Mitigating imported fuel dependency in agricultural production: Case study of an island nation's vulnerability to global catastrophic risks.

A major global catastrophe would likely disrupt trade in liquid fuels. Countries dependent on imported oil products might struggle to sustain industrial agriculture. Island nations importing 100% of refined fuels are particularly vulnerable. Our case study aimed to estimate the agricultural land area and biofuel volumes needed to feed the population of New Zealand in the absence of trade. Results showed that stored diesel would quickly be exhausted with ordinary use (weeks) and even with strict rationing (months). To preserve fuel, we found that farming wheat (requiring as little as 5.4 million liters [L] of diesel per annum) was more fuel-efficient than potatoes (12.3) or dairy (38.7) to feed the national population under a climate-as-usual scenario. In a nuclear winter scenario, with reduced agricultural yields, proportionately greater diesel is needed. The wheat would require 24% of current grain-cropped land, and the canola crop used as feedstock for the required biofuel would occupy a further 1%-7%. Investment in canola biodiesel or renewable diesel refineries could ensure supply for the bare minimum agricultural liquid fuel needs. Were subsequent analysis to favor this option as part of a fuels resilience response and as a tradeoff for routine food use, expansion in refining and canola cropping before a catastrophe could be encouraged through market mechanisms, direct government investment, or a combination of these. Logistics of biofuel refining scale-up, post-catastrophe, should also be analyzed. Further, biodiesel produced in normal times would help the nation meet its emissions reduction targets. Other countries should conduct similar analyses.

Food security during nuclear winter: a preliminary agricultural sector analysis for Aotearoa New Zealand.

AIM: We aimed to estimate the current dietary energy content of food exports for Aotearoa New Zealand and food security during "nuclear winter" scenarios following a nuclear war. METHODS: From published sources we estimated dietary energy available from the major domains of food exports, with adjustments for wastage. The impacts on food production in New Zealand during three nuclear winter scenarios were based on those published in Nature Food in 2022 and from an earlier New Zealand Planning Council study. RESULTS: Current major food exports are equivalent to 3.9 times current dietary energy intakes for all New Zealand citizens i.e., 34,100 kJ (8150 kcal) per person per day. Exported dairy products were estimated to be able to provide 338% of this energy intake, followed by exports of meat (34%), fruit (8.6%), alcohol (4.8%), marine products (4.6%) and vegetables (2.7%). During the various nuclear winter scenarios considered (minimal to severe), food production available from diverted exported foods was estimated to still be 3.6 to 1.5 times current daily energy intakes. Nevertheless, the agriculture sector could be at risk of various levels of collapse from lack of imports (e.g., diesel, fertiliser, pesticides, seeds, and machinery parts) and from socio-economic collapse, including if the financial system collapsed. CONCLUSIONS: This analysis suggests that this country could theoretically have excess food production capacity, even after a severe nuclear winter scenario. But this benefit could be very short-term if the agricultural system was not made more resilient to potential lack of international trade and socio-economic collapse in a post-catastrophe setting.

Mathematical optimization of frost resistant crop production to ensure food supply during a nuclear winter catastrophe.

This study aimed to estimate the optimal mix of frost resistant crops and land area needed to provide basic nutrition during various nuclear winter scenarios for New Zealand (NZ), a temperate island nation. It used linear programming to minimize land area required for cropping while producing enough food to achieve dietary energy and protein requirements for the whole population. The potential agricultural impacts of three nuclear winter scenarios on NZ, were sourced from the literature. The optimized combinations of frost resistant crops that were found to feed the entire population were, in descending order: wheat and carrots; sugar beet; oats; onions and carrots; cabbage and barley; canola and cabbage; linseed and parsnip; rye and lupins; swede and field beans; and cauliflower. But in terms of current production levels of these frost resistant crops in NZ, there would be a 26% shortfall for the "war without a nuclear winter" scenario and a 71% shortfall for the severe nuclear winter scenario (150 Tg of soot in the stratosphere with a 61% decline in crop yields). In conclusion, at current production levels, frost resistant food crops could not feed all NZ citizens following a nuclear war. There is a need for the NZ Government to conduct a detailed pre-war analysis on how these shortfalls are best addressed. For example, by: increased pre-war production of these crops and/or post-war scalability; growing enough frost sensitive crops (i.e., in greenhouses or the warmest parts of the country); and/or ensuring continuing production of food derived from livestock fed on frost resistant grasses.

Impact of the Tambora volcanic eruption of 1815 on islands and relevance to future sunlight-blocking catastrophes.

Island nations may have potential long-term survival value for humanity in global catastrophes such as sun-blocking catastrophes from nuclear winter and large magnitude volcanic eruptions. One way to explore this issue further is to understand the impact on islands after the largest historically observed volcanic eruption: that of Mt Tambora in 1815. For each of the 31 large, populated islands selected, we conducted literature searches for relevant historical and palaeoclimate studies. We also analysed results from a reconstruction (EKF400v2), which uses atmospheric-only general circulation model simulations with assimilated observational and proxy data. From the literature review, there was widespread evidence for weather/climate anomalies in 1815-1817 for these islands (29/29 for those with data). But missing data was an issue for other dimensions such as impaired food production (seen in 8 islands out of only 12 with data). Based on the EKF400v2 reconstruction for temperature anomalies (compared to the relatively "non-volcanic" reference period of 1779 to 1808), the islands had lower temperature anomalies in the 1815-1818 period than latitudinally equivalent continental sites (at 100 km and 1000 km inland). This was statistically significant for the great majority of the comparisons for group analyses by hemisphere, oceans, and temperate/tropical zone. When considering just the islands, all but four showed statistically anomalous temperature reductions in the 1816-1817 period (for most p < 0.00001). In the peak impact year of 1816, the lowest anomalies were seen for islands in the Southern Hemisphere (p < 0.0001), the Indian Ocean (p < 0.0001), and in the tropics and subtropics of the Southern Hemisphere (p = 0.0057). In conclusion, the findings of both the literature review and reconstruction simulations suggest climatic impacts of the Tambora eruption for nearly all these 31 large islands, albeit less than for continental sites. Islands with the smallest temperature anomalies were in the Southern Hemisphere, in particular the Indian Ocean and the tropics and subtropics of the Southern Hemisphere.

Assumptions, uncertainty, and catastrophic/existential risk: National risk assessments need improved methods and stakeholder engagement.

Two key shortcomings of national risk assessments (NRAs) are: (1) lack of justification and transparency around important foundational assumptions of the process, (2) omission of almost all the largest scale risks. Using a demonstration set of risks, we illustrate how NRA process assumptions around time horizon, discount rate, scenario choice, and decision rule impact on risk characterization and therefore any subsequent ranking. We then identify a neglected set of large-scale risks that are seldom included in NRAs, namely global catastrophic risks and existential threats to humanity. Under a highly conservative approach that considers only simple probability and impact metrics, the use of significant discount rates, and harms only to those currently alive at the time, we find these risks have likely salience far greater than their omission from national risk registers might suggest. We highlight the substantial uncertainty inherent in NRAs and argue that this is reason for more engagement with stakeholders and experts. Widespread engagement with an informed public and experts would legitimize key assumptions, encourage critique of knowledge, and ease shortcomings of NRAs. We advocate for a deliberative public tool that can support informed two-way communication between stakeholders and governments. We outline the first component of such a tool for communication and exploration of risks and assumptions. The most important factors for an "all hazards" approach to NRA are ensuring license for key assumptions and that all the salient risks are included before proceeding to ranking of risks and considering resource allocation and value.

Island refuges for surviving nuclear winter and other abrupt sunlight-reducing catastrophes.

Some island nations in the Southern Hemisphere might survive a severe sun-reducing catastrophe such as nuclear winter and be well placed to help reboot-collapsed human civilization. Such islands must be resilient to the cascading effects abrupt sunlight reduction scenarios (ASRS) would impose beyond the impacts on agricultural systems. We aimed to identify island nations whose societies are most likely to survive nuclear winter or other ASRS. We also aimed to conduct a case study of one island nation to consider how it might enhance its resilience and therefore its chance of aiding a global reboot of complex technological society. We performed a threshold analysis on food self-sufficiency under severe nuclear winter conditions to identify islands. We then profiled each island across global macroindices representing resilience factors reported in the literature. We undertook a case study of the island nation of New Zealand. The island nations of Australia, New Zealand, Iceland, the Solomon Islands, and Vanuatu appear most resilient to ASRS. However, our case-study island nation of New Zealand is threatened in scenarios of no/low trade, has precarious aspects of its energy supply, and shortcomings in manufacturing of essential components. Therefore, inadequate preparations and critical failures in these systems could see rapid societal breakdown. Despite some islands' favorable baseline conditions and apparent food security even in a severe ASRS, cascading impacts through other socioecological systems threaten complex functioning. We identified specific resilience measures, many with cobenefits, which may protect island nodes of sustained complexity in ASRS.

The 2021 Global Health Security (GHS) Index: Aotearoa New Zealand's improving capacity to manage biological threats must now be consolidated.

The 2021 Global Health Security (GHS) Index Report was published on 8 December 2021. With an average country score of 38.9 out of a possible 100 points, global scores are essentially unchanged from 2019. Despite experience with the COVID-19 pandemic, no country is adequately prepared for future biological threats. No country scored above 75.9 and the scores of the bottom 11 States have all fallen since 2019. Aotearoa New Zealand, however, has substantially improved its country score, rising to 13th in the world at 62.5/100. This gain is partly driven by consolidation of capabilities developed and deployed in response to COVID-19. This is promising progress, but a lot more can be done to ensure legacy benefits from the pandemic response, notably through the proposed restructuring of the health system (Pae Ora (Healthy Futures) Bill). In this viewpoint article, we discuss this recent further development of the GHS Index, highlight the global results for 2021, delve into New Zealand's progress, and discuss what more is needed.

Photorefraction Screening Plus Atropine Treatment for Myopia is Cost-Effective: A Proof-of-Concept Markov Analysis.

Purpose: The prevalence of myopia is increasing globally, putting individuals at risk of myopia-associated visual impairment. Low-dose atropine eye drops have been found to safely reduce the risk of progression from myopia to higher levels of myopia and pathological states. In New Zealand, school children have an eye check at age 11. In this study, we aimed to estimate the cost-effectiveness of introducing photorefractive screening for myopia at age 11 in the New Zealand context, with atropine 0.01% eye drops treatment for those screening positive. Patients and Methods: A Markov cohort simulation was used to model the impact of screening plus atropine compared to usual care across a lifetime horizon and societal perspective with a 3% discount rate. Cost-effectiveness was determined by the incremental cost-effectiveness ratio (ICER), with utility measured in quality-adjusted life-years (QALYs). Multivariate sensitivity analyses were carried out to investigate factors influencing cost-effectiveness. Results: The ICER for screening plus atropine was NZ$1590 (95% CI 1390, 1791) per QALY gained, with 7 cases of lifetime blindness prevented per 100,000 children screened. Conclusion: Screening for myopia with photorefraction at age 11 and atropine 0.01% eye drop treatment of children screening positive is likely to be cost-effective. These results suggest that a real-world trial and cost-effectiveness analysis would be worth considering in New Zealand.

Chemical, Biological, Radiological, or Nuclear Response in Queensland Emergency Services: A Multisite Study.

A disaster overwhelms the normal operating capacity of a health service. Minimal research exists regarding Australian hospitals' capacity to respond to chemical, biological, radiological, or nuclear (CBRN) disasters. This article, and the research supporting it, begins to fill that research gap. We conducted a descriptive quantitative study with 5 tertiary hospitals and 1 rural hospital in Queensland, Australia. The study population was the hospitals' clinical leaders for disaster preparedness. The 25-item survey consisted of questions relating to each hospital's current response capacity, physical surge capacity, and human surge capacity in response to a CBRN disaster. Data were analyzed using descriptive statistics. The survey data indicated that over the previous 12 months, each site reached operational capacity on average 66 times and that capacity to respond and create additional emergency, intensive care, or surgical beds varied greatly across the sites. In the previous 12 months, only 2 sites reported undertaking specific hospital-wide training to manage a CBRN disaster, and 3 sites reported having suitable personal protective equipment required for hazardous materials. There was a noted shortfall in all the hospitals' capacity to respond to a radiological disaster in particular. Queensland hospitals are crucial to CBRN disaster response, and they have areas for improvement in their response and capacity to surge when compared with international preparedness benchmarks. CBRN-focused education and training must be prioritized using evidence-based training approaches to better prepare hospitals to respond following a disaster event.

Optimizing Island Refuges against global Catastrophic and Existential Biological Threats: Priorities and Preparations.

Human civilization is vulnerable to global catastrophic biological threats and existential threats. Policy to mitigate the impact of major biological threats should consider worst-case scenarios. We aimed to strengthen existing research on island refuges as a mitigating mechanism against such threats by considering five additional factors as well as recent literature on catastrophic risks and resilience. We also analyzed the performance of potential refuge islands during early phases the COVID-19 pandemic. Using a composite indicator (scored from 0-1) based on 14 global macroindices, we present analysis supporting Australia (0.71), New Zealand (0.64), and Iceland (0.58) as the leading candidate island nation refuges to safeguard the survival of humanity and a flourishing technological civilization from the threat of a catastrophic pandemic. Data from the COVID-19 pandemic supports this finding where islands have performed relatively well. We discuss the persisting weaknesses of even the best candidate refuges and the growing literature describing what preparations such a refuge should ensure to enhance resilience. Refuge preparations by Australia and New Zealand, in particular, may additionally provide some immunity against winter-inducing catastrophes such as global nuclear war. Existing disaster resilience frameworks such as the Sendai framework could be worded to mandate preventive measures against global catastrophic and existential threats. The issue of island refuges against certain global catastrophic risks should be raised at relevant international political summits.

Proof-of-concept calculations to determine the health-adjusted life-year trade-off between intravitreal anti-VEGF injections and transmission of COVID-19.

BACKGROUND: Clinical ophthalmological guidelines encourage the assessment of potential benefits and harms when deciding whether to perform elective ophthalmology procedures during the COVID-19 pandemic, in order to minimize the risk of disease transmission. METHOD: We performed probability calculations to estimate COVID-19 infection status and likelihood of disease transmission among neovascular age-related macular degeneration patients and health-care workers during anti-VEGF procedures, at various community prevalence levels of COVID-19. We then applied the expected burden of COVID-19 illness and death expressed through health-adjusted life-years (HALYs) lost. We compared these results to the expected disease burden of severe visual impairment if sight protecting anti-VEGF injections were not performed. RESULTS: Our calculations suggest a wide range of contexts where the benefits of treatment to prevent progression to severe visual impairment or blindness are greater than the expected harms to the patient and immediate health care team due to COVID-19. For example, with appropriate protective equipment the benefits of treatment outweigh harms when the chance of progression to severe visual impairment is >0.044% for all scenarios where COVID-19 prevalence was 1/1000, even when the attack rate in the clinical setting is very high (5-43%). CONCLUSION: Unless COVID-19 prevalence is very high, the reduced disease burden from avoiding visual impairment outweighs the expected HALYs lost from COVID-19 transmission. This finding is driven by the fact that HALYs lost when someone suffers severe visual impairment for 5 years are equivalent to nearly 400 moderate cases of infectious disease lasting 2 weeks each.

Existential Risks to Humanity Should Concern International Policymakers and More Could Be Done in Considering Them at the International Governance Level.

In this perspective, we consider the possible role of the United Nations (UN) with respect to existential risks to human civilization and the survival of humanity. We illustrate how existential risks have been discussed at an international governance level, specifically in documents in the UN Digital Library. In this large corpus, discussions of nuclear war account for over two-thirds (69%, 67/97) of mentions of existential risks, while mention of other existential risks, or such risks as a category, appears scant. We take these observations to imply inadequate attention to these significant threats. These deficits, combined with the need for a global response to many risks, suggest that UN member nations should urgently advocate for appropriate action at the UN to address threats, such as artificial intelligence, synthetic biology, geoengineering, and supervolcanic eruption, in analogous fashion to existing attempts to mitigate the threats from nuclear war or near-Earth objects.

The 2019 Global Health Security Index (GHSI) and its implications for New Zealand and Pacific regional health security.

It is important for all countries to secure themselves against infectious disease threats, including potential global catastrophic biological risks. The Global Health Security Index (GHSI), first published in 2019, is a comprehensive, objective assessment of health security capabilities across 195 States Parties to the International Health Regulations. The GHSI is a broader assessment than the World Health Organization Joint External Evaluation and emphasises public documentation of preparedness as well as sustainable capabilities. New Zealand scored 54/100 on the GHSI (35th in the world). But also worryingly, the range of scores for New Zealand's Pacific neighbours was 19.2-27.8, highlighting potential regional vulnerabilities. Clearly, the New Zealand Government needs to do more to ensure its own optimal preparedness for global biological threats, and document these preparations to assure the international community. But it should also provide additional overseas development assistance (bringing this assistance up to 0.7% of GNI as per UN recommendations) and work with Pacific Nations to enhance health security in the region.

The Prioritization of Island Nations as Refuges from Extreme Pandemics.

In this conceptual article with illustrative data, we suggest that it is useful to rank island nations as potential refuges for ensuring long-term human survival in the face of catastrophic pandemics (or other relevant existential threats). Prioritization could identify the several island nations that are most suitable for targeting social and political preparations and further investment in resiliency. We outline a prioritization methodology and as an initial demonstration, we then provide example rankings by considering 20 sovereign island states (all with populations greater than 250,000 and no land borders). Results describe each nation in nine resilience-relevant domains covering location, population, resources, and society according to published data. The results indicate that the most suitable island nations for refuge status are Australia, followed closely by New Zealand, and then Iceland, with other nations all well behind (including the relatively high-income ones of Malta and Japan). Nevertheless, some key contextual factors remain relatively unexplored. These include the capacity of the jurisdiction to rapidly close its borders when the emerging threat was first detected elsewhere, and whether or not large subnational islands should be the preferred focus for refuge design (e.g., the Australian state of Tasmania, the island of Hokkaido in Japan, or the South Island of New Zealand). Overall, this work provides conceptual thinking with some initial example analysis. Further research could refine the selection of metrics, how best to weight the relevant domains, and how the populations of prioritized island nations view their nation's selection as a potential refuge for human survival.

Cataract surgery for falls prevention and improving vision: modelling the health gain, health system costs and cost-effectiveness in a high-income country.

AIM: To estimate the health gain, health system costs and cost-effectiveness of cataract surgery when expedited as a falls prevention strategy (reducing the waiting time for surgery by 12 months) and as a routine procedure. METHODS: An established injurious falls model designed for the New Zealand (NZ) population (aged 65+ years) was adapted. Key parameters relating to cataracts were sourced from the literature and the NZ Ministry of Health. A health system perspective with discounting at 3% was used. RESULTS: Expedited cataract surgery for 1 year of incident cases was found to generate a total 240 quality-adjusted life years (QALYs) (95% uncertainty interval (UI) 161 to 360) at net health system costs of NZ$2.43 million (95% UI 2.02 to 2.82 million) over the remaining lifetimes of the surgery group. This intervention was cost-effective by widely accepted standards with an incremental cost-effectiveness ratio (ICER) of NZ$10 600 (US$7540) (95% UI NZ$6030 to NZ$15 700) per QALY gained. The level of cost-effectiveness did not vary greatly by sex, ethnicity and previous fall history, but was higher for the 65-69 age group compared with the oldest age group of 85-89 years (NZ$7000 vs NZ$14 200 per QALY gained). Comparing cataract surgery with no surgery, the ICER was even more favourable at NZ$4380 (95% UI 2410 to 7210) per QALY. Considering only the benefits for vision improvement and excluding the benefits of falls prevention, it was still favourable at NZ$9870 per QALY. CONCLUSIONS: Expedited cataract surgery appears very cost-effective. Routine cataract surgery is itself very cost-effective, and its value appears largely driven by the falls prevention benefits.

Expediting cataract surgery in New Zealand is cost-effective for falls prevention and improving vision-so what might be the next steps?

Multifactorial individual assessment with interventions tailored to the individual's risk factors can reduce the rate of falls and risk of fractures. Assessment of vision is one key aspect of multifactorial assessment and first eye cataract surgery reduces the rate of falls. We recently modelled the impact of expediting first eye cataract surgery in New Zealand for falls prevention (Boyd et al Injury Prevention). The model used was the same model used for previous modelling of home safety assessment and modification and community exercise programmes. This study found that expedited cataract surgery was highly cost-effective by generating a quality-adjusted life-year (QALY) for NZ$10,600 (95%UI: NZ$6,030-15,700). Routine cataract surgery itself (relative to no such surgery being available) was even more cost-effective at $4,380 per QALY gained, when considering vision benefits and falls prevention benefits. In this viewpoint article, we discuss the potential next steps for expediting cataract surgery and further improving its cost-effectiveness in the New Zealand setting.

Economic evaluation of border closure for a generic severe pandemic threat using New Zealand Treasury methods.

OBJECTIVE: To perform a comprehensive economic evaluation of border closure for an island nation in the face of severe pandemic scenarios. METHODS: The costing tool developed by the New Zealand (NZ) Treasury (CBAx) was used for the analyses. Pandemic scenarios were as per previous work;1 epidemiological data were from past New Zealand influenza pandemics. RESULTS: The net present value of successful border closure was NZ$7.86 billion for Scenario A (half the mortality rate of the 1918 influenza pandemic) and $144 billion for preventing a more severe pandemic (10 times the mortality of scenario A). Cost-utility analyses found border closure was relatively cost-effective, at $14,400 per QALY gained in Scenario A, and cost-saving for Scenario B (taking the societal perspective). CONCLUSIONS: This work quantifies the economic benefits and costs from border closure for New Zealand under specific assumptions in a generic but severe pandemic threat (e.g. influenza, synthetic bioweapon). Preparing for such a pandemic response seems wise for an island nation, although successful border closure may only be feasible if planned well ahead. Implications for public health: Policy makers responsible for generic pandemic planning should explore how border closure could be implemented, including practical and legal frameworks.

Just ask Siri? A pilot study comparing smartphone digital assistants and laptop Google searches for smoking cessation advice.

OBJECTIVE: To compare voice-activated internet searches by smartphone (two digital assistants) with laptop ones for information and advice related to smoking cessation. DESIGN: Responses to 80 questions on a range of topics related to smoking cessation (including the FAQ from a NHS website), compared for quality. SETTING: Smartphone and internet searches as performed in New Zealand. MAIN OUTCOME MEASURES: Ranked responses to the questions. RESULTS: Google laptop internet searches came first (or first equal) for best quality smoking cessation advice for 83% (66/80) of the responses. Voiced questions to Google Assistant ("OK Google") came first/first equal 76% of the time vs Siri (Apple) at 28%. Google and Google Assistant were statistically significantly better than Siri searches (odds ratio 12.4 and 8.5 respectively, p<0.0001 in each comparison). When asked FAQs from the National Health Service website, or to find information the Centers for Disease Control has made videos on, the best search results used expert sources 59% (31/52) of the time, "some expertise" (eg, Wikipedia) 18% of the time, but also magazines and other low quality sources 19% of the time. Using all three methods failed to find relevant information 8% (6/80) of the time, with Siri having the most failed responses (53% of the time). CONCLUSION: Google internet searches and Google Assistant were found to be significantly superior to the Siri digital assistant for smoking cessation information. While expert content was returned over half the time, there is still substantial room for improvement in how these software systems deliver smoking cessation advice.