As Pakistan prepares for another monsoon season, the country faces a threat that extends beyond floods and infrastructure damage. Rising temperatures, erratic rainfall and increasing humidity are creating ideal conditions for dengue-carrying mosquitoes, raising the risk of another surge in infections. Climate change is no longer merely an environmental concern, it has become a major public health challenge.
Dengue outbreaks impose a heavy burden on Pakistan’s healthcare system, economy and communities. Hospitals become overcrowded during peak transmission periods, children miss school, adults lose valuable workdays and families bear significant medical expenses. As climate change accelerates, these outbreaks are likely to become more frequent and more severe unless preventive strategies evolve accordingly.
Scientific evidence increasingly shows that climatic conditions directly influence dengue transmission. Higher temperatures allow mosquitoes to develop more rapidly and shorten the time needed for the virus to multiply inside them. Increased rainfall and humidity create abundant breeding sites, particularly in densely populated urban areas where poor drainage and inadequate waste management allow stagnant water to accumulate. Together, these environmental changes expand both the geographical range and the duration of dengue transmission.
Climate variability may also influence the evolution of the virus itself. Pakistan has experienced shifts in the dominant dengue virus lineages over the past two decades. While DENV-2 Cosmopolitan Genotype has historically been the most common strain, recent outbreaks between 2022 and 2024 have been increasingly associated with DENV-1 Genotype III. Continuous genomic surveillance is therefore essential to detect emerging viral variants and understand whether these changes are driven by local evolution, repeated introductions from neighbouring countries or changing environmental conditions.
Despite this growing threat, Pakistan’s dengue surveillance system remains largely reactive. Public health authorities often intensify control measures only after outbreaks have already begun. This approach limits opportunities for early intervention and increases both healthcare costs and disease burden.
The country now needs a climate informed molecular surveillance system capable of detecting outbreaks before they escalate. Such a system would combine routine sample collection from sentinel hospitals with laboratory diagnosis, dengue serotyping, genome sequencing and phylogenetic analysis. Integrating these molecular data with climate information and epidemiological surveillance would enable health authorities to identify high-risk areas, detect emerging viral lineages early and implement targeted interventions before widespread transmission occurs.
Investment in surveillance is not simply a scientific priority, it is an economic necessity. Studies have estimated that the 2011 dengue outbreak imposed an economic burden of approximately US$11-12 million in just four Pakistani cities through healthcare expenditure and productivity losses. By comparison, establishing a provincial molecular surveillance programme would require only a fraction of those losses. Even modest reductions in outbreak size would generate substantial savings while protecting lives.
Punjab has already demonstrated strong commitment to strengthening public health programmes. Building on these initiatives, the province has an opportunity to establish Pakistan’s first comprehensive climate informed molecular surveillance network for dengue. Such a programme could serve as a national model by integrating laboratory diagnostics, genomic surveillance, epidemiological monitoring and climate data into a unified early warning system.
Pakistan should also embrace the World Health Organisation’s One Health approach, which recognises the interconnectedness of human, animal, vector and environmental health. Effective dengue prevention requires coordinated action across multiple sectors. Communities must be educated about eliminating mosquito breeding sites and seeking early medical care. Vector surveillance should monitor mosquito populations and insecticide resistance, while urban planners and local governments should prioritise drainage improvement, sanitation and environmentally sustainable waste management. Climate scientists, epidemiologists and biomedical researchers must work together to develop evidence-based policies that anticipate rather than simply respond to outbreaks.
Climate change is reshaping the landscape of infectious diseases across the world, and Pakistan is among the countries most vulnerable to its effects. Dengue control can no longer rely solely on seasonal mosquito control campaigns. It requires sustained investment in scientific research, climate informed surveillance, resilient urban infrastructure and coordinated public health planning.
The cost of prevention is far lower than the cost of repeated epidemics. Pakistan possesses the scientific expertise and institutional capacity needed to build a modern dengue surveillance system. What is needed now is the political commitment to act before the next outbreak arrives. The decisions taken today will determine whether the country continues reacting to dengue emergencies or begins preventing them.
Dr Kaneez Fatima is a molecular virologist and infectious disease researcher.
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