Developing Resilient Nations - Towards a Public Heath Early Warning System via Urban Water Profiling (ReNEW)

我们正在为当前的问题提出一个创新的解决方案，快速识别和应对LMIC国家快速发展的城市环境中不断恶化的公共卫生和环境状况，旨在管理与城市化，人口增长，基础设施缺乏和气候变化的总体挑战有关的公共和环境健康风险。我们将建立一个尖端的，跨学科的研究能力，基于工程和数字技术方法，实时社区范围的诊断和可调的多危害公共卫生预警系统（EWS），最终目标是加强社区的复原力。我们将通过关注来自城市住宅的水来实现这一目标，因为它汇集了该人口的内源性和外源性产品，从而反映了人口和周围环境的健康状况。实时测量来自不同社区的城市水中的这些特定危害生物标志物，可以快速评估公共卫生状况，预测未来的危机，从而能够为快速或缓慢发生的危害制定缓解策略，甚至在它们表现出特征性终点（例如大流行事件中的死亡率）之前。因此，可以降低发病率和死亡率，大大提高被调查城市系统的复原力和可持续性。在这个尖端项目中，我们将开发用于公共卫生诊断的创新工具，并在斯泰伦博斯市进行范围研究，以了解在南非及其他地区开发和实施多危害EWS的要求。ReNEW解决了国际发展部（UK Aid，2015）设定的所有四个战略目标，并专注于“加强对危机的应变能力和应对能力：科学和技术支出用于全球公共卫生风险，如抗菌素耐药性，并支持缓解和适应气候变化的努力”。英国致力于“应对重大的全球挑战-从大规模移民和疾病的根源，到恐怖主义和全球气候变化的威胁-所有这些都直接威胁到英国的利益”。ReNEW将通过设计用于现场监测的新型集成传感器和使用大数据对城市水系统中的标记进行建模来解决这一问题，作为EWS的一部分。我们将重点关注传染病。世纪已经见证了SARS（2003）、H1N1（2009）、埃博拉（2014）和最近的寨卡病毒（2015）的流行。英国政府最近委托的奥尼尔报告（2016年）敦促“到2050年，由于耐药感染的增加，每年有1000万人的生命和累计100万亿美元的经济产出面临风险。大部分直接影响将落在中低收入国家”。这突出表明全球易受传染病的影响，以及全球在监测和疾病控制方面的共同责任。迫切需要易于操作和具有成本效益的预警系统，以提供及时的反应，并在最需要的社区解决关键的公共卫生问题，并减少疾病在全球的传播。城市水概况分析可以实时提供这种响应，如果与及时响应系统相联系，它可以减轻LMIC乃至全球公共卫生的负担。

We are proposing an innovative solution to current problems with rapidly identifying and responding to deteriorating public health and environmental conditions in fast developing urban environments in LMIC countries, aiming to manage risks to public and environmental health relating to urbanisation, population growth, lack of infrastructure and the overarching challenge of climate change. We will establish a cutting-edge, interdisciplinary research capability, based on engineering and digital technology approaches, for real-time community-wide diagnostics and tuneable multi-hazard public health early warning system (EWS) with the ultimate goal of strengthening communities' resilience. We will do this through a focus on water from urban dwellings, which reflects the health status of a population and surrounding environment as it pools the endo- & exogenous products of that population. Real-time measurement of these specific hazard biomarkers in urban water from different communities allows for rapid evaluation of public health status, prediction of future crises, and thus enables mitigation strategies to be developed for either rapid or slow onset hazards, even before they manifest themselves with characteristic endpoints (e.g. mortality in the event of pandemics). Thus morbidity and mortality can be reduced and resilience and sustainability within the surveyed urban system significantly increased. In this cutting-edge project we will develop innovative tools for public health diagnostics and undertake a scoping study in the city of Stellenbosch to understand the requirements for the development and implementation of a multi-hazard EWS in South Africa and beyond. ReNEW tackles all four strategic objectives set by the Department for International Development (UK Aid, 2015) and it focuses on "strengthening resilience and response to crises: (...) science and technology spend on global public health risks such as antimicrobial resistance, and support for efforts to mitigate and adapt to climate change". The UK is committed to "tackling the great global challenges - from the root causes of mass migration and disease, to the threat of terrorism and global climate change - all of which also directly threaten British interests". ReNEW will address this through engineering novel integrated sensors for on-site monitoring and use of big data for modelling markers within the urban water system as part of an EWS. We will focus on infectious disease. 21st century has already seen the epidemic of SARS (2003), H1N1 (2009), Ebola (2014) and recently Zika virus (2015). The recent O'Neill report (2016) commissioned by the UK government urges that "by 2050, 10 million lives a year and a cumulative 100 trillion USD of economic output are at risk due to the rise of drug resistant infections. Most of the direct impact will fall on LMIC countries". This highlights global vulnerability to infectious diseases and shared global responsibility for surveillance and disease control. Easy to operate and cost effective EWSs are urgently needed to provide timely response and to tackle key public health issues in communities that need it most, and to reduce disease spread globally. Urban water profiling can provide such a response in real-time and, if linked with a timely response system, it could reduce burden on public health in LMIC and ultimately worldwide.