of Canada.
Representation of Indigenous communities.
In addition to groups experiencing health conditions or disabilities, Indigenous communities were the leading population being most strongly represented within the grey literature, appearing in 11 (13.6%) of the governmental action plans that specified groups beyond vulnerable populations in general. This aligns with Canada’s national commitment and efforts to achieve reconciliation with Indigenous Peoples through active involvement and partnership [218]. According to the 2021 Census by Statistics Canada, over 1.8 million people in Canada identify as Indigenous, making up 5% of the country’s total population [219]. Indigenous populations, including First Nations, Inuit, and Métis, are important groups to consider as climate change poses unique threats to their natural resources, ecosystems, and cultural practices [74]. This focus on Indigenous communities in climate change adaptation strategies is consistent with the findings of our study. Governmental plans, such as those in the NWT, highlight the importance of fostering strong partnerships, effective communication, and coordinated actions to support Indigenous and Northern communities [75]. These plans emphasize the need to incorporate traditional knowledge into adaptation responses [75]. Similarly, the National Inuit Climate Change Strategy, developed by the Inuit Tapiriit Kanatami (ITK)- a national organization that represents Inuit communities across Canada- reflects these same recommendations [220].
Indigenous communities are disproportionately affected by environmental changes, as climate change is negatively impacting wildlife and ecosystem health, which in turn threatens traditional food systems, hunting and fishing practices, and their overall livelihoods [74]. Consequently, it is critical for adaptation strategies to prioritize these communities to uphold health equity and address the specific vulnerabilities they face. This recognition in the grey literature reflects a growing awareness of the need to include Indigenous perspectives and leadership in developing effective climate adaptation actions.
One Health
Given the need for collaboration in climate change responses, it is important to examine how the One Health paradigm, an emerging multisectoral and interdisciplinary approach, has been integrated into existing adaptation plans [221]. Notably, only a small proportion of the reviewed plans (9.0%) explicitly mentioned One Health, with 7 out of 8 (87.5%) of these initiatives being conducted at the national level. This representation could be attributed to the nature of the documents retrieved, as federal reports tend to focus on broad, overarching strategies, whereas provincial, territorial, and municipal documents typically emphasize specific actions or initiatives. It may also reflect Canada’s current position as a “leader in One Health” [221].
The One Health approach is intrinsically linked to the most cited category, ‘Management, Planning, and Policy’, where several provincial and territorial plans (NB, ON, YT) and municipal plans (Toronto, Vancouver, Winnipeg, Quebec City) incorporated multidisciplinary or collaborative action. While these plans may already be applying One Health principles without explicitly stating it, they could benefit from formalizing a One Health strategy to provide a clear structure and coordination for planning and execution.
Additionally, One Health is highly relevant to ‘Information and Research’, which is well represented in adaptation plans across the country (NT, ON, SK, YT, Montreal, Hamilton, Toronto, Ottawa). The approach also underpins the category of ‘Warning and Observation Systems’, particularly in the development, improvement, and expansion of surveillance efforts and networks, where One Health principles are critical to a comprehensive response.
Scope and limitations
This review takes a comprehensive approach to assess the recommended adaptation strategies and governmental actions for addressing the emerging risks posed VBDs in Canada; however, several limitations should be acknowledged. First, while adaptation strategies were grouped using frameworks previously established in the literature, we recognize that specific recommendations or actions often belonged to multiple categories. To account for this, data were extracted into categories which most strongly reflected the intended objective outlined by the respective recommendation or plan. While the reported frequencies offer insight into the relative distribution within each category, they should not be used as standalone metrics for interpretation.
Additionally, the geographic scope was limited to Canada, and municipalities were selected based on population size. While our search strategy focused on sources explicitly linking adaptation, VBDs, and climate change, this may have potentially overlooked relevant recommendations and actions that did not explicitly mention climate change adaptation. This may explain gaps, particularly in ‘Practice and Behaviour’, where ongoing activities such as vector surveillance may have been excluded. When interpreting the findings of this review, it is also important to recognize that the absence of identified actions or plans from internal and advanced searches does not necessarily imply that such actions are not being undertaken.
Conclusions
This review provides valuable insights into Canada’s response strategies related to climate change and VBDs, highlighting some discrepancies between what is being recommended in the literature and how governments are integrating these recommendations into their climate change adaptation plans.
It is apparent that coordinated, evidence-based adaptation strategies across all levels of government are essential to effectively address the impacts of VBDs and climate change on health. Our review demonstrates that while many recommended strategies are being incorporated into actions and plans across Canada, there are significant regional variabilities and gaps that remain in certain adaptation areas. To strengthen Canada’s response and preparedness, it will be important to increase investment in adaptation measures targeting emerging risks of VBDs and promote broader integration of the One Health approach in subnational and municipal plans. Prospective research should expand our current methodology to diverse global regions to identify worldwide trends in implementation. Additionally, subsequent investigations could assess the effectiveness of both proposed and implemented adaptation measures, contributing to a more comprehensive understanding of how to effectively respond to VBDs in the context of a changing climate.
Supporting information
S1 PRISMA Checklist. Preferred reporting items for systematic reviews and meta-analyses extension for Scoping Reviews (PRISMA-ScR) checklist.
https://doi.org/10.1371/journal.pclm.0000546.s001
(DOCX)
S1 Table. Search query for each database used to identify peer-reviewed articles.
https://doi.org/10.1371/journal.pclm.0000546.s002
(DOCX)
S2 Table. Conducted search for each region used to identify grey literature documents.
https://doi.org/10.1371/journal.pclm.0000546.s003
(DOCX)
S3 Table. Detailed summary of peer-reviewed literature results (primary analysis) of recommended climate change adaptation strategies relating to VBDs.
https://doi.org/10.1371/journal.pclm.0000546.s004
(DOCX)
S4 Table. Detailed summary of peer-reviewed literature results (secondary analysis) of recommended climate change adaptation strategies relating to VBDs.
https://doi.org/10.1371/journal.pclm.0000546.s005
(DOCX)
S5 Table. Detailed summary of grey literature results of climate change adaptation actions relating to VBDs.
https://doi.org/10.1371/journal.pclm.0000546.s006
(DOCX)
S1 Data. Summary characteristics of included peer-reviewed literature (primary analysis).
https://doi.org/10.1371/journal.pclm.0000546.s007
(XLSX)
S2 Data. Summary characteristics of included peer-reviewed literature (secondary analysis).
https://doi.org/10.1371/journal.pclm.0000546.s008
(XLSX)
S3 Data. Summary characteristics of included grey literature.
https://doi.org/10.1371/journal.pclm.0000546.s009
(XLSX)
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