There are major gaps in surveillance of climate change and health in the EU and globally, making it difficult to track health burdens and policy outcomes. The HIGH Horizons project, over four years, involves 5 partners in the EU, 3 in Africa and 2 international organisations (WHO and UNICEF). It centres on pregnant and postpartum women, infants, and health workers, groups heavily affected by climate change. We quantify and monitor direct and indirect health impacts of extreme heat; test a personalised Early Warning System (EWS); and implement integrated adaptation-mitigation actions in health facilities. Analyses of heat impacts and data science predictive modelling using data from Sweden; Lazio Italy, and health facilities in Kenya and South Africa underpin all activities. These analyses and systematic reviews inform testing and selection of global, EU and national indicators. Analyses also inform cut-off thresholds for EWSs, stratified by risk groups. A smartphone app (ClimApp-MCH) will deliver warnings and setting-specific messages, co-designed locally. The app will be evaluated among 200 mothers and infants in Sweden, South Africa and Zimbabwe, from antepartum through 12 months of infant age. Simultaneously, we will document impacts of heat exposure on health worker wellbeing, health, productivity and quality of care, including through time-motion studies. Modifications to health facilities will be co-designed and modelled to reduce heat exposure for health workers and to limit facilities carbon emissions. Health worker outcomes and facility emissions will be compared pre- and post-intervention. Analyses weighing costs and benefits cut across all activities. Throughout we will disseminate project findings to relevant stakeholders, prioritising EU and global policy makers and leveraging existing networks. The final set of indicators on climate change and maternal, newborn and child health will be released in a WHO, UNICEF and UNFPA guidance document. In order to optimise synergies, avoid overlaps and increase the impact of the projects selected for funding from the call HORIZON-HLTH-2021-ENVHLTH-02-03 (Health impacts of climate change, costs and benefits of action and inaction, Horizon Europe projects 101057843 HIGH Horizons, 101057131 CATALYSE, 101057764 BlueAdapt, 101057690 CLIMOS, 101057554 IDAlert and 101057739 TRIGGER), the projects will form a cluster. Common cluster activities will include the following: 1 . Common kick-off meeting of the six projects, to be organized in cooperation between DG R&I and the cluster; 2. Annual cluster meetings and periodic report of joint activities (delivered at each reporting period); 3. Common dissemination and communication activities, including a common dissemination and communication strategy for the cluster, cluster web portal and visual identity, cluster brochure, cluster newsletters, stakeholder list, Shared individual Data Management Plans between cluster partners, Policy Strategy of the cluster, including joint policy briefs and Scientific strategy of the cluster. The penholder and project responsible for each joint deliverable will be decided in the document setting out the Modalities for Implementation of the Cluster to be agreed on during 2022. 4. Thematic workshops/trainings on issues of common interest to be defined in the context of the scientific strategy of the cluster; 5. Working groups on topics of common interest (e.g., data management, communication and dissemination, science-policy link): to be defined in the context of the scientific strategy of the cluster;

Early ARV treatment in sub-Saharan Africa (SSA) reaches only approximately 50% of infants born with HIV. Mortality in infants in the first 12 months after diagnosis is still over 10% in early treated infants diagnosed at birth, 25% in infants diagnosed with opportunistic infections. According to our experience, the probability of virological control 1 year after diagnosis is only 25 to 35%, even after the rollout of dolutegravir (DTG). As a solution for this problem, we propose the addition of four shots of subcutaneous (SC), long-half-life broadly neutralizing antibodies (bNAbs) at diagnosis, and 3, 6 and 9 months after diagnosis, as an add-on to standard oral ART will provide immediate therapeutic benefit and decrease HIV viral load levels in the most critical period of life of children with HIV, allowing for a decreased risk of co-infections, HIV-encephalopathy and death. We will evaluate for the first time the efficacy of combining two bNAbs (ePGT121v1-LS and VRC07-523-LS, as intensification therapy for ART, to achieve viral suppression within one year after diagnosis in high risk-infants with HIV. The specific aims to achieve this general aim will be: to perform a phase II/III trial with bNAbs, capacity strengthening related with bNAbs in Africa, to characterize biomarkers for anticipating response to bNAbs, to identify the barriers and facilitators of rollout of bNAbs as a treatment, and to liaise with relevant stakeholders The pathway to achieve this aim will be a collaborative framework between a scientific network with partners in several SSA countries, producers of bNAbs, and European and African laboratories. With this approach, the probability of viral suppression 1 year after diagnosis will be increased from 30% to 95% to achieve 2030 UNAIDS 3rd target. This achievement will impact in a reduction of HIV- associated morbidity and mortality in the first year of life and beyond in more than 130 000 infants every year.

Despite of the successful advances achieved to date in the fight against the COVID-19 pandemic with the development of vaccines and therapy, the worldwide propagation of SARS-CoV-2 has resulted in the rapid evolution of this virus and in the emergence of variants of concern (VOC) that may dampen the efficacy of the first generation vaccines. To tackle the challenges associated with the VOC, the CoVICIS program is proposing a global approach with a powerful state-of-the-art virologic and immunologic platforms coupled with large genomic surveillance studies and diverse cohorts in EU and SSA. This allows CoVICIS to contribute to the early identification of emerging VOC and address key unanswered questions regarding i) the susceptibility to infection with VOC after a prior infection in the setting of a long-COVID or after vaccination with different vaccines, ii) the risk posed by VOC in immunocompromised patients, and iii) the modalities of infection and immune responses in children. The diversity of the cohorts provides a unique opportunity to study virus evolution in different settings, where SARS-CoV-2-specific humoral and cellular immune responses are predicted to vary very significantly. Beyond the genomic surveillance, the ground-breaking research and innovation of the program is the characterization of virologic and immunologic properties of VOC and the identification of immune correlates of protection after disease or vaccination. CoVICIS’ ambitious goals are only achievable thanks to the existing population studies and cohorts funded by national and international public agencies and public-private partnerships, and the combined collective expertise of CoVICIS partners in the fields of epidemiology, genomics, virology, immunology, data science and public health.