Climate change and tropical medicine in the Amazon: contributions from a research center, gaps and future priorities

The Amazon Basin is undergoing rapid climatic and environmental changes, with direct impacts on infectious disease transmission and public health. Rising temperatures, altered rainfall patterns, and more frequent extreme events are reshaping vector and pathogen dynamics. Additionally, deforestation and land-use change increase human and animal exposure. These combined factors intensify the risk of disease transmission in the region. This narrative review synthesizes evidence generated by researchers from a reference center in tropical medicine in the Amazon, integrating epidemiological analyses, experimental studies, ecological and predictive modelling, and health systems research conducted over the past decade. The evidence indicates that temperature and hydrological variability affect vector competence, pathogen development, and host-vector contact rates, producing nonlinear and context-dependent transmission outcomes. Extreme hydroclimatic events additionally disrupt healthcare delivery, hinder surveillance, and compromise continuity of care for infections requiring sustained treatment, such as tuberculosis and HIV. Emerging advances, including species distribution modelling, remote sensing, and integrated climate-epidemiological surveillance, provide predictive capacity to anticipate outbreaks and identify emerging hotspots. However, substantial research gaps persist, particularly regarding multi-stressor interactions, mechanistic pathways of climate-pathogen-vector adaptation, and health system resilience under climatic extremes. From the perspective of a reference center that integrates education, research, and healthcare delivery in tropical medicine, this article articulates a research agenda for climate-informed tropical medicine, highlighting priorities for interdisciplinary research, surveillance innovation, and adaptive public health strategies in the Amazon and other climate-sensitive regions.