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

我们正在提出一项创新的解决办法，以迅速查明和应对中低收入和中等收入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、缺乏基础设施和气候变化的总体挑战有关的公共卫生和环境健康风险。我们将建立基于工程和数字技术方法的前沿跨学科研究能力，用于实时社区诊断和可调多灾种公共卫生预警系统（EWS），最终目标是加强社区的复原力。为此，我们将把重点放在城市住宅用水上，这反映了人口和周围环境的健康状况，因为它汇集了人口的内源性和外源性产品。对来自不同社区的城市水中这些特定危害生物标志物进行实时测量，可以快速评估公共卫生状况，预测未来的危机，从而能够制定针对快速或缓慢发作的危害的缓解战略，甚至在它们表现出特征端点之前（例如，在发生大流行病时的死亡率）。因此，发病率和死亡率可以降低，被调查城市系统内的复原力和可持续性可以显著提高。在这个前沿项目中，我们将开发用于公共卫生诊断的创新工具，并在斯泰伦博斯市开展一项范围研究，以了解在南非及其他地区开发和实施多灾种EWS的要求。ReNEW解决了国际发展部制定的所有四个战略目标（英国援助署，2015年），重点是“加强复原力和应对危机：（…）针对抗菌素耐药性等全球公共卫生风险的科学和技术支出，以及支持减缓和适应气候变化的努力”。英国致力于“应对巨大的全球挑战——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将通过工程上新颖的集成传感器来解决这个问题，该传感器用于现场监测，并使用大数据在城市水系统中建模标记，作为EWS的一部分。我们将重点关注传染病。21世纪已经经历了SARS（2003年）、H1N1（2009年）、埃博拉（2014年）和最近的寨卡病毒（2015年）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，每年将有1000万人的生命和累计100万亿美元的经济产出面临风险。”大多数直接影响将落在中低收入国家身上。”这突出了全球对传染病的脆弱性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环境卫生系统，以便在最需要的社区及时作出反应并解决关键的公共卫生问题，并减少疾病在全球的传播。城市水分析可以提供这种实时反应，如果与及时反应系统相结合，它可以减轻低收入和中等收入国家以及最终全世界的公共卫生负担。

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.