WickedSchisto: Developing an robust interdisciplinary-informed WASH framework for the wicked public-health problem of schistosomiasis

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Over 240 million people have schistosomiasis, a debilitating disease intrinsically linked to inadequate water, sanitation and hygiene (WASH). A wicked problem is a social or cultural problem that is difficult or impossible to solve. Despite extensive mass drug administration (MDA), schistosomiasis remains a wicked public-health problem. WASH-interventions are needed to reach the World Health Organization (WHO) 2030 goal of elimination as a public-health problem. Yet we don't understand the full impact of schistosomiasis, and therefore cannot identify what feasible and cost-effective WASH interventions best reduce this impact, nor the threats to long-term control programme success, and how to mitigate these. I will address five ambitious questions:1. What are the true health, economic and societal impacts of schistosomiasis?2. What are the most cost-effective combinations of WASH and MDA interventions?3. How best can we scale-up these public-health WASH interventions to reach WHO 2030 goals?4. What are the risks from human mobility to achieving and sustaining WHO 2030 goals?5. How can cross-sectorial policy buy-in be leveraged to help reach these goals?I will use innovative interdisciplinary methods to tackle this wicked public-health problem including: an unprecedented, bottom-up approach to identify acceptable, equitable, cost-effective, feasible, multifaceted interventions with highest 'value for money' and impact on schistosomiasis health-related quality of life; develop a field-based morbidity marker to monitor success; combine state-of-the-art parasite genomics with mathematical models to inform on control programme endpoints; and identify community, through to international level, facilitators to leverage for intervention success. My pioneering research will inform policymakers in Uganda and beyond on how best to eliminate schistosomiasis. I will fill a critical global-health knowledge gap and provide a framework for other WASH-associated diseases.