While democracy typically correlates with superior population health outcomes, and inequality adversely affects population wellbeing, their roles in pandemic performance remain contested, particularly across geographic context and when using methodologically robust metrics. We examined associations between liberal democracy (V-Dem Liberal Democracy Index) and income inequality (Gini coefficient) with Covid-19 health and economic outcomes across 193 jurisdictions, stratified by island (n = 48) versus non-island (n = 145) status. Outcomes were age-standardised cumulative excess mortality (2020–2021) and GDP per capita growth (2019–2020, 2020–2021). Ordinary least squares regression models controlled for GDP per capita, population size, Global Health Security Index, and government corruption. Democracy predicted reduced excess mortality in islands (β = –5.92 ±2.20 SE, p = 0.013, adjusted R² = 0.37) but not non-islands (β = –0.47 ±0.65 SE, p = 0.47), confirmed by island interaction (β = –4.51 ±1.72, p = 0.0095). Higher inequality predicted increased mortality in non-islands (β = +0.052 ±0.019 SE, p = 0.009, adjusted R² = 0.50) and larger GDP contractions in 2019–2020 (β = –0.242 ±0.053 SE, p = 0.000013, adjusted R² = 0.22), but not in islands. Democracy showed no systematic association with economic trajectories. Democracy’s pandemic benefits are geographically contingent, concentrated in island jurisdictions, while inequality’s adverse effects on health and economic outcomes are pervasive in non-island states. Preparedness strategies should account for these contextual dependencies to mitigate the impact of infectious disease and potential future global catastrophic biological risks. This research aimed to establish the relationship between jurisdiction regime type (level of democracy) as well as level of income inequality and Covid-19 pandemic health and economic outcomes. We found that a higher Gini inequality coefficient predicted greater cumulative excess mortality (2020–2021) and a larger initial economic contraction, while greater democracy predicted lower cumulative excess mortality in islands only. These findings suggest that non-specific factors such as inequality and democracy may drive pandemic outcomes and important policy relevant differences exist across jurisdiction types (island vs non-island).

ABSTRACT What places on Earth are most resilient to global catastrophic risk (GCR)? We provide the first study of what locations are more resilient against the impacts of nuclear war, near‐Earth objects, large‐magnitude volcanic eruptions, large‐scale cyberattacks, high altitude electromagnetic pulse, geomagnetic storms and pandemics. This shows there is no place on Earth which is resilient against all kinds of GCR. Australia shows resilience across the widest range of GCR scenarios in the literature we reviewed, but even for it, continued international cooperation and trade are essential. Across the different risks, common resilience factors that show up most are geographic isolation (e.g. islands), self‐sufficiency (especially in food production), high governance quality (more democratic and lower inequality) and decentralization to mitigate single point catastrophic failures (e.g. impacting trade or food supply). Many of these factors stand in tension with each other and trade‐offs are required to balance between different GCR scenarios and between a higher resilience against the immediate impacts or against the longer‐term consequences. The literature suggests that increased GCR resilience requires more investment in preparation (e.g., food security), planning (e.g., national risk assessments), and international agreements that facilitate cooperation on preparation and GCR response.

Human civilization faces a range of global catastrophic risks (GCRs), including nuclear war, bioengineered pandemics, major solar storms, and uncontrolled artificial intelligence. In New Zealand, limited information exists on public views about whether the government should respond to such risks. A representative survey of 1012 adults in July 2024 included two questions on GCRs. Sixty-six percent (95%CI: 63%-70%) supported the government developing specific plans to address extreme risks, and 60% (95%CI: 56%-63%) supported establishing a dedicated commission or agency. In multivariable models, support increased with age, education, income, and trust in scientists (the latter also associated with support for an agency). There were no significant differences by gender, ethnicity, or political orientation. These findings suggest a clear majority of the public supports government planning for catastrophic risks. Further research, including repeat surveys and deliberative methods such as citizens' assemblies, could help explore underlying reasons for opposition and how the public weigh policy trade-offs.

This descriptive study examined biographical data on the health conditions of 51 deceased leaders of the nine nuclear weapon states. It found that eight (17%) died from chronic disease while in office, with a mean of 3.9 health conditions per person (range: 1 to 10). A majority of these eight (62%) had cardiovascular disease and other conditions included personality disorders, depression, substance use disorders, and cognitive decline from multi-infarct dementia. Of the leaders leaving office alive, 15 (38%) were considered to have had health reasons playing a potential role in this departure. This group had a mean of 2.9 health conditions per person (range: 1 to 5), and all plausibly had their performance in office impaired by their health conditions (e.g., via a severe stroke, severe depression, likely personality disorders, mood and anxiety disorders, and substance use disorders). In conclusion, these findings indicate that physical and mental health conditions among leaders of these nuclear weapon states have been common (45% [23/51] of the leaders studied). Given the importance of the decision-making around nuclear weapons by political leaders, further research on this group should be prioritized.

The Covid-19 pandemic caused approximately 27.3 million excess deaths globally as of June 2024. Despite growing research on pandemic response factors, the effectiveness of different strategic approaches to Covid-19 control remains insufficiently investigated. We aimed to examine associations between Covid-19 pandemic control strategies (including stringent border restrictions) with age-standardized excess mortality and GDP per capita growth outcomes during 2020-2021. We analyzed 193 sovereign jurisdictions with existing Global Burden of Disease Study data. Jurisdictions were classified by implementation of exclusion/elimination strategies reported in published literature, and the level of border restriction measures based on the Oxford Stringency Index. Multivariable analyses adjusted for island status, GDP per capita, and an index of government corruption. Excess mortality was cube root transformed and GDP per capita log transformed for regression analysis. Jurisdictions implementing explicit exclusion/elimination strategies showed the lowest cumulative age-standardized excess mortality (-2.1/100,000) compared to others (166.5/100,000). Island jurisdictions experienced lower mortality (64.8/100,000) than non-islands (194.3/100,000). Duration of border restrictions correlated with reduced excess mortality in islands (Pearson's r = -0.624, p < 0.001; β -0.004, island interaction -0.005, p < 0.001), but not in non-islands. However, this effect weakened when controlling for government corruption in a subsample (lower corruption was associated with lowered mortality). No consistent significant relationships emerged between border measures and GDP growth, suggesting that stringent border restrictions in a pandemic may not significantly harm economies. We concluded that exclusion/elimination strategies and related stringent border restrictions were associated with better health outcomes, particularly for islands. Effectiveness was likely partially mediated by governance quality. Future pandemic planning should consider both control strategy selection and implementation context, both of which are modifiable.

Introduction: Human civilisation faces such global catastrophic risks as a: nuclear war, bioengineered pandemic, major solar storm, and volcanic winter. For some of these catastrophes, island nations may have relative survival potential but any collapse in international trade could also end critical imported goods such as pharmaceuticals. We aimed to explore the latter using the case study country of Aotearoa New Zealand (NZ). Methods: We identified the 10 most extensively prescribed pharmaceuticals in NZ that are used for acute treatment (by annual prescription numbers). Based on modern synthesis pathways for these pharmaceuticals in the literature, we identified ingredients and then determined if these ingredients were currently produced in NZ. Results: The results suggest that none of these 10 pharmaceuticals could be produced in NZ in a trade-ending catastrophe: paracetamol, omeprazole, amoxicillin, ibuprofen, aspirin, metoprolol succinate, salbutamol, prednisone, cetirizine hydrochloride, and amlodipine. This is primarily because NZ does not refine petrochemicals. For seven of these 10 pharmaceuticals the relevant catalysts or other specific chemical ingredients are also not mined or otherwise produced in NZ. There may, however, be some scope for the post-catastrophe scavenging of minerals for producing some catalysts. Conclusions: This preliminary analysis suggests that none of the 10 most extensively prescribed pharmaceuticals used for acute treatments could be manufactured in this case study country after a trade-ending global catastrophe. To address this and other domains lacking in resiliency (eg, liquid fuel supply), a research programme for building shared resiliency with other neighbouring nations (eg, Australia) could be considered. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement The author(s) received no specific funding for this work. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: This study did not require ethical review as it was about the potential for pharmaceutical manufacturing in post-catastrophe situations and did not involve any human participants. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript and its Supporting Information files.

The Department of the Prime Minister and Cabinet’s 2025 draft briefing on long-term hazard resilience is commendable in emphasising anticipatory governance. However, it still exemplifies broader limitations in risk assessment focusing on familiar localnatural hazards while excluding global catastrophic risk. We examine how current risk reduction approaches remain trappedwithin frameworks addressing symptoms rather than systemic forces. Effective resilience requires expanding hazard scope to includeglobal hazards: large-scale (nuclear) conflict, large global volcanic eruptions, and bioengineered pandemics. Building resilience tothese and similar risks requires recognising cascade dynamics and implementing transparent approaches to generalised resilience toensure basic needs.

Objectives Past studies show a mixed relationship between the Global Health Security (GHS) Index and COVID-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. We aimed to determine the relationship between GHS Index scores and COVID-19 pandemic excess mortality 2020–2021 and macroeconomic pandemic outcomes.Design Cross-sectional, multivariable regression design (controlling for per capita gross domestic product (GDP) and political corruption), comparing island and non-island jurisdictions.Setting 194 jurisdictions with 2019 GHS Index scores.Outcome measures Age-standardised cumulative excess mortality 2020–2021, GDP per capita growth 2019–2020 and 2020–2021.Results The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020–2021 in non-island jurisdictions (β=−0.046, p=0.00068, adj R2=0.48), but not in island jurisdictions (β=0.012, p=0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP per capita growth through 2019–2020 or 2020–2021.Conclusions The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the COVID-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion/elimination strategies that successfully protected islands during the COVID-19 pandemic.

BACKGROUND:Abrupt global catastrophic risks (GCRs) are not improbable and could massively disrupt global trade leading to shortages of critical commodities, such as liquid fuels, upon which industrial food production, processing and distribution depends. Previous studies have suggested urban agriculture as a resilience measure in the context of climate change and other natural hazards. AIMS:To estimate the contribution a radical pivot to urban agriculture could have in building resilience to GCRs and the near-urban industrial agriculture needed to supplement urban food production. METHODS:We determined optimum crops through mathematical optimization for food calorie and protein supply per land area for both urban and near-urban (industrial) agriculture. We calculated the land area available for food production within a temperate globally median-sized city using Google Earth image analysis of residential lots and open city spaces. We calculated the population that could be fed through urban agriculture alone, and the extra near-urban land required for cropping with industrial agriculture to feed the remaining city population, under both normal climate, and potential nuclear winter conditions. RESULTS:The optimal crops for urban agriculture were peas (normal climate), and sugar beet/spinach (nuclear winter); while those optimal for industrial near-urban production were potatoes (normal climate), and wheat/carrots (nuclear winter). Urban agriculture could feed a fifth (20%) of the population. At least 1140 hectares of near-urban cultivation could make up the shortfall. Another 110 hectares of biofuel feedstock like canola (rapeseed) could provide biodiesel to run agricultural machinery without fuel trade. Significantly more cultivated area is needed in nuclear winter scenarios due to reduced yields. CONCLUSION:Relatively little optimized near-urban industrial agriculture, along with intensified urban agriculture could feed a median-sized city in a GCR, while minimizing fuel requirements. Governments and municipal authorities could consider land use policy that encourages development of urban agriculture and near-urban cultivation of optimal crops, along with processing and local biofuel refining capacity.

With a rise in global tensions among nuclear-armed states, preventative measures against nuclear war have once again attracted attention. However, recovery measures remain heavily neglected. A nuclear winter and its associated climatic effects would devastate global agriculture. Understanding vulnerabilities in post nuclear war trade networks could inform efforts to mitigate collapse risks and enable recovery. We posit that even in a limited nuclear war, key trading chokepoints and infrastructure could be targeted, severely disrupting global trade and supply chains for food, essential medicine, fossil fuels, and fertilizers, resulting in widespread famine and increasing humanity’s vulnerability to unforeseen aftershocks. The precise mechanisms and vulnerabilities in post nuclear war trade and supply chains remain poorly understood. Large fluctuations in price compounded by infrastructure destruction will impact every part of the post catastrophe aid delivery process. The trajectory of this disruption and recovery will be critical in determining the extent of the resulting famine and loss of life. We reviewed the relevant literature for the nuclear winter hypothesis, relevant famine studies, and existing complex adaptive system research on trade and supply chains. Our modeling indicates that expected deaths would peak in 250–550 detonation scenarios, therefore, the medium exchange scenarios should be a priority for future resilience research. We identify three layers of inquiry that would help future modeling work to address nuclear resilience, and recommend their inclusion by the 2025–26 UN Independent Scientific Panel on the Effects of Nuclear War. Importantly, a better understanding of reduced sunlight scenarios is applicable to several classes of catastrophe beyond nuclear exchanges.

INTRODUCTION:Human civilisation faces global catastrophic risks such as: nuclear war, bioengineered pandemics, major solar storms and a volcanic winter. For some of these catastrophes, island nations may have relative survival potential but any collapse in international trade could also end critical imported goods such as pharmaceuticals. We aimed to explore the latter in New Zealand, a highly trade-dependent island nation. METHODS:We identified the 10 most extensively prescribed pharmaceuticals in New Zealand that can be used for acute treatment (by annual prescription numbers). Based on modern synthesis pathways for these pharmaceuticals in the literature, we identified ingredients and then determined if these ingredients were currently produced in New Zealand. RESULTS:The results suggest that none of these 10 pharmaceuticals could be produced in New Zealand in a trade-ending catastrophe: paracetamol, omeprazole, amoxicillin, ibuprofen, aspirin, metoprolol succinate, salbutamol, prednisone, cetirizine hydrochloride and amlodipine. This is primarily because New Zealand does not refine petrochemicals. For seven of these 10 pharmaceuticals the relevant catalysts or other specific chemical ingredients are also not mined or otherwise produced in New Zealand. There may, however, be some scope for the post-catastrophe scavenging of minerals for producing some catalysts. CONCLUSIONS:This preliminary analysis suggests that none of the 10 most extensively prescribed pharmaceuticals that can be used for acute treatments could be manufactured in New Zealand after a trade-ending global catastrophe. To address this and other domains lacking in resiliency (e.g., liquid fuel supply), planning for building shared resiliency with other neighbouring nations (e.g., Australia) could be considered.

Background: Past studies show a mixed relationship between the Global Health Security (GHS) Index and Covid-19 pandemic health outcomes. Some recent work that suggested higher GHS Index scores are associated with better mortality outcomes has been criticised on methodological grounds. There remains scope for improved analyses of these relationships, including of island nations and macroeconomic pandemic outcomes. Methods: Multiple linear regression analyses (controlling for per capita GDP and political corruption) across GHS Index scores, age-standardised excess mortality for 2020-2021, and GDP per capita growth, for island and non-island jurisdictions separately. Results: The GHS Index predicted better health outcomes in terms of age-standardised excess mortality through 2020-2021 in non-island jurisdictions (β = -0.046, p = 0.00068, adj R2 = 0.45), but not in island jurisdictions (β = 0.027, p = 0.734). For a starting age-standardised excess mortality of 100 per 100 000, a +10-point rise in overall GHS Index score predicts a 26.7 per 100 000 reduction in age-standardised mortality. We found no robust evidence that a higher GHS Index predicted higher year-on-year GDP growth through 2019-2020 or 2020-2021. Conclusion: The GHS Index demonstrated clear associations with favourable health outcomes of non-island jurisdictions through the Covid-19 pandemic, supporting its use to guide pandemic preparedness investments. Contrasting findings for islands suggest the need to enhance how the Index measures border biosecurity capacities and capabilities, including the ability to support the exclusion/elimination strategies that successfully protected islands during the Covid-19 pandemic. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Links (url) to all data are provided at the end of the manuscript [https://adaptresearchwriting.com/wp-content/uploads/2024/12/241219-ghs-index-covid-data\_code\_results.zip][1] [1]: https://adaptresearchwriting.com/wp-content/uploads/2024/12/241219-ghs-index-covid-data_code_results.zip

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.

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.

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 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.

S1 Table 1 Values of transition probability estimates and the 95% credible intervals for the natural history parameters; SFig 1 Model predicted versus observed average colorectal cancer mortality counts per year (2007-2010) by age, sex and ethnicity; SFig 2 Health systems cost inputs by Dukes stage and clinical phase (y-axis log scale) for males (female cost inputs available on request from author); STable 2 Model validation: percentage reduction (95% confidence or uncertainty interval) in colorectal cancer mortality in MSLT model, selected RCTs and selected other simulation models; SFig 3 Tornado plots* for one-way sensitivity analyses of the total population incremental cost-effectiveness ratio (ICER †); STable 3 Optimal CRC screening age-range for MÄori; STable 4 Optimal CRC screening age-range for non-MÄori

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.

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.

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.