Open Network for WAter-Related Diseases (ONWARD)

The ONWARD Network (Open Network for Water-Related Diseases) is dedicated to forecasting, early warning and risk mapping for water-associated diseases through use of remote sensing, field observations and mathematical modelling. Our vision is to enable cost-effective, regularly updated, geo-referenced early warning for areas vulnerable to water-associated diseases, which in turn will enable preventive measures to be deployed in a timely manner to minimise the probability of epidemics. Our long-term vision is to establish a system that will be applicable broadly, in a variety of localities and for a variety of diseases.

By "water-associated" disease, we mean a rather broad class, including diarrhoeal diseases such as cholera; skin diseases associated with water-borne bacteria or metazoan parasites; vector-borne diseases such as malaria and dengue fever; and others such as hepatitis. Any or all of them will be relevant to the activities of the network. The "water" involved may be fresh, or brackish or coastal seawater. The network will respond primarily the GCRF Challenge of Global Health (infectious diseases), and secondarily to that of Resilience to Environmental Shocks and Change (since outbreaks of water-associated diseases are affected by extreme weather events, expected to become more frequent as a result of climate change).

The network will also address UN Sustainable Development Goal 3, Target 3d, to "Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks." According to the World Health Organisation, some two billion people use faecally-contaminated drinking water, putting them at risk of death or chronic poor health from water-borne infectious diseases such as cholera, dysentery, typhoid and polio. Provision of safe drinking water is hostage to the influence of extreme weather and flooding. Apart from the fatalities, the effect of a chronic burden of lower-level infection by water-associated diseases is antagonistic to the maintenance of a healthy work force and to the well-being of society in general, to the detriment of sustainable development. For example, cholera kills an estimated 95,000 people every year, but it also makes another 2.9 million seriously ill with a debilitating disease. Hence the need to address, in addition, the resilience of communities to perturbations of the safe drinking water supply under extreme weather events associated with a changing climate.
Before now, our ability to develop early warning, risk reduction and management of national and global health risks due to water-associated diseases has been limited by mutual isolation of the scientific communities whose collective effort is required to make progress. Forecasting outbreaks of water-associated diseases and their geo-referenced risk mapping is a complex matter for which the collaboration of experts from several disciplines (ranging from environmental biochemistry, genetics, molecular biology, social sciences and epidemiology to remote sensing and modelling) is needed if we are to make real advances. Hitherto, the required experts have rarely encountered each other in a scientific setting. A multidisciplinary network is essential to foster exchange of ideas between them, and so build a collaborative approach to a difficult problem by uniting them behind a common target. We believe that progress in early warning, risk forecasting and risk management of water-associated diseases will be possible through the combined efforts of specialists in the stated disciplines. Establishment of a related network is the perfect way to bring this about. An international team of outstanding experts, as well as related stakeholders, has been assembled to undertake the work. The network will be an open one. As well as the research activity, there will be a component of capacity building delivered through two training courses.

We see the impact of our project in a broad societal context: implications for human health and stewardship of aquatic resources are issues of growing societal concern, related to the state of our ecosystems (specifically, aquatic ecosystems), under threat from climate change and pollution, which impact the ability of the ecosystems to meet increasing demands from the human population for food, recreation and industry. These concerns are encapsulated in a declaration of the United Nations on the need for an "ecosystem-based management" of aquatic resources. Our proposal deals with a network committed to adopt an ecosystem-based approach to risk forecasting and risk management of waterborne diseases, to help reduce their societal impact at the global scale.

We address the United Nations Sustainable Goal 3 (Health) Target 3.3 "By 2030, end the epidemics ......of malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases." And Target 3d to "Strengthen the capacity of all countries, in particular developing countries, for early warning, risk reduction and management of national and global health risks." Given the influence of a changing climate on the distribution and intensity of outbreaks of water-associated diseases, we address also SDG 13 (Climate), Target 13.3 to "Improve education, awareness-raising and human and institutional capacity on climate change mitigation, adaptation, impact reduction and early warning". The UK Government's Climate Change Risk Assessment 2017 identified the risk of emerging Vibrio pathogens [important water-borne disease leading to cholera] and associated disease outbreaks as one of the top six inter-related climate-change risks, and highlighted it as an urgent (next five year) Research Priority. In other words, the arena we plan to work in is ripe for attention.

Against this background, the potential impact of the proposed network ONWARD is very great. It would represent a united mobilisation of expertise from different disciplines to deal with a single, complex problem: the provision of early warnings and geo-referenced risk mapping for outbreaks of water-associated diseases. By taking an ecosystem-based approach, in which the first-principles of all the participating disciplines are combined to develop the necessary forecasting protocols, we will work towards a methodology that is scalable within countries and transferable to other countries where conditions will, inevitably, vary. The initial impact will be greatest on coastal communities in tropical, developing countries. For example, on countries contributing to the estimated 95,000 people killed by cholera and the further 2.9 million it makes seriously ill each year. The chronic, non-fatal infections are devastating to communities, their well-being, their work forces and their prospects for development. The positive impact of the geo-referenced risk maps will allow public health officials to make geo-targeted interventions with vaccines and other measures in advance of potential outbreaks, with enormous benefit to the communities involved. The public health services will also be impacted through major improvement of their operational methods.

A related impact will be through the training workshops, delivered by expert network members to participants from developing and developed countries, on the new cross-disciplinary procedures for risk mapping developed by the network. The training will have the effect of disseminating the new knowledge with maximum speed, thus increasing the impact, and making ONWARD a highly cost-effective project.

Intergovernmental bodies such as GEO (especially its communities of practice on Diseases and on Costal Communities, its Blue Planet and its Aquawatch) will see a direct impact, as they hope to expand the societal benefits of Earth observation by increasing its applications in real situations. This is exactly what ONWARD will achieve.