Coordinated responses to maintain tuberculosis care amid climate emergencies: challenges and perspectives based on the events of Brazil

The Unified Health System (<i>Sistema Único de Saúde</i>, SUS) is a cornerstone of Brazil's public health, offering universal care and playing a critical role during crises such as the COVID-19 pandemic and climate emergencies. Climate change poses escalating threats to public health, intensifying vulnerabilities and increasing the burden of diseases like tuberculosis. This study focuses on the analysis of events resulting from heavy rains in the state of Rio Grande do Sul, addressing the impacts of climate change, strategies for continued tuberculosis control, logistical and operational challenges and prospects for strengthening the SUS in times of climate crises. With Brazil's high tuberculosis prevalence, climate events, such as the severe 2024 floods in Rio Grande do Sul, disrupted healthcare infrastructure, delayed tuberculosis diagnosis and treatment and worsened health inequities. The floods in Rio Grande do Sul affected 96% of municipalities, displacing over 160 000 people and damaging health centres. Efforts to maintain tuberculosis care included deploying mobile units, relocating diagnostic equipment and implementing extended medication dispensing. The SUS demonstrated resilience, but gaps in real-time case monitoring and health infrastructure persist. Addressing these gaps is critical, especially as climate change exacerbates social vulnerabilities. The need for an effective tuberculosis vaccine has become urgent in mitigating climate-related health crises. Additionally, adopting the one health approach, improving cross-sector collaboration, investing in digital health technologies and empowering communities are essential for building a resilient health system. Integrated policies addressing climate change impacts can safeguard public health and equity in Brazil.