Rapid and global urban transitions have led to the rise of Emerging Infectious Diseases (EIDs), like Coronavirus, Avian Flu, MERS, SARS and Ebola. According to the Centers for Disease Control (CDC), the United States’ national security is at risk within 36 hours of a pathogen outbreak in any remote area of the world.
There is no shortage of mysteries about how EIDs have medically evolved; on the other hand, we have a relatively clear understanding of where they have – their geography. Over the past 15 years, our research has shown “spillover” of infectious zoonotic pathogens from domesticated animals to humans happens most frequently where unplanned and rapid urbanization has combined with agricultural intensification and the conversion of natural habitats. In part due to weak human and veterinary health infrastructures, EIDs are no longer confined to remote areas. Rather than succumb to irrational panic, we must better understand that zoonotic disease transmission has occurred throughout history, but it is urbanization that enables these formerly remote diseases to quickly spread to large population centers like never before.
Urban megaregions are the nodes through which these pathogens arrive in the United States. Our research has shown that - thanks to its multiple ports of entry - the Piedmont Atlantic Megaregion (PAM) is one of the fastest growing in the country. The area stretches from Birmingham, Ala. to Raleigh, N.C. and encompasses Atlanta’s Hartsfield-Jackson International Airport, the world’s busiest. Several major port cities and inland ports are also in the region, including in Savannah, Ga., Charleston, S.C. and Wilmington, N.C. These entry points play a critical role in how pathogens can arrive stateside, and only by developing a network of smarter cities can we begin to combat outbreaks.
Better understanding EIDs and the PAM’s place in this network will not just protect our health, but also limit the risk of irrational fear dampening our economy. In 2015, the U.S. exported over $300 billion in material goods and services to 49 health security priority countries, a sector that supported over 1.6 million jobs across America, many of which are right here in the PAM.
The CDC has called for better integration of global public health through shared surveillance systems for detection and reporting, international laboratory networks to accurately identify causes of illness, a trained workforce to identify, track and contain outbreaks, and emergency management systems to coordinate an effective response. While these are critical initial efforts, the difficulty of identifying risks before they become unmanageable, and the fact that threats are so diffuse over a global set of potential origin areas, we also need new frameworks and technologies – especially those that can be integrated into daily practice between the intermittent waves of pandemic fear.
Enter the smart city of the future.
Today, there is an ever-present buzz about “smart cities.” Too often this simply means using technology to increase the scope and reduce the costs of typical urban infrastructures. A more comprehensive approach leveraging this attention and protecting global human health would help institutionalize better tools to control pandemic risks, and in the process reduce unintended and negative economic impacts the fear of those risks creates. Today’s cities are dense clusters of interacting people, technology and governing rules that play out in very constrained land areas – they operate on local scales but often have global impact.
Truly “smart” cities will have infrastructure to manage this density that is equally embedded in localities, but globally connected.
We see today’s world as a network, a “global urban ecosystem,” that increasingly acts like a “metro system” in which non-proximal neighborhoods, communities and regions are connected through a standardized system of pathways that make travel to unknown areas predictable and navigable. However, unlike a formal transportation infrastructure like a “metro system”, the “global urban ecosystem” is governed by multiple – and often disjointed– global regulations on the mobility of people, goods and services, combined with numerous cultural and linguistic norms that allow it to function. When one node on this network comes under threat from a zoonotic EID arising in a city undergoing a rapid urban transition, the whole system goes on high alert. Because this is a system, we need to ensure each of its nodes has the capacity to manage these biological threats without shutting the system down. As with any good transit system, it is standardized infrastructure at each node that enables everything to function well. Thus, even more so than shared surveillance systems, compatible social and urban infrastructure are needed to manage EID risks credibly.
Better planning of mega-urban regions is needed: improved sanitation and water supply are some of the first investments needed. That’s followed closely by more regulation of open-air “wet” markets, where dead or living animals are bought, sold, or butchered; and viable community-based systems that allow and incentivize local poultry - and other farm-workers to self-report and self-police rather than elude public health control efforts. Even beyond that, leveraging nascent technologies supporting telemedicine would be very well received far from the U.S. shores even before the next EID threat arises, and like the other infrastructures, help ensure the system’s sustainability. Even further ahead, one of our former students is in the initial stages of developing a personal security and risk assessment mobile-app. What if this app were to have an option that develops an EID risk profile for users with an algorithm monitoring the user’s temperature, divergence from normal coloring, and a GPS-tracking function determining the user’s overlap with recent geographic hotspots of EIDs. Here we would leverage residents’ very strong interest in knowing their own health status, and identify those who need to get checked by a health provider as soon as possible. Even more important, it gives the shared global public health workers more tools than mass quarantine based on the assumption that everyone is maximally infected.
If we don’t make these kinds of investments, we will surely face another EID crisis in the near future with even greater reluctance of local communities to report the first signs of infection.
James H. Spencer is associate dean and professor of city and regional planning, Clemson University. Catherine L. Ross is regents’ professor, Harry West professor of city and regional planning and civil and environmental engineering at Georgia Tech. Sumeet Saksena is senior fellow, the East West Center, Honolulu.
