Strengthening Climate Leadership for Vector-Borne Disease Resilience: Policy Pathways for Adaptive Urban Health Systems in Developing Regions

Abstract Background Climate change is intensifying the transmission of vector-borne diseases (VBDs), particularly in developing urban regions characterized by rapid population growth, environmental degradation, and limited adaptive capacity. Understanding how climate leadership shapes resilience to climate-sensitive health risks is essential for effective policy and intervention planning. Methods We integrated climate–disease modeling, satellite-derived environmental indicators, urban vulnerability assessments, and a governance-based climate leadership index across multiple developing cities. Multivariate regression, temporal correlation analyses, and resilience scoring were used to quantify relationships between climatic variables, institutional capacity, and VBD incidence. Results Rising temperatures, extreme precipitation, and intensified urban heat islands significantly increased VBD incidence. Cities exhibiting stronger climate leadership characterized by cross-sectoral coordination, early-warning systems, and climate-informed planning demonstrated lower disease burdens despite similar climate exposures. Higher resilience scores were consistently associated with reduced outbreak magnitude, shorter transmission peaks, and more effective vector-control responses. Discussion Findings indicate that climate leadership is a pivotal determinant of urban health resilience, mediating climate impacts through governance integration, adaptive planning, and equitable environmental management. Strengthening institutional climate leadership can substantially mitigate climate-sensitive disease risks and enhance long-term urban health security.