A Fever They Did Not Cause: Dengue, Climate Injustice, and the Communities on the Front Lines

Dengue fever cases have surged to record highs globally. In 2024, the Pan American Health Organization reported the highest dengue caseload in recorded history for the Americas. Across East Africa — Kenya, Uganda, Tanzania — dengue transmission zones are expanding as temperatures rise and rainfall patterns shift, extending the range of the Aedes aegypti mosquito into communities that had never before faced the disease. The WHO now lists dengue as one of the ten greatest public health threats globally, and the trajectory is upward.

The countries and communities carrying the highest dengue burden are not the ones who caused the climate conditions driving it. Sub-Saharan Africa, South and Southeast Asia, and Latin America account for a fraction of historical carbon emissions. The nations that industrialized earliest — and emitted most heavily over the past two centuries — sit largely outside the dengue belt. The fever follows the heat. The heat follows the emissions. And the emissions were never distributed equally.

What Climate Justice Requires Us to Name

Climate justice is not an abstract framework. It is a precise description of a specific injustice: the communities that contributed least to the carbon emissions driving climate change are bearing the most severe and immediate consequences of its effects — including the geographic expansion of infectious diseases like dengue, malaria, and chikungunya that thrive in warming, wetter conditions.

In Kenya, climate change is extending dengue’s reach beyond Mombasa and coastal zones into highland areas that were previously too cool for sustained Aedes aegypti populations. In Uganda, changing rainfall patterns are creating year-round mosquito breeding conditions in communities that previously saw seasonal peaks. This is not a natural disaster without a cause. It is the predictable outcome of over a century of industrial carbon emissions, concentrated in the wealthiest nations, whose consequences are concentrated in the communities with the fewest resources to respond.

The framing of dengue as a “tropical disease” or a “developing world problem” obscures this causal chain. Dengue is a climate justice problem. The communities experiencing it are not passive victims of bad geography. They are bearing an externalized cost of a global economic system that enriched others on their ecological account.

What Community-Led Response Looks Like

Public health responses to dengue typically center on vector control (eliminating mosquito breeding sites), vaccination (where the Dengvaxia and Qdenga vaccines are available), and fever management. These are real tools — echoing the promise of the new R21 malaria vaccine now reaching communities across Sub-Saharan Africa. They also echo the everyday, household-level work of adapting a wellness routine to an emerging infectious threat — the same posture of preparedness communities are being asked to hold for avian flu applies just as much to dengue’s expanding front lines. But communities on the front lines have also developed their own forms of environmental intelligence — knowledge about water pooling patterns, mosquito behavior, plant-based repellents, and early symptom recognition — that formal public health programs frequently ignore or bypass.

Community health workers in East Africa, often women, often working without formal infrastructure, have been the actual first line of response: going door to door, distributing nets, identifying cases, educating neighbors. These are not supplementary to the public health response. They are the public health response in many communities. Their knowledge, labor, and community trust are what make interventions work at the household level. Yet they are systematically underfunded, underrecognized, and excluded from the policy conversations that allocate resources.

African ancestral environmental knowledge also matters here. Indigenous plant knowledge — including plants with documented mosquito-repelling properties like lemongrass, basil, and neem, all present in African traditional pharmacopeias — offers community-accessible, low-cost harm reduction that formal health systems rarely integrate. What grandmothers knew about plant medicine is not a backup plan. It is parallel infrastructure.

The Debt That Is Owed

Climate financing — the commitment of wealthy nations to fund adaptation and loss-and-damage response in countries bearing the brunt of climate impacts — is among the most underfulfilled promises in global governance. The communities now managing dengue outbreaks on expanding disease frontlines are managing a crisis they are owed resources to address. This is not charity. It is accountability for a debt created by emissions that enriched the lenders and sickened the borrowers.

The history of colonialism and global health is the history of extracting resources from communities while leaving them to bear the costs of that extraction. Climate change is the latest chapter. The communities on the dengue front line did not choose this. They are choosing, nonetheless, how to respond — and they are responding with the knowledge, the relationships, and the community infrastructure that has always been their first line of survival. —MM

References

Pan American Health Organization: Dengue — 2024 Record Caseload

WHO: Dengue and Severe Dengue — Global Threat Overview

PMC: Climate Change and Dengue Range Expansion in Africa

PMC: Climate Justice and Infectious Disease Burden

Related Reading

• ‣ Colonialism & Global Health Policy
• ‣ When the Land Returns to Its Keepers
• ‣ What Our Grandmothers Knew: African Herbalism
• ‣ Plastic in the Womb: Environmental Racism and Reproductive Justice

Michele Mitchell is the Founder, President & CEO of Ubuntu Village Inc., a 501(c)(3) nonprofit with programs in Kenya, Uganda, and Nigeria. A writer, advocate, and community strategist working at the intersection of ancestral wisdom, public health, and community power, Michele leads Ubuntu Village’s work to center communities as the protagonists of their own healing. She writes from the conviction that science and spirit are complementary, that healing is relational, and that community is the medicine. Read more about Michele, or connect with her on LinkedIn.