According to United Nations’ data, more than 50 percent of the world population resides in urban areas. This is expected to grow to 70 percent by 2050, primarily driven by urbanisation in Asia and Africa. To host at least 40 percent of its people in cities by 2030, may be lower than some other developing nations, still pose a scary proposition for its already gasping urban ecosystem.
The Indian government’s “Smart Cities Mission” aims to set the urban agenda right, through its slew of schemes and innovative approaches to address the known challenges and futuristic needs. It is envisioned to provide impetus for comprehensive urban development through institutional, physical, social and economic infrastructure, while incrementally adding the layers of smartness. Mindful of the emerging pattern of disease outbreaks globally, strengthening of cities’ resilience to biological threats should clearly be one of these layers.
Fifteen years ago, on 5 July 2003, WHO’s announcement that SARS outbreak has been finally curtailed made cities across the world, who were under the grip of the disease, heave a sigh of relief. However, further emergence of newer forms of biological threats in the past 15-odd years exposed the under preparedness among cities, especially in the developing world. SARS was distinct among its genre to wake up cities from their perceived sense of comfort and confidence.
In 2009, the H1N1 pandemic, basically an influenza outbreak, piggybacking on the booming migrations and burgeoning air travels, again challenged the preparedness across cities. In 2014, the deadly Ebola Virus of West Africa sprang a surprise by showing up in cities, first time in its four decade-long documented history. Further, the danger of spread through air travel is no more limited to flu causing influenza, as more bugs – MERS in 2012, Zika virus in 2014 and Yellow fever most recently – have also taken unrestricted passports for global spread, hopping across several cities.
With biological threats embarking their urban journeys, the scale of their impact on cities will be inversely proportional to the thoughtfulness in city planning and effectiveness in execution of multi-faceted urban development process. Large-scale mass transportation projects like metro rail, planned across almost all Indian cities, are restrictive in safety with their focus primarily on the parameters of feasibility and viability. The recent 6 July news on the execution of the Japanese cult leader Shoko Asahara for his 1995 crime of Sarin gas release into the Tokyo subway system serves as a chilling reminder of transport infrastructure vulnerabilities in cities -- not just for the natural, but also bioterrorism attacks. Sadly, the health security dimension is grossly missing in the current public discourses on urban development.
Urban transmission abilities of outbreak-causing agents can technically be seen through two mediums – those that spread freely as airborne or via vectors like mosquitoes – both controllable to varying extents. However, actual risk of outbreaks is amplified by rapid urbanisation and ease of human mobility.
Infectious diseases like influenza, SARS, H1N1, measles and tuberculosis become airborne, through the very light and tiny infectious aerosols – particles released when an infected patient coughs, sneezes or even talks. Aerosols tend to remain suspended in air for long periods of time, prolonging the duration of exposure and increasing the hazard, unless cleared off naturally by ventilation or artificially, through air filtration. In 2003, SARS, which started from just two cities in South Asia, showed alarming swiftness and spread over 26 countries across five continents within a couple of months. Crowded spaces and extensive air connectivity of Hong Kong offered the perfect combination for SARS to first cause an outbreak in a short and then turn into a pandemic by spreading globally.
Rapidly growing cities in Asia and Africa are hallmarked for their haphazard growth and significant inequities within themselves. Their large informal settlements and unhygienic sanitation conditions become breeding zones for disease carriers like mosquitoes and rats promoting various infections like Dengue, Zika, Yellow fever, Plague and Leptospirosis. While Delhi is continuing its fight against mosquitoes and Dengue for years now, some Chinese cities have been battling deadly Seoul Hantavirus fever, associated with the urbanisation and increase in rat populations and greater human-rat contact. Manila in Philippines is currently on its toes against Leptospirosis, again spread by rats. Contaminated water and poor sewerage conditions can propel a range of threats as simple as food-borne diarrheal outbreaks to the most dreaded outbreaks caused by drug resistant pathogens.
Despite better access to basic amenities in urban areas over their rural counterparts, high urban population density multiples the overall risk for outbreaks. Both perennially crowded settings of slums and shorter duration crowding for public transport pose similar high risks for transmission of outbreaks. While the ability of local trains in Mumbai and the Delhi metro to move millions of passengers daily earns them the title “lifelines” for these cities, they can also double up as “sicklines” in the face of biological outbreaks.
While cities can get shaped physically by their finances and become sustainable through their governance, resilience of cities will still be a function of the citizens’ involvement in its development process. Solutions aimed at decongestion, including better housing policies and safeguarding people across microenvironments such as transport systems, should be the top priorities for city administrators and political leaders, who should embrace participatory governance over any myopic electoral gains or administrative convenience.
Citizens should be engaged and well informed of the true determinants of growth and the strategic restraints needed for responsible sharing of limited urban spaces. Only when fully aware, citizens could become key partners for sharing the responsibilities of risk reduction, community-based early warning systems and even as strong propellers for city-specific preparedness measures. In the face of outbreaks, simple acts of citizens like following strict personal hygiene including cough etiquette and exercising self-restraint in their movements could be of big help to city administrators in controlling them.
Empowering all stakeholders and agencies to be fully alert is crucial. Surveillance should be made real time, widely accessible and predictive and linked to advanced health technologies. In cities dominated by the service industry, innovative alternatives should be tried to ensure continuity of work to minimise economic disruption. For example, “self-quarantining” coupled with “home-based working options” further integrated with “absenteeism management plans” merit inclusion into preparedness policies for corporates and even for some public agencies.
Both physical and procedural improvements need to be driven through various departments and agencies involved in design, construction and operation of the shared enclosures and public utilities. Policy changes, to incorporate adequate natural ventilation into the design aspects of housing and to promote rectifications to ensure adequate ventilation or air filtration in offices, buses, trains, metro cars, underground tunnels, airports and flights, are crucial for limiting the spread. Biosafety measures adopted by airline industry after the SARS scare, can provide leads to other modes of transportation as well.
All emerging urban agglomerations, irrespective of their official urban designation and slums irrespective of their official status, should be guided through spatial planning approach and not allowed to grow haphazardly. City-wide technology platforms for security and surveillance should also embed the sensors and protocols for health and biological threats, to aid in early detection and timely preventive measures.
In face of natural or man-made biological outbreaks, the need for resilience remains the same. If cities fail to keep its people safe, the belief of cities being the drivers of prosperity will sadly fall flat on its premise. Smart cities mission, as the very basic, should stimulate meaningful discourse and properly channelise the investments, to not let this happen.
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