If there was any lingering doubt that climate change threatens human health and well-being, this year put it to rest. Wildfire smoke aggravated heart disease and lung disease up and down the West Coast and across the country. A record-breaking hurricane season killed and injured people from North Carolina to Texas, and left tens of thousands homeless and at risk of PTSD and other mental health problems. Oppressive heat across the Southwest imperiled outdoor workers and athletes, the elderly and the poor, and people with underlying health problems, with risks ranging from heatstroke to heart attacks and even death.

2020 reinforced another lesson: If we don’t prepare for health disasters and manage them skillfully, informed by the best evidence, thenpeople suffer and die needlessly. In confronting a novel virus, the United States failed in its response, and we continue to have one of the world’s highest COVID-19 death rates.

What is true for COVID is true for climate change. We’re not prepared. Part of the gap is a knowledge gap: We haven’t done the needed research, and we lack critical information.

As former directors of the Center for Disease Control’s National Center for Environmental Health, we are alarmed by this neglect of a major climate and public health emergency. And so we recommend a solution: the urgent creation of a new National Institutes of Health division—the National Institute of Climate Change and Health.

With a budget of over $40 billion, the NIH is the largest, best funded health research institution in the world. Yet currently a measly $9 million is spent annually on research directly related to climate change and health, according to theNIH’s own tally. If the NIH budget were scaled to $100, climate change and health funding would amount to two hundredths of one penny—what’s called “budget dust.”

How could NIH spend so little on one of our greatest health threats? The longstanding culture of reductionist biomedical thinking—approaching health research as if an organ-by-organ approach meets population health knowledge needs—plays a role. (If you’ve ever been shunted from specialist to specialist, wishing for a doctor who could care for you as a whole person, you’ll know how well that works.) So does undue emphasis on disease over health, on treatment over prevention. Lobbying by special interests such as disease advocacy groups, and in recent years political meddling, inappropriately shape priorities. The result islong-standing neglect of what should be a health research priority.

A climate change institute within NIH would support research to answer critical questions related to climate and health. This would help Americans be better prepared for mental and physical health risks and identify effective prevention and treatment strategies. Research could quantify the health benefits, and cost savings, from cutting carbon emissions across the economy, to help chart the healthiest path forward. It could provide a blueprint for reconfiguring hospitals and clinics to be climate-ready and to reach net zero carbon emissions as soon as possible, while delivering top quality care to all. The United Kingdom’s National Health Service, for example, has already launched an ambitious plan to eliminate nearly all of its carbon emissions.

In addition to supporting research, NIH funding helps train young researchers—a critical role. For a comparison, consider the Pentagon, which robustly supports the nation’s military academies and other training infrastructure. Military leaders know that failure to maintain a pipeline of smart, competent service members would undermine U.S. defense capability. The same is true for health and medicine, particularly in the face of inexorable threats such as climate change. We need a cutting-edge research workforce for years to come. Today, dangerously, there is no research training pipeline on climate change and health. A climate change institute at NIH could meet that need.

Nobody wants another government agency if it is not needed. It’s fair to ask: Could an existing NIH institute deliver the needed research and training? NIH does have an environmental health institute, the National Institute of Environmental Health Sciences. But it is almost entirely focused on chemical toxins and pollutants. Its history and expertise make it unsuited to a major climate change research effort. We need a new NIH institute.

A climate change and health institute would break new ground at NIH. Even with a midrange budget (by NIH standards)—say, $1 billion/year, smaller than 10 of the existing institutes—such an institute would revolutionize research on climate change and health. It would deliver needed insights to protect the public from the ravages of climate change, and it would create a world-class health workforce.

Existential threats call for groundbreaking innovations. It’s time for a National Institute of Climate Change and Health.