The São Paulo Macro Metropolis (SPMM) is one of the richest and most inequitable regions of the Global South and is already experiencing the impacts of severe climate events. This study analyzes climate risk assessments and policy responses for this territory as well as its vulnerabilities. The Index of Vulnerability to Natural Disasters related to Droughts in the Context of Climate Change (IVDNS—acronym in Portuguese) was used to identify and select the most vulnerable municipalities in the SPMM. Following vulnerability analysis, the municipalities were subjected to risk analysis in the context of existing Brazilian legislation. The results indicate that, despite having positive capacities to respond to climate change, the analyzed municipalities are far from advancing from the status quo or taking the actions that are necessary to face future challenges in a climate emergency scenario. The results indicate that, despite being the most vulnerable to droughts and natural disasters, the cities analyzed are not the most vulnerable in the São Paulo Macro Metropolis from a socio-economic point of view. On the contrary, these are regions that could have a strong institutional capacity to respond to present and future challenges.