European Law and Policy from climate crisis response to systemic resilience: A network meta-analysis

Background

Climate change intensifies disaster frequency across Europe, creating unprecedented challenges for health systems. The interconnectedness of human, animal, and environmental health demands an integrated One Health approach to disaster medicine. Current European guidelines lack frameworks addressing climate-driven emergencies. This network meta-analysis synthesises evidence on existing protocols, identifying gaps where climate adaptation and One Health principles remain inadequately incorporated.

Methods

We conducted a systematic review and network meta-analysis following PRISMA-NMA guidelines. PubMed, Scopus, and Embase were searched from 2015-2025 for studies on disaster medicine guidelines and One Health implementation. Eligible studies included trials and policy evaluations from European contexts. Network geometry compared intervention effectiveness. Risk of bias was assessed using Cochrane ROB-2. Analyzed in R version 4.5.2. software incorporated climate vulnerability indices and health system capacity metrics.

Results

A total of 4,287 records, 127 studies met inclusion criteria across 38 European countries. Network analysis revealed significant heterogeneity (I²=78%). Integrated One Health disaster protocols demonstrated superior outcomes versus siloed approaches (OR = 2.47, 95% CI:1.89-3.21). Climate-adapted emergency frameworks ranked highest in SUCRA values (0.84). Evidence gaps emerged regarding cross-border coordination and veterinary-public health integration. Northern Europe showed more advanced implementation than Mediterranean regions.

Conclusions

This network meta-analysis supports urgent need for European guidelines integrating disaster medicine, climate adaptation, and One Health. Unified approaches outperform fragmented systems in emergency response. Policymakers should prioritise guidelines incorporating ecosystem health surveillance cross-sectoral coordination climate-resilient public health innovation, and strengthen preparedness.

Key messages

• This study addresses the need for a new contextualized European guideline framework integrating disaster medicine, climate crisis response and One Health resilience.

• Conventional disaster medicine approaches showed strong short‑term effectiveness for acute mortality reduction but limited performance in prolonged or compound climate‑related crises.