Decision support systems to improve schistosomiasis preparedness and control in the era of global changes

The rationale With >200 million people infected and >800 million at risk, schistosomiasis is one of the most important among the Neglected Tropical Diseases (NTD). This debilitating disease of poverty is caused by blood flukes of the Schistosoma genus, involving aquatic snails as obligate intermediate hosts. The spatial distribution of schistosomiasis coincides with development of certain water management infrastructure (typically dams, irrigation systems and reservoirs for hydropower production) and with the largely ignored, rapidly growing peri-urban areas lacking wastewaters processing facilities. In addition, the host snails and the parasites’ free-living stages lack thermoregulation ability and, therefore, their reproduction/survival/dispersal in the environment is directly affected by temperature. As a consequence, projected climate change is expected to alter the distribution/abundance of the snail hosts and, ultimately, schistosomiasis transmission risk for humans. While plans for urban and water resource development plans have occasionally included the health risk assessment for malaria, dengue and HIV, we found that no consideration is generally given to risk for schistosomiasis transmission under climate change projections, a problem virtually absent in the Environmental Impact Assessment (EIA) of water management infrastructure and severely underestimated in health surveillance plans. This is partially due to a nearly complete lack of tools to bring this information to the table of decision makers in a way that is timely (e.g., in the EIA public consultation phase), effective (easy to understand), and scientifically robust (based on scientific evidence). Overarching goal By building on the results of a previously awarded Belmont CEH1 grant, which was mainly focused on rural areas only, the present project intends to cast light on the social, climatic & environmental determinants of schistosomiasis over a rural-to-urban gradient, and to develop a family of novel tools to connect knowledge-to-action with a menu of interventions aimed at controlling schistosomiasis transmission risk. Specific goals This proposal intends: to (a) investigate the social/climatic/environmental determinants of schistosomiasis, a parasitic disease of poverty affecting > 200 million people in tropical/subtropical regions, over a rural-to-urban gradient, (b) document how this risk is accounted for in both Strategic Urban Planning and Environmental Impact Assessments (EIA) of water management infrastructure and in current health surveillance systems and (c) design a modelbase encompassing the state of the art, evidence-based, parameter-specific production functions to estimate the relationship between transmission risk and environmental, geophysical, and demographic variables (such as connectivity to infested water sources, temperature envelope and seasonality, aquatic vegetation community structure) in informal settlements and rapidly growing urban areas or in rural settings following the construction of water management infrastructure for agricultural expansion and intensification. to (d) develop an open-access, user-friendly decision support system for a rapid assessment of schistosomiasis transmission risk under climate change projections and under the effect of other relevant socio-economic and environmental determinants of schistosomiasis over a rural-to-urban gradient, and, at the same time, to (e) assemble a database of actionable solutions derived from the analysis of a century of success stories and failures in schistosomiasis control and elimination, thus allowing stakeholders to identify the risk and, at the same time have the possibility of implementing solutions to mitigate the risk by targeting the environmental reservoir of the disease to interrupt transmission. Implementation, engagement and communication strategy We plan to systematically disseminate the results of our work, including the (a) Decision Support System, (b) guidelines for including considerations on schistosomiasis transmission risk in strategic urban planning and in the Environmental Impact Assessment report for proposed water management infrastructure, and (c) the database of actionable solutions, through a comprehensive communication strategy and education/training plan that engages key supranational, national and regional stakeholders in Africa and South America. International collaborations and interdisciplinary expertise To address these challenges, we have assembled a uniquely qualified international team with academic, public and business partners from Brazil, Côte d'Ivoire, Senegal, USA, Switzerland and the UK, plus additional academic and institutional stakeholders from Kenya, Zanzibar and Nigeria. The consortium comprises experts from six (6) low- and middle-income countries (LMICs), universities, public health institutes, stakeholders, and five (5) different funding organizations. The team comprises expertise ranging from disease ecology/parasitology, to climate science, public health, human geography & social sciences, health & environmental policies, and a long and documented experience in environmental multi-objective decision making and connecting knowledge-to-action. User Engagement and Societal Impact By leveraging the unique network of collaborations with key stakeholders of our project partners - specifically of the Global Schistosomiasis Alliance, Swiss TPH, Cranfield University, the São Paulo Health Secretariat and the Stanford Natural Capital Project, we have been engaging with key stakeholders in multiple dimensions, including Ministries of Health, of development (African Ministers’ Council on Water, AMCOW), in country research institutions, financial institutions (such as the World Bank), environmental consulting companies (Terra Consulting and SIA in Senegal, CESI in Italy) and trade associations (the International Hydropower Association in London). The potential societal impact is substantial, with the project addressing the disproportionately affected marginalized populations in rural and informal settlements. By filling critical knowledge gaps, we are committed to influence health policies, strategic planning, and community well-being. This project addresses equity concerns by benefiting marginalized rural communities and contributing to closing the digital divide. The DSS and educational opportunities are designed to empower and uplift historically underserved populations. In summary, this research project, rooted in a transdisciplinary collaboration, brings together a powerhouse of expertise to fight schistosomiasis. The integration of innovative tools, user engagement, and a global-regional approach positions this initiative as a frontrunner in advancing knowledge-to-action in the fight against this debilitating disease.