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1、WHO global health foresight seriesEmerging technologies and scientific innovations:A global public health perspective2023WHO global health foresight seriesEmerging technologies and scientific innovations:A global public health perspective20232023 Emerging technologies and scientific innovations:a gl

2、obal public health perspective(WHO global health foresight series)ISBN 978-92-4-007387-6(electronic version)ISBN 978-92-4-007388-3(print version)World Health Organization 2023Some rights reserved.This work is available under the Creative Commons Attribution-NonCommercial-ShareAlike 3.0IGO licence(CC

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10、he part of WHO concerning the legal status of any country,territory,city or area or of its authorities,or concerning the delimitation of its frontiers or boundaries.Dotted and dashed lines on maps represent approximate border lines for which there may not yet be full agreement.The mention of specifi

11、c companies or of certain manufacturers products does not imply that they are endorsed or recommended by WHO in preference to others of a similar nature that are not mentioned.Errors and omissions excepted,the names of proprietary products are distinguished by initial capital letters.All reasonable

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13、hall WHO be liable for damages arising from its use.ContentsForeword.ivAcknowledgements.vAbbreviations and acronyms.viiGlossary.viiiExecutive summary.x1.Introduction.12.Methods.42.1 Overview.42.2 Desk research,literature review and identification of experts.52.3 Preliminary call for ideas.52.4 Horiz

14、on scan .63.Innovations for the future of global health.83.1 Overall ranking.93.2 Rating of innovations according to their potential impact,chance of adoption and time to adoption.104.Enablers of adoption.404.1 Technological enablers.414.2 Skill-and capacity-building enablers.454.3 Structural,legal

15、and political enablers.464.4 Cultural enablers.495.Risks and other considerations.516.Discussion.537.Conclusions.56References.57Annex 1.List of innovations considered.61Annex 2.Consensus among experts in scoring the potential impact of innovations.64iiiivForewordAdvances in science and technology ho

16、ld great promise and hope for new,improved ways to address global health challenges and ensure healthier populations worldwide.Science and technology are advancing rapidly,and WHO strives to remain abreast of the latest developments in relevant areas of scientific research and technology to identify

17、,anticipate and prepare for issues that hold potential for global health.The WHO Global Health Foresight function was established to assist Member States in building“futures-thinking”into strategic health planning.WHO Global Health Foresight actively monitors scientific and technological advances to

18、 support Member States in ensuring better anticipation of risks,better preparation for governance,and more timely adoption and scale-up of scientific advances with significant potential for global health.This document presents the findings of a global horizon scan of advances that deserve focus and

19、could be harnessed to improve global public health.While this report does not provide a definitive or exhaustive list of emerging technologies,it is intended to serve as a starting-point for optimizing the benefits,identifying critical enablers,and mitigating the risks associated with some of the mo

20、st promising emerging technological and scientific innovations.While the Foresight function is not a crystal ball designed to predict the future,it offers a set of tools by which possible futures can be imagined via a structured and inclusive approach,to create opportunities for deliberate discussio

21、ns to inform decision-making.By adopting a futures-thinking mindset,WHO and Member States can inform actions today to shape the optimal development and governance of scientific advances,in hopes of providing timely and equitable access to new treatments,diagnostics,vaccines and health-related innova

22、tions to populations worldwide.John ReederDirectorDepartment of Research for HealthWHOHarold Varmus ChairWHO Science CouncilvAcknowledgementsThe WHO Research for Health Department thanks the many individuals who contributed to this document.The project was conducted under the leadership of the Emerg

23、ing Technologies,Research Prioritization and Support(EPS)unit,which hosts the WHO Global Health Foresight function in the WHO Science Division Research for Health Department,and took place between June 2022 and January 2023.It was organized by Marion Laumonier,Clarinda Cerejo(consultant)and Anna Lau

24、ra Ross.The WHO EPS unit was assisted by a joint venture led by New Angle Portugal.Advice and feedback on the technical concept were received from the WHO Science Council,in particular:Edith Heard(European Molecular Biology Laboratory,Germany;College de France,France),Adeeba Kamarulzaman(Monash Univ

25、ersity Malaysia;International AIDS Society,Malaysia),Salim Abdool Karim(Centre for the AIDS Program of Research in South Africa,South Africa;Columbia University,USA),Mary-Claire King(Genome Sciences and Medicine,University of Washington,USA),Jean William(Bill)Pape(Haitian Group for the Study of Kapo

26、sis Sarcoma and Opportunistic Infections(GHESKIO),Haiti),Abla Mehio Sibai(Faculty of Health Sciences,American University of Beirut,Lebanon),Harold Varmus(Meyer Cancer Center of Weill Cornell Medicine;New York Genome Center,USA)and Yongyuth Yuthavong(National Centre for Genetic Engineering and Biotec

27、hnology,National Science and Technology Development Agency,Thailand).WHO expresses its sincere appreciation to all experts for their contributions in interviews,in online responses or in roundtable discussions.The experts were:Mohammad Abdollahi(Tehran University of Medical Sciences,Islamic Republic

28、 of Iran),Dissou Affolabi(National Tuberculosis Programme,Benin),Anurag Agrawal(Ashoka University,India),Nisreen Al-Hmoud(Royal Scientific Society,Jordan),Uche Amazigo(Pan African Community Initiative on Education and Health,Nigeria),Angela Brand(Maastricht University,Netherlands Kingdom of the,Mani

29、pal Academy of Higher Education,India),Vijay Chandru(Indian Institute of Science,India),Isaac T.Chikwanha(Global Health Innovative Technology Fund,Japan),Rajiv Chowdhury(Florida International University,USA),Dawn Craig(National Institute for Health ResearchInnovation Observatory,Population Health Sc

30、iences Institute,Newcastle University,United Kingdom),Ben Durham(National Department of Science and Innovation,South Africa),Vittorio Fattori(Food and Agricultural Organization of the United Nations,Italy),Tobias Gantner(HealthCare Futurists,Germany),Michele Garfinkel(previously,European Molecular B

31、iology Organization,Germany),Claudia Gonzaga-Jauregui(International Laboratory for Human Genome Research,National Autonomous University of Mexico,Mexico),Philip Hines(European Medicines Agency,Netherlands Kingdom of the),Shahid Jameel(Oxford Centre for Islamic Studies,and Green Templeton College,Oxf

32、ord,United Kingdom),Vivekanand Jha(George Institute for Global Health,India),Adeeba Kamarulzaman(Monash University Malaysia;International AIDS Society,Malaysia),Salim Abdool Karim(Centre for the AIDS Program of Research in South Africa,South Africa;Columbia University,USA),Paul Kazyoba(National Inst

33、itute for Medical Research,United Republic of Tanzania),Ejaz Ahmad Khan(Health Services Academy,Pakistan),Marie-Paule Kieny(Medicines Patents Pool,Switzerland),Kristopher Kilian(University of New South Wales,Australia),Niti Kumar(Council of Scientific and Industrial Research,Central Drug Research In

34、stitute,India),Desmond Kuupiel(Durban University of Technology,South Africa),Malini Laloraya(Rajiv Gandhi Centre for Biotechnology,India),Thierry Laugel(Kurma Partners,France),Poh Lian Lim(Ministry of Health,Singapore),Michael Makanga(European and Developing Countries Clinical Trials Partnership,Net

35、herlands Kingdom of the),Sebastian Maurer-Stroh(GISAID A*STAR Bioinformatics Institute,Singapore),Bertalan Mesk(The Medical Futurist Institute,Hungary),Carlos Morel(Oswaldo Cruz Foundation,Brazil),Anye Nyamnjoh(University of Capetown,South Africa),Prasit Palittapongarnpim(Mahidol University,Thailand

36、),Jeemon Panniyammakal(Sree Chitra Tirunal Institute for Medical Sciences and Technology,India),Wibool Piyawattanametha(King Mongkuts Institute of Technology Ladkrabang,Thailand),Michele Ramsay(University of the Witwatersrand,South Africa),William(Bill)Rodriguez(FIND,Switzerland),Catherine Rhodes(Un

37、ited Kingdom),Melanie Saville(Coalition for Epidemic Preparedness Innovations,United Kingdom),Abla Mehio Sibai(Faculty of Health Sciences,American University of Beirut,Lebanon),Brennan Spiegel(Cedars-Sinai,USA),Steffanie Strathdee(University of California San Diego,USA),Petro Terblanche(Afrigen Biol

38、ogics,South Africa),Jane Thomason(United Kingdom),Harold Varmus(Meyer Cancer Center of Weill Cornell Medicine;New York Genome Center,USA),Helena Hui Wang(The Lancet,China),Yongyuth Yuthavong(National Centre for Genetic Engineering and Biotechnology,National Science and Technology Development Agency,

39、Thailand)and Nadia Batool Zahra(Department of Biotechnology,Qarshi University,Pakistan).vi2023 Emerging technologies and scientific innovations:A global public health perspective The experts participated as individuals and not as representatives of their organizations.This publication benefited from

40、 technical advice from Efstratios Chatzixiros,Maria Magdalena Guraiib,Patricia Ndumbi Ngamala,Mercedes Perez Gonzalez,Anita Sands,Emmanuelle Tuerlings,Soatiana Rajatonirina,at WHO headquarters and Yongyuth Yuthavong of the WHO Science Council.The publication was developed and produced with funding f

41、rom Global Affairs Canada.viiAbbreviations and acronyms3Dthree-dimensional AIartificial IntelligenceCRISPR/Cas clustered regularly interspaced short palindromic repeats with Cas enzymeEPSEmerging Technologies,Research Prioritization and Support(WHO unit)IGinnovation groupLMIClow-and middle-income co

42、untriesmAbs monoclonal antibodies MLmachine learningmRNAmessenger RNAR&Dresearch and developmentWHOWorld Health OrganizationviiiGlossaryThe following terms and explanations of their meanings are those used in the context of this document.They may have different meanings or formal definitions in othe

43、r contexts.3D-printingConstruction of a three-dimensional(3D)object from a computer-aided design model or a digital 3D model by a process in which material is deposited,joined or solidified under computer control,material being added,usually layer by layer.Artificial intelligenceThe ability of compu

44、ters to demonstrate intelligence and perform acts usually associated with intelligent beings.Augmented realityAugmentation of the users reality and surroundings by digital means;can be used in health care to train health-care professionals in diagnosis and treatment.Big DataVery large sets of data t

45、hat,when analysed on a computer,can reveal patterns,trends and associations.BiobankCollection,storage of biological material for use in research.BioprintingUse of 3D-printing-like techniques with biomaterials to fabricate body parts,often with the aim of imitating natural tissue characteristics.Bios

46、ensorAn analytical device used for the detection of a chemical substance that combines a biological component with a physicochemical detector;typically consists of a bio-receptor(enzyme,antibody,cell,nucleic acid or aptamer),a transducer component(semi-conducting material or nanomaterial),and an ele

47、ctronic system that includes a signal amplifier,processor and display.BlockchainA distributed ledger with growing lists of records(called blocks)that are securely linked.Body on a chipMulti-organ system,often designed to study disease mechanisms and emulate human physiological response to drugs.Clou

48、d“The cloud”refers toservers that are accessed on the Internet and to the software and databases that run on those servers.CRISPR/CasClustered,regularly interspaced short palindromic repeats with CRISPR-associated enzyme.CryonicsLow-temperature freezing and storage of human remains.DelphiAn anonymou

49、s survey method with iterative structured feedback for pooling expert opinion on potential future events and their comparative probabilities.Digital healthField of knowledge and practice associated with the development and use of digital technologies to improve health.Digital twinA digital represent

50、ation of an intended or actual physical product,system or process that serves as its effectively indistinguishable digital counterpart for practical purposes,such as simulation,integration,testing,monitoring and maintenance.ForesightA systematic,participatory,multi-disciplinary approach to explore t

51、rends,emerging changes,systemic impacts and mid-to long-term alternative futures that might evolve from those changes.GamificationStrategic use of game mechanisms and elements to enhance systems,services,organizations and activities in order to motivate and engage users.ixGlossaryGenomicsStudy of th

52、e total or part of the genetic or epigenetic sequence information of organisms to understand the structure and function of those sequences and of downstream biological products,including the interplay of molecular information,health interventions and environmental factors in disease.Horizon scanning

53、A set of systematic methods for monitoring evolving change by collecting data on trends and identifying weak signals of change that may impact futures.Internet of thingsA network of devices that contain sensors,processing ability,software and other elements that connect and exchange information thro

54、ugh communication networks.Lab on a chipA platform for integration and automation of several laboratory functions onto an integrated circuit measuring millimetres to a few square centimetres.Machine learningA field of inquiry for understanding and building methods that“learn”by using data to improve

55、 performance in a set of tasks;machine learning algorithms typically build a model from a set of sample data(referred to as“training data”)and make predictions or decisions without explicit programming;part of artificial intelligence.MetagenomicsThe study of genetic material recovered from environme

56、ntal or clinical samples by sequencing.MetaverseA deep augmented virtual reality;a mixture of social media and a massive online video game.NanomedicineApplication of nanotechnology for medical purposes,such as diagnosis,prevention and treatment of diseases and conditions.NutrigenomicsStudy of the re

57、lations and interactions between the human genome,nutrition and health.PolypillA single pill containing multiple medications.ProteomicsStudy of all proteins in a living organism or a biological system.Regenerative medicine Field of medicine in which damaged tissues or organs are replaced or regenera

58、ted to restore normal function.Sio-membraneA thin layer of silicon oxide consisting of a microporous structure with a pore size distribution of 0.3 nm,which enables small molecules to pass through its channels.TelehealthUse of electronic information and telecommunication technology in long-distance

59、clinical health care,for health education of patients and professionals,and for public health and health administration.Tissue engineeringA discipline of biomedical engineering in which functional constructs are produced from cells,scaffolds and biologically active molecules to restore,maintain,impr

60、ove or replace damaged tissues or organs.Virtual realityAn immersive experience that allows the user to experience an alternative simulated reality.Wearable“Smart”electronic devices worn close to a person that can monitor and transmit information about the wearer.xExecutive summaryAimIn 2022,the WHO

61、 Science Division initiated a horizon scan to identify innovations in science and technology that could improve global health,including to address health needs that are frequently neglected or not addressed adequately or rapidly enough.The exercise is part of the discipline of“foresight”,which is th

62、e exploration,anticipation and shaping of the future,to build and use collective intelligence in a structured,systemic way to anticipate developments.The objective of the exercise was to identify innovations in areas of research and emerging technologies and their potential uses and opportunities to

63、 obtain useful insights for strategic planning,policy-making and preparedness.The horizon scan was not designed to predict the future but rather to identify areas that deserve focus and could be harnessed to be better prepared and to catalyse equitable access and innovation for global public health.

64、MethodsThe exercise comprised a literature review,a broad call to identify innovations and consultation with a group of international experts,balanced in terms of gender and geographical distribution.The horizon scan was conducted online with the Delphi method,with roundtables for discussion among e

65、xperts.Some key informant interviews were conducted.Eight innovation groups(IGs)with over 100 innovations were defined:xiExecutive summaryIn each of two Delphi rounds,the experts were asked to rate the innovations according to their potential impact for global health,their chance of adoption(and wid

66、e use)and the associated time horizon.The experts were also asked to rank the most promising innovations in each group and the top five overall.In roundtables between the two Delphi rounds,the experts discussed the findings of the first round.New innovations and enablers were added for the second De

67、lphi round,while those that the experts considered less relevant were discarded.The exercise also included classification of up to 40 enablers according to their relevance for facilitating and optimizing development or adoption of the innovations.The enablers were grouped into technological;skill-or

68、 capacity-building;structural,legal and political;and cultural enablers.In the second Delphi round,the experts were also asked to identify risks related to the innovations that might have important implications for global health.OutcomesThe outcomes of the exercise were ranking of the innovations an

69、d enablers from a global public health perspective and identification of risks.InnovationsOverall rankingThe following five innovations were considered,according to the experts votes in the second Delphi round,to be the most promising overall:application of genomics for early diagnosis and pre-diagn

70、osis of diseases,starting from universal genomic prenatal screening to identify metabolic and other congenital disorders pre-symptomatically to enable a precise diagnosis and to guide management and treatment;better coordinated,more effective systems of vaccine production and global distribution;low

71、-cost viral diagnostics.Rapidly design and construct cost-effective point-of-care diagnostics for HIV and hepatitis B virus load testing with CRISPR/Cas techniques;broad-spectrum antimicrobial drugs that do not cause resistance or tolerance,that,for example,adapt their conformation to target structu

72、ral changes and mutations;and rapid remote diagnostics through cell phones,watches and other devices(such as smart implants,protheses and wearable sensors)that can provide information on markers and link health information in real-time for clinicians and other(public)health entities,supporting indiv

73、idual health promotion,disease prevention and disease(self)management and also providing real-world data for public health management and health economics.Potential impact and chance of adoptionA cross-analysis was performed to map potential impact against the chances of adoption within each group.T

74、he experts responses indicated 36 innovations as having a high or very high potential impact and a high chance of adoption(Table 1).Full descriptions of the innovations considered are given in Annex 1.xii2023 Emerging technologies and scientific innovations:A global public health perspective Table 1

75、.Innovations considered to have a high or very high potential impact and a high chance of adoption Innovation group(IG)InnovationsIG1 Diagnostic technologyIG1-7Low-cost viral diagnostics.Rapidly design and construct cost-effective point-of-care diagnostics for HIV and hepatitis B virus load testing

76、with CRISPR/Cas techniquesIG1-11Open-source diagnostic toolkits.Free,open-source toolkits that would allow laboratories in developing countries to produce their own tools(e.g.for COVID-19 research and diagnosis),reducing their dependence on the global supply chainIG1-12Rapid remote diagnostics.Conne

77、ct people through cell phones,watches and other devices(such as smart implants,prostheses and wearable sensors)that can provide information on key markers and link health information in real time for clinicians,people and other(public)health entities,supporting individual health promotion,disease pr

78、evention and disease(self)management and also providing real-world data for public health management and health economics.IG1-6“Lab on a chip”to diagnose several diseases with small easy-to-use devices,based,for example,on the CRISPR enzyme Cas12 or micro-electro-mechanical systems-based dual axes c

79、onfocal microendoscopyIG1-9Home“laboratory”tests and direct-to-consumer genetic testsIG2 Health products and drug delivery technology IG2-7Better coordinated,more effective systems of vaccine production and global distribution IG2-2Broad-spectrum antimicrobial drugs that do not cause resistance or t

80、olerance,that for example,adapt their conformation to target structural changes and mutationsIG2-1Potent monoclonal antibodies against infectious diseasesIG3Tissue engineering and regenerative medicineIG3-8Stem-cell technology for replacement of muscles,organs(eyes,ears)and bone or teeth,and,later,h

81、eart,brain and neural tissues.An example is transplantation of retinal cells to treat blindness.IG3-6Regenerative medicine with therapies involving proliferation and transplantation of cells to improve the functioning of tissues or organs,potentially to treat diseases such as diabetes,nervous system

82、 disorders and cardiovascular disordersIG3-2Bio-adhesives for tissue adhesion,haemostatic agents and membrane transplantationIG4Molecular biology:cell,immune and gene therapyIG4-5Biobanks for discovery of biomarkers and for monitoring,surveillance,testing,diagnostics and improving response to pandem

83、ics IG4-19mRNA vaccine platforms as a new way of programming for antigenic stimulation,developing potential new vaccines for tuberculosis,HIV,syphilis,hepatitis B,cancer and other diseasesIG4-2Adaptive platform trials in which multiple interventions are studied continuouslyIG4-11Microbiome analytica

84、l tools for research,clinical prevention and treatmentsIG5Public health:environment,climate change,epidemiology and surveillance,nutrition,and healthIG5-6Global early warning systems and solutions to monitor conditions related to development of global infections and for disease monitoring,worldwide

85、genomic surveillance of pathogens to identify potential zoonoses with information technologyIG5-5Global capacity for rapid response to infectious disease outbreaks by real-time pathogen sequencing for surveillance,with equitable sharing and distribution of countermeasuresIG5-8Machine learning-powere

86、d surveillance tools with symptom data,interpretation of basic tests(e.g.imaging,electrocardiograms),with algorithms for selecting further laboratory testingIG5-14Use of digital technologies to automate the collection and analysis of data at the intersection of health and environment to better predi

87、ct,prevent and reduce environmental risks to health,such as enhanced widely deployed aerosol and wastewater surveillance technologiesIG5-10Monitoring and predicting new or recurrent pandemics from analysis of,for example,medical records,mobile phone traffic,social mediaIG5-15Water storage for clean

88、water in countries prone to flooding(heavy rain catchment areas)IG5-9Making plastics without harmful chemicals or contaminantsIG5-4Use of mobile phones(and other wearable technology)to improve human health,specifically with sensors,data and analyticsxiiiExecutive summaryIG6 Dissemination and impleme

89、ntationIG6-9Innovations to make new scientific and technological advances available and affordable for low-and middle-income countries IG6-13Technology to prevent and reduce the prevalence of post-partum haemorrhage that is understood and can be applied by women and adolescent girls in hard-to-reach

90、 communities in low-and middle-income countriesIG6-8Digital tools,especially mobile apps,that enable provider-to-provider communication and provide community health workers,clinical officers and other front-line generalist health workers with support from specialists in real time,bringing expertise

91、on medical and surgical specialties to where patients live and seek careIG6-3An innovative implementation science model for use in major global health issues,such as the health consequences of climate change and mental health,to improve the reach,effectiveness,adoption and impact of innovations at p

92、opulation level and to implement(and sustain)best practicesIG6-7Digital health tools for public health research and for development of new clinical preventive measures,treatments and vaccinesIG6-11Medical devices to improve evidence generation in trials,replacing previous end-points,ensure that clin

93、ical studies truly address patient-relevant outcomes,and,when used on treatment,increase compliance with treatmentIG7Artificial intelligence,the Internet of things,wearables,telehealth,augmented and virtual realityIG7-4Big Data,artificial intelligence and machine learning to evaluate large amounts o

94、f patient data and other information and create tailored algorithms,to support physicians in personalized medicine,possible diagnoses,medications and treatment plans IG7-2Artificial Intelligence prediction of the 3D structures of proteins and for drug developmentIG7-12Artificial Intelligence-based d

95、ecision-support systems based for(public)health surveillance and public health promotion,creating risk models for noncommunicable and communicable diseases in order to predict the risk of an individual in 5 or 10 yearsIG7-1 Artificial Intelligence-aided diagnostics from databases of medical images t

96、o ensure earlier,more accurate detection of various pathologiesIG8Materials and biomaterials,prostheticsIG8-4New materials and prosthetics,such as artificial hearts(heart valves)made of aluminium,exoskeletons for spinal cord injuries,prosthetic fingers,arms,knee joint replacements,wide-range hearing

97、 aids,bionic eyes,electronic olfaction IG8-2Minimally invasive surgery or minimally invasive procedures that replace surgery altogetherIG8-1Diagnosis and monitoring with intelligent materials that continuously sense,respond and adaptEnablersThe most relevant enablers for facilitating and optimizing

98、development or adoption of the innovations are listed in Table 2.These enablers obtained more than 75%of experts votes.Technological enablers Big Data Cloud Building and sustaining broad health infrastructure Artificial intelligence and machine learning Availability of data and better data capture a

99、t source Open-source platforms Skills-and capacity-building enablers Skilled health professionals and technicians Leadership and good governance Data analysis Skilled communities and people Best practices for synthesizing and diffusing evidenceStructural,legal and political enablers Regulatory and p

100、olicy framework High-quality Internet access and power supply Investment and access to funding Use of globally accepted ethical and legal guidelines Publicprivate partnerships for research and development Regulations on data privacy and trust Universal primary health care Establishment of regional n

101、etworks for high-cost research Intellectual property managementCultural enablers Building trust in science,disabling spread of misinformation Accountability and cooperation Communication of science(various platforms)Proactive approach and attitude Health and digital literacy Empowered patientsTable

102、2.Enablers that were considered most relevant for facilitating and optimizing development and adoption of the innovationsTable 1.continuedxiv2023 Emerging technologies and scientific innovations:A global public health perspective RisksAlthough emerging technologies and scientific innovations provide

103、 many opportunities,they may also be associated with certain risks.Some of the risks identified by the experts are common to all innovations,others are common to groups of innovations,and others are specific to certain innovations.The risks that were considered common to all innovations are:potentia

104、l to accentuate gaps in health equity;dependence of reliability and accuracy on the quality of inputs(such as data)and of processes and the ability to make good use of results;cost for both development of the desired quality,accuracy and reliability and for commercialization and scaling up;and data

105、privacy.ConclusionA horizon scan is a first step in a foresight approach.It invites readers to consider innovations from a public health perspective:What innovations are being made?How can they be made available for the benefit of all in the near future?The subsequent steps may include scenario plan

106、ning to build plausible scenarios for the future,deep dives into the most promising innovations,and defining means to improve adoption for the ultimate benefit of populations.The most promising innovations should be monitored to follow their evolution and adoption.Introduction11.Introduction WHO str

107、ives to remain abreast of the current and future developments in relevant areas of research,science and technology to proactively identify,anticipate and prepare for issues that could improve global health.In 2020,the WHO Science Division established a“global health foresight function”to assist Memb

108、er States in building futures thinking and including horizon scanning in their strategic health planning so that they can both better anticipate and prepare for a changing world and accelerate acquisition of the gains offered by emerging technologies.To monitor emerging technologies and trends,the E

109、merging Technologies,Research Prioritization and Support(EPS)unit initiated a new project to scan the horizon for innovations in science and technology,including those that could be used to address health needs that are frequently neglected or not addressed adequately or in a timely manner.This hori

110、zon scan was not designed to predict the future but rather to identify areas that deserve focused attention and could be harnessed for better preparation and to catalyse innovation for global public health.A group of international experts was approached to identify,discuss new and emerging science a

111、nd technology relevant to global public health and consider enablers that could increase the chances of adoption of the innovations by maximizing the benefits globally while mitigating risks.The project was conducted between June 2022 and January 2023.Foresight is a systematic,participatory,multi-di

112、sciplinary approach to exploring trends,emerging changes,systemic impacts and mid-to long-term alternative futures that might evolve from those changes(1).Various methods are available,and WHO has published a document providing guidance on foresight approaches in global public health(1).Foresight ca

113、n start with a horizon scan to identify trends and to analyse their promise(Fig.1).22023 Emerging technologies and scientific innovations:A global public health perspective Fig.1.Areas for consideration in a preliminary foresight exerciseWhat is changing?What patterns of change created the current c

114、onditions?What assumptions are we making about how things work and how they will continue to work?Are the emerging changes contributing to continued stability,or are they challenging and invalidating our current working assumptions?If so,how,and how might we have to adjust?What might be the impacts

115、of emerging change?Where will WHO,its staff,stakeholders,partners,networks and communities feel change first?Who will feel those impacts the most?Who will benefit,and who will pay the costs?How can systematic exploration of the potential impacts of change enhance accountability and responsibility fo

116、r those impacts?What alternative outcomes and different possible futures could the interplay of emerging changes create?How might emerging changes and their impacts on our present systems create different future outcomes?How can exploration of those different future contexts help build greater flexi

117、bility and adaptability into current programmes and activities?What future do we want to build?How do we create the most inclusive possible conversation about the future we want?How do we negotiate from individual values to shared values,to specific goals and actions to create those goals,given our

118、different world views,cultural frames and local contexts?How do we create the change we wish to see?How do we monitor the impacts of our actions in creating change in order to enhance accountability and responsibility for unintended consequences?Source:WHO(1).Todays world is volatile,uncertain,compl

119、ex and ambiguous,including the fast pace of technological and scientific advances.Horizon scanning is therefore critical to ensure better preparation for the future.Various time horizons can be considered in scanning future trends(2)(Fig.2):05 years,the known horizon,which concerns science and techn

120、ological innovations that are starting to be used but have not yet been scaled up;510 years,the medium-term horizon,for innovations and trends that have already begun to affect health care but for which it is not yet known how they will develop or play a role in health;and 10 years,a more distant ho

121、rizon,for which trends and drivers of change are difficult to see.Those identified are very early innovations or signals that point in certain directions and will then be monitored.31.IntroductionHorizon scanning is not a one-off exercise.Information updates,monitoring of signals of change and work

122、on various plausible scenarios are necessary to understand how the global health landscape could change if some of the identified technologies and science became widely used(3)(Fig.3).This report presents the conclusions of the horizon scan exercise with a group of international experts.It presents

123、the methods used,the innovations identified during the exercise,consolidated views on their potential impact and their chance of adoption,with the corresponding timeframes,and enablers that might increase,optimize or accelerate scaling up of the most promising innovations.Mega trendsSpecific trendsS

124、cenariosRisks,opportunitiesMonitoringOptimize benefitsStrategic planningMitigate risksHORIZON SCANNINGFig.3.Horizon scanning cycleFig.2.Time horizons of technological advancesUncertainty levelHORIZON SCANNINGLong term horizonMedium term horizonShort term horizonMethods42.Methods2.1 OverviewThe horiz

125、on scanning exercise comprised a literature review and consultations with experts.In this multi-stage,multi-layered approach,a preliminary step was a call for ideas.The exercise was then conducted online with the Delphi method,rounds of discussion and interviews with experts.Some adaptations were ma

126、de to the original Delphi exercise(4,5)for wide participation of a diverse group of experts and to identify as many promising innovations as possible.Consensus was analysed and discussed but was not considered the ultimate goal.The number of Delphi rounds was limited to two,and roundtables were used

127、 to discuss innovations and to determine the reasons for lack of consensus.Experts were invited to participate in at least one roundtable.The aim was to obtain as many views and opinions as possible in an organized format,and experts were given the possibility to meet virtually.At each step,the list

128、 of innovations was refined and processed.The work flow is shown in Fig.4.The project was granted an exemption from review by the WHO Research Ethics Review Committee.Consent was obtained for participation,and declarations of interests were collected from experts who participated in the horizon scan

129、 exercise.After WHO review of the declarations,the participation of experts in the horizon scan was adapted when deemed appropriate,in particular with regard to participation in online scoring of innovations.52.MethodsCall for ideasInterviewsRoundtablesFirst Delphi exerciseSecond Delphi exerciseFig.

130、4.Work flow 2.2 Desk research,literature review and identification of expertsThe purpose of the literature review was to identify categories of innovations that hold promise and,for innovations within those categories,to identify general areas of promising innovation for the expert consultations.The

131、 review was also used to identify experts to be consulted,on the basis of their professional experience in emerging technologies,science and global public health.2.3 Preliminary call for ideasA preliminary call for ideas was conducted online with open-ended questions,summarized as follows:What innov

132、ations in science and technology could have the greatest impact for global public health?(Indicate specific examples and estimated time to adoption.)What are the barriers to uptake of and access to these innovations?What are the five most promising areas in the following list:artificial intelligence

133、,Internet of things and wearables;virtual and augmented reality;telehealth;diagnostic technology;drug delivery technology;tissue engineering;nanomedicine;molecular biology,cell,immune and gene therapy;phage therapy;materials and biomaterials,prosthetics;cryonics;application of data in decision-makin

134、g;epidemiology and surveillance;environment,climate change and health;nutrition and health;production and distribution of health products;proof of scientific evidence(misinformation and disinformation);dissemination and implementation;other.Links,citations and other information that would support th

135、e project were requested.The call was sent to more than 200 professionals identified in the desk research and literature review,with attention to ensuring a fair balance with respect to gender and geographical distribution.About 45 responses were considered.Of those who responded,27%were aged 10 yea

136、rs;rank the list of enablers for their relevance in supporting adoption of innovations on a scale of 1 to 4,where 1 is no significant relevance and 4 is very high relevance;rank the first five most promising innovations,from the most to the least promising;rank the first five most important innovati

137、ons per innovation group,from those with the most to the least potential impact;and add any other innovations or enablers.72.MethodsResponding to every question was not mandatory.A four-point scale,with no middle value,was chosen to avoid the central tendency bias(6)and to ensure an adequate number

138、of options for reliable results.Analysis of results Individual responses for innovations and for enablers were aggregated and analysed.The innovations were ranked from one to five,five points being the highest and one the lowest.2.4.4 Discussions in roundtablesThree roundtables were organized to dis

139、cuss the findings of the first Delphi exercise and to align the understanding of the experts.About 30 experts attended at least one online roundtable.The meetings consisted of main sessions for discussing key findings and breakout rooms for group discussions of innovations of a similar nature.The ro

140、undtable discussions resulted in revision of the list of innovations,with exclusion of some with a lower impact and less chance of adoption and addition of new innovations considered to be relevant.Furthermore,the impact and chance of adoption were discussed for each innovation,leading to some chang

141、es in the analysis.Special attention was paid to innovations for which there was a low level of agreement,with discussion of the possible reasons and a wider view of perspectives that could not be captured in the Delphi exercise.The list of enablers was also revised,with changes in wording,additions

142、 and deletions.The final list of enablers comprised 40 for building technological,skills and capacity,and regulatory and cultural enablers.2.4.5 Second Delphi exerciseScoringIn the second Delphi round,each expert was asked to rank each innovation again for potential impact,chance of adoption and ass

143、ociated horizon time.Experts were also asked to indicate any risk(s)associated with each innovation that might have implications for global health(including risks to safety and security due to accidents and inadvertent or deliberate misuse).The experts were then asked to classify the revised list of

144、 enablers according to their relevance for enabling the adoption of innovations;to rank the five most promising innovations overall;and to rank the three most promising innovations in each innovation group.Analysis of resultsThe results were analysed with the approach used in the first round.Consens

145、us among participants was analysed on box-and-whisker plots to illustrate variations(Annex 2).Descriptive information on risks was collected and reviewed and is summarized in section 5.Innovations for the future of global health83.Innovations for the future of global healthThe innovations identified

146、 were categorized and grouped.The results presented here reflect the participants opinions and compiled responses.When useful or relevant to the context,additional information has been provided from the literature review and comments from experts in the roundtables or the interviews.The innovations

147、are presented by group(Fig.5).The results presented are from the second Delphi round.Annex 1 provides complete descriptions of the innovations considered.IG1 Diagnostic technologyIG 2 Health products and drug delivery technologyIG 3 Tissue engineering and regenerative medicineIG 4 Molecular biology,

148、cell,immune and gene therapyIG5 Public healthEnvironment,climate change,epidemiology and surveillance,nutrition and healthIG 6 Dissemination and implementationIG 8 Materials and biomaterials,prostheticsIG 7 Artificial intelligence,Internet of things,wearables,telehealth,augmented and virtual reality

149、 8 innovationgroups(IG)Fig.5.Innovation groups for the horizon scan exercise 93.Innovations for the future of global health3.1 Overall rankingAfter overall ranking analysis,the five innovations determined to be the most promising were those listed in Table 4.Table 4.The five most promising innovatio

150、ns RankInnovationInnovation group1Application of genomics for early diagnosis and pre-diagnosis of diseases,starting from universal genomic prenatal screening to identify metabolic and other congenital disorders pre-symptomatically to enable a precise diagnosis and to guide management and treatment(

151、IG1-3)IG1:Diagnostic technology2Better coordinated,more effective systems of vaccine production and global distribution(IG2-7)IG2:Health products and drug delivery technology3Low-cost viral diagnostics.Rapidly design and construct costeffective point-of-care diagnostics for HIV and hepatitis B virus

152、 load testing,with CRISPR/Cas techniques(IG1-7)IG1:Diagnostic technology4Broad-spectrum antimicrobial drugs that do not cause resistance or tolerance;e.g.adapt their conformation to structural changes or mutations in the target(IG2-2)IG2:Health products and drug delivery technology5Rapid remote diag

153、nostics:connect people through cell phones,watches and other devices(such as smart implants,protheses and wearable sensors)that can provide information on key markers and link health information in real-time to clinicians,people and other(public)health entities,supporting individual health promotion

154、,disease prevention and disease(self)management and also provide real-world data for public health management and health economics(IG1-12)IG1:Diagnostic technologyAll five of the most promising innovations were in either IG1,Diagnostic technology,or IG2,Health products and drug delivery technology.P

155、articipants also ranked the top three promising innovations in each group(Table 5).Table 5.The three most promising innovations in each innovation group Innovation groupRank and innovationIG1 Diagnostic technology1.Application of genomics for early diagnosis and pre-diagnosis of disease(IG1-3)2.Mole

156、cular multiplex point-of-care testing with low-cost,accurate,easy-to-use platforms(IG1-10)3.Rapid remote diagnostics to connect people through cell phones,watches and other devices(IG1-12)IG2 Health products and drug delivery technology1.Broad-spectrum drugs(IG2-2)2.Better coordinated,more effective

157、 systems of vaccine production and global distribution(IG2-7)3.Potent monoclonal antibodies against infectious diseases(IG2-1)IG3 Tissue engineering and regenerative medicine1.Regenerative medicine(IG3-6)2.Stem-cell technology(IG3-8)3.3D printing of tissues and body parts(IG3-1)IG4 Molecular biology

158、;cell,immune and gene therapy1.Biobanks for discovery of biomarkers and for monitoring and surveillance(IG4-5)2.mRNA vaccine platforms(IG4-19)3.Adaptive platforms trials(IG4-2)IG5 Public health1.Real-time pathogen sequencing(IG5-5)2.Global early warning systems and solutions for global infections(IG

159、5-6)3.Mobile phones and wearables(IG5-4)IG6 Dissemination and implementation1.Co-design and co-implement innovations in poor rural settings in low-and middle-income countries(IG6-4)2.Make scientific and technological innovations available and affordable for low-and middle-income countries(IG6-9)3.An

160、 innovative model for implementation science to improve reach,effectiveness,adoption and impact of innovations(IG6-3)IG7 Artificial intelligence,Internet of things,wearables,telehealth,augmented and virtual reality1.Big Data,artificial intelligence and machine learning to evaluate large amounts of p

161、atient data and other information,and create tailored algorithms(IG7-4)2.Artificial intelligence-aided diagnostics from databases of medical images(IG7-1)3.Artificial intelligence decision support systems for(public)health surveillance and promotion(IG7-12)102023 Emerging technologies and scientific

162、 innovations:A global public health perspective IG8 Materials and biomaterials,prosthetics1.Minimally invasive surgery or procedures to replace surgery altogether(IG8-2)2.New materials and prosthetics,such as artificial hearts,exoskeletons for spinal cord injuries,prosthetic fingers,arms,knee joint

163、replacements,wide-range hearing aids,bionic eyes,electronic olfaction(IG8-4)3.Diagnosis and monitoring with intelligent materials that continually sense,respond and adapt(IG8-1)As expected,most of the innovations in the global top five were also top in their innovation group.In the diagnostic techno

164、logy group,low-cost viral diagnostics was ranked fourth.Several innovations in this group were assessed as having a high potential impact,as described in section 3.2.1.3.2 Rating of innovations according to their potential impact,chance of adoption and time to adoptionParticipants also rated the inn

165、ovations in each group according to the criteria of impact,plausibility(chance of adoption)and horizon time.(All of the most promising innovations listed in Table 5 are associated with a high or very high potential impact.For some,the chance of adoption provides complementary information).Innovation

166、s with a good chance of adoption appear more likely to reach their full potential for global health.3.2.1 Innovation group 1:Diagnostic technology Fig.6 represents the experts evaluation of innovations in diagnostic technology in terms of potential impact and chance of adoption.Full descriptions of

167、each innovation are provided in Annex 1.Table 5.continuedPotential impactChance of adoptionHighModerateNot significantModerateHighVery highLow-moderateHigh impacthigh chance of adoption areaIG1-14IG1-1IG1-2IG1-13IG1-9IG1-4IG1-3IG1-5IG1-6IG1-12IG1-10IG1-7IG1-11IG1-8IG1-15Vocal biomarkersNutrigenomics

168、Body on a chipVirtual biopsy and in situ diagnosesSingle-cell omics technologiesUse of metagenomics in the diagnostics frameworkApplication of genomics for early diagnosis and pre-diagnosis of diseasesGenomics,including microbial genomicsLab on a chipOpen-source diagnostic toolkits Low-cost viral di

169、agnostics Rapid remote diagnostics At-home lab testsBiosensor-based point-of-care diagnostic platforms Molecular multiplex point-of-care testing with new,low-cost,accurate,easy-to-use platformsLowFig.6.Innovation group 1:potential impact vs chance of adoption Note:IG1-2:Body-on-a-chip was not ranked

170、 for its chances of adoption;the opinions expressed during the roundtables were used to rank the chances of adoption of this innovation on the matrix.113.Innovations for the future of global healthFive innovations were analysed as having a high or very high potential impact and a high chance of adop

171、tion:Low-cost viral diagnostics.Rapidly design and construct cost-effective point-of-care diagnostics for HIV and hepatitis B virus load testing,with CRISPR/Cas techniques Open-source diagnostic toolkits.Free,open-source toolkits that would allow laboratories in developing countries to produce their

172、 own tools(e.g.for COVID-19 research and diagnosis),reducing their dependence on the global supply chain Rapid remote diagnostics.Connect people through cell phones,watches and other devices(such as smart implants,protheses and wearable sensors)that can provide information on markers and link health

173、 information in real-time for clinicians and other(public)health entities,supporting individual health promotion,disease prevention and disease(self)management and also providing real-world data for public health management and health economics“Lab-on-a-chip”to diagnose several diseases with small,e

174、asy-to-use devices,based for example on the CRISPR enzyme Cas12 or micro-electro-mechanical systems-based dual axes confocal microendoscopy Home“laboratory”tests and direct-to-consumer genetics testsThe time horizon(Fig.7)for adoption of most of these innovations is short,within the next 5 years,pro

175、bably because the technology and science in those areas are already developed,and,in some cases,there is some limited experience in their use.10 years510 years 5 yearsIG1-14IG1-10IG1-4IG1-6IG1-15IG1-11IG1-12IG1-5IG1-8IG1-3IG1-9IG1-7IG1-13IG1-2IG1-1 10 years 510 years 5 yearsFig.7.Innovation group 1:

176、time horizon for adoption IG1-1 G1-1 Vocal biomarkers IG1-2 Body on a chipIG1-3 Application of genomics for early diagnosis and prediagnosis of diseasesIG1-4 Biosensor-based point-of-care diagnostic platforms IG1-5 Genomics,including microbial genomicsIG1-6 Lab on a chip to diagnose several diseases

177、 with small,easy-to-use devIcesIG1-7 Low-cost viral diagnosticsIG1-8 Use of metagenomics in diagnostics IG1-9 Home“laboratory”tests and direct-to-consumer genetics tests IG1-10 Molecular multiplex point-of-care testingIG1-11 Open-source diagnostic toolkits IG1-12 Rapid remote diagnosticsIG1-13 Singl

178、e-cell omics technologiesIG1-14 NutrigenomicsIG1-15 Virtual biopsy and in situ diagnosis technology For each innovation considered to have a very high or high potential impact and a high chance of adoption,information is provided below from the literature review and the input of participants in the

179、horizon scan.Full descriptions of each innovation are provided in Annex 1.122023 Emerging technologies and scientific innovations:A global public health perspective Low-cost viral diagnostics(IG1-7)Rapid design and construction of costeffective point-of-care tests for HIV and hepatitis B viral load

180、testing with CRISPR/Cas techniques to detect nucleic acids will require development of low-cost techniques.Currently,polymerase chain reaction is the preferred method for most nucleic acid-based technologies,but the cost of reagents can be high,particularly when used on a closed analyser or platform

181、,and the technique generally requires sophisticated laboratory equipment that must be maintained and trained personnel.CRISPR-based assays do not require complex,costly laboratory equipment or the reagents used in polymerase chain reaction.Their accessibility will depend on how prices evolve after t

182、he development of several tests for viral diseases(7).An example is a project under way in South Africa(8).This innovation would be important for settings where diagnosis is not readily accessible to the population.Cost savings may be achieved;however,diagnostic services often require out-of-pocket

183、expenditure for patients.Open-source diagnostic toolkits(IG1-11)A free,open-source toolkit for diagnostics that would allow laboratories in developing countries to produce their own tools(e.g.for research on and diagnosis of coronavirus 19 COVID-19)and could reduce dependence on the global supply ch

184、ain.The open-source approach combines several potential advantages,such as reduced costs and faster innovation,as anyone can improve and contribute to designing devices.The critical change is the open approach to design,which enables modification for highly specific uses and makes devices easy to re

185、pair,at same time reducing the environmental impact.It has been noted that an open-source medical device is safer and more robust,as more people can optimize its design(9).Some cooperative initiatives are being seen.For example,a free,open-source toolkit was developed to allow laboratories in develo

186、ping countries to work on COVID-19 research and diagnosis(10).Open-source systems and open platforms may provide advantages such as price reduction;however,their regulation and post-market surveillance may prove complex,such as ensuring accountability in case of adverse events and other incidents(ma

187、lfunction and deterioration).Functioning quality assurance programmes are necessary to ensure accurate,reproducible results.Rapid remote diagnostics(IG1-12)Rapid remote diagnostics connect people through cell phones,watches and other devices(such as smart implants,prostheses and wearable sensors)tha

188、t can provide information on markers and link health information in real time for clinicians,people and other(public)health entities,supporting individual health promotion,disease prevention and disease(self)management but also providing real-world data(for example for regulatory purposes with post-

189、market surveillance)or informing public health management and health economics.It could be associated with a unique(medical)device identifier and a card containing a chip that stores information that can be used by doctors on any visit.Rapid remote diagnosis is of particular importance in remote rur

190、al locations,far from health-care centres and with difficult access,and can save time and cost(11).Markers such as atrial fibrillation,spikes in blood pressure and falls in blood sugar,heart rate,temperature,blood pressure and oxygen saturation level can be monitored continuously by an individual or

191、 by a medical doctor if the data are shared.Devices may start with a few markers and add more over time.Such innovations will require users to be informed on how to read the signs(device result outputs)and act accordingly.One participant said:When you get your drivers license,you dont have to have a

192、ny knowledge whatsoever about how the car works,just needing how to use it.And I think that we pretty much are going to have to go somewhere along those lines with health monitoring.There must be some kind of test that the person who is agreeing to this knows what they are agreeing to.Lab on a chip(

193、IG1-6)A“lab on a chip”allows diagnosis of several diseases with a small,easy-to-use device.A laboratory on a chip could be based on CRISPR/cas or a micro-electro-mechanical system with dual-axis confocal micro-endoscopy.These devices automate different laboratory techniques into an integrated system

194、 that fits on a chip of up to a maximum of a few square centimetres in size.Manipulation of reagents on a microscale minimizes exposure to dangerous chemicals and waste(12).133.Innovations for the future of global healthOne participant reported:“Lab on a chip is now very close to implementation.For

195、example,laboratory on a chip based on the CRISPR enzyme Cas12.”A key advantage is fast point-of-care testing and initiation of treatment,as no time is required for sending patient specimens to a laboratory and receiving test results.Home“laboratory”tests and direct-to-consumer genetics tests(IG1-9)T

196、his innovation refers to testing that is usually conducted in a laboratory but that would be accessible at home or in another convenient setting with ability to interpret.Such tests are already available for several diseases;however,the number of diseases for which testing can be done at home could

197、be increased.The COVID-19 pandemic enforced the appeal of self-testing(13).Although home“laboratory”tests hold good promise,their recognition and credibility may still be challenged,and they must undergo proper review and authorization by regulatory authorities.Tests could become available in areas

198、such as genetics,the microbiome,allergies and blood sugar.One participant said:At-home laboratory tests are something that became crucial.Because of the pandemics impact on health care as millions of,I think tens of millions of patients learned how to do at-home laboratory tests,COVID antigen tests.

199、And now more and more patients realize that if they can do a laboratory test,even a blood-based laboratory test from home without meeting other sick people and traveling to a point of care,then,of course,they choose the direct-to-consumer solution.Innovations with high or very high potential impact

200、but less chance of adoptionMolecular multiplex point-of-care testing with new,low-cost,accurate,easy-to-use platforms(IG1-10)Such tests could be used in primary care facilities to manage illness in a patient-centred rather than a disease-centred way.The illnesses could include respiratory and system

201、ic illnesses or gastrointestinal illnesses.This innovation was evaluated as having a chance of adoption that was very close to high.Genomics,including microbial genomics(IG1-5)Genomics could be used to replace or supplement most current microbiological diagnostic technology.The technology addresses

202、such major issues as pathogen surveillance,global burden of disease and food security.Several other innovations discussed in the exercise are based on genomics.Investment in genomics and biosensors will be necessary to ensure wide adoption of low-cost point-of-care diagnostics.The WHO Science Counci

203、l has made recommendations for accelerating access to genomics for global health(14).Application of genomics for early diagnosis and pre-diagnosis of diseases(IG1-3)The first such application would be for universal genomic prenatal screening to identify pre-symptomatic metabolic and other congenital

204、 disorders to allow precise diagnoses and guide patient management and treatment.The potential impact and chance of adoption of this specific application of“Genomics including microbial genomics”(IG1-5)were evaluated similarly.Biosensor-based point-of-care diagnostic platforms(IG1-4)Diagnostic platf

205、orms with chemical,magnetic,optical or nanotechnological modalities would be cheaper,more accessible,more effective alternatives to methods that require polymerase chain reaction.Participants agreed that the chance of adoption would be lower if the point of care was the patients home.It is,however,e

206、xpected that the diagnostic could be accessed on a mobile phone.One participant,referring to the promise of biosensors said:The field of,of biosensors in general will be growing immensely.Even during this pandemic,simple sensors were widely used.So,with new technology,I think the same thing that you

207、 do now,lets say the lateral flow,it will be part of many things that maybe you do automatically,just coughing at your smart watch.So,so Im pretty sure its going to go there in 20 years.142023 Emerging technologies and scientific innovations:A global public health perspective Virtual biopsy and in-s

208、itu diagnoses(IG1-15)Use of high-resolution optical imaging would allow analysis of tissues in situ,without having to remove them.This innovation would make biopsy much more efficient,as the process of biopsy currently takes many days.It was considered that,if this innovation became available,it wou

209、ld have a strong impact.One participant highlighted the possible gains to be expected with this innovation:The process right now for biopsy is going to magnetic resonance imaging,take the tissue out,look into microscope and reschedule again.But if we can cut all those steps,using high-resolution ima

210、ging technology,which is mainly going to be optical,I think that could be the next big thing.Use of metagenomics in a diagnostics framework(IG1-8)Use of metagenomics would allowing safer,more accurate diagnoses.Metagenomics would allow diagnosis of many diseases at the same time,rather than one by o

211、ne.One expert considered that this would have a large impact on health,as many diseases are not currently identified.3.2.2 Innovation group 2:Health products and drug delivery technologyFig.8 represents the experts evaluation of innovations in health products and drug delivery technology in terms of

212、 potential impact and chance of adoption.Fig.8.Innovation group 2:impact vs chance of adoption Potential impactChance of adoptionHighModerateNot significantModerateHighVery highLow-moderateHigh impacthigh chance of adoption areaIG2-6IG2-5IG2-1IG2-2IG2-7IG2-4IG2-3PolypillsDrug development changed fro

213、m a“push-through”to a“pull-through”system TheranosticsExtension of 3D-printed pills and polypillsBetter coordinated,more effective systems of vaccine production and global distributionPotent monoclonal antibodies against infectious diseasesBroad-spectrum drugs LowThree innovations were considered to

214、 have a high or very high potential impact and a high chance of adoption:Better coordinated,more effective systems of vaccine production and global distribution Broad-spectrum drugs against microbes that do not cause resistance or tolerance,that for example adapt their conformation to target structu

215、ral changes or mutations Potent monoclonal antibodies(mAbs)against infectious diseases153.Innovations for the future of global healthThe time horizon for adoption(Fig.9)is shorter for innovations that were considered to have a high potential impact and a high chance of adoption.Most of the experts c

216、onsidered that all innovations in this group could be adopted within 10 years.Fig.9.Innovation group 2:time horizon for adoption IG2-1 Potent monoclonal antibodies against infectious diseases IG2-2 Broad-spectrum drugs against microbes that do not cause resistance or toleranceIG2-3 Drug development

217、changes from a“push-through”to a“pull-through”system IG2-4 Expansion of 3D-printed pills and polypills IG2-5 Theranostics IG2-6 Polypills,produced in a plant environment IG2-7 Better coordinated,more effective systems of vaccine production and global distribution 10 years510 years 5 yearsIG1-6IG1-2I

218、G1-4IG2-7IG1-3IG1-5IG2-1 10 years 510 years 5 yearsFor each innovation considered to have very high or high potential impact and a high chance of adoption,information is provided below from the literature review and the input of participants in the horizon scan.Full descriptions of each innovation a

219、re provided in Annex 1.Better coordinated,more effective systems of vaccine production and global distribution(IG2-7)The COVID-19 pandemic highlighted the importance of more coordinated,effective systems of vaccine production and global distribution.For widespread adoption of this innovation,product

220、ion centres would be established in several countries,closer to the populations in need.The future would be distributed manufacture.In a recent initiative,the BioNTech company developed containers of a module for mRNA vaccine bulk production to be shipped to Rwanda(15).One participant noted:I think

221、we are going to see more and more consciousness and development of sustainable business models to localize production in low middle income countries.Also,for advanced products.This innovation could result not only in the design of new vaccines but also in faster production and testing.Production sys

222、tems can be expected to change.Another innovation in this area is re-purposable vaccines using technology platform,such as RNA,DNA and proteins,to optimize production systems for several diseases.As an imagination of a possible future,one participant said:We will have old vaccines rabies,yellow feve

223、r being produced on a platform or a virus-like particle platform or a DNA platform that is rapid,cost-effective,adaptable and easier scaled.So,we will repurpose some of the existing older vaccines.Application of such innovation could strongly impact the infectious disease landscape.Broad-spectrum dr

224、ugs(IG2-2)This innovation concerns broad-spectrum drugs against microbes,that do not cause or reduce the risk of resistance or tolerance.For instance,drugs could adapt their configuration to match a change in the target microbe or a new structural change caused by mutations.Nanotechnology might be u

225、sed for developing such drugs in the future.162023 Emerging technologies and scientific innovations:A global public health perspective One participant said:“Although now the drugs are static,in the future,I can foresee that the nano structures will change as they sense that the target has changed.”S

226、ome concern was expressed about the risk of microbial resistance to broad-spectrum antibiotics associated with non-compliance with long-term use of such drugs.It is,however,foreseen that some innovations will reduce the use of antibiotics,as new technology may be used to increase their functionality

227、 and bioavailability.In such an approach,antibiotic use would be restricted to severe infections with non-resistant microbes.Another topic discussed was the bioavailability of health products to reduce the global burden of microbes in water and soil,in which the ecosystem of antibiotic use would be

228、replaced by vitamins,minerals and natural products.Traditional funding of innovations for bacterial infections was considered a challenge,as the model is not attractive enough for most private actors.A possible solution could be new pricing models for broad-spectrum drugs and new avenues for funding

229、 innovations.Potent monoclonal antibodies against infectious diseases(IG2-1)Potent mAbs against infectious diseases were rated as having a high potential impact on global health but were considered to require some improvement before they could be widely adopted.mAbs may be intended for treating or p

230、reventing infections.The first and second mAbs for infectious diseases were approved for use in the European Union 18 years apart,suggesting that research may still be necessary(16).Research is under way on mAbs to treat patients with Middle East respiratory syndrome,and advances were made against E

231、bola virus disease,which provides some evidence of the promise of this technology(16).mAbs could be also be used against other diseases,including non-communicable diseases.To be effective,mAbs should be used early in an infectious disease to neutralize the pathogen before it has the chance to establ

232、ish an infection.One participant noted:“It is possible to take B cells from a recovered person and make monoclonal antibodies in a laboratory setting in a weeks time.”One of the points debated was the high cost of this innovation,which would limit widespread adoption,in particular in low-and middle-

233、income countries(LMIC).Better coordination of research and funding would be required to develop these approaches and find ways to distribute them.Greater potency would require lower doses,which would pave the way for intramuscular administration of these treatments rather than intravenously,so that

234、they might be easier to administer.One participant commented:“The potency piece for me,I take as the critical piece of the innovation to reduce cost of goods and increase delivery,to lower middle-income countries”.Innovations with a high or very high potential impact but less chance of adoptionChang

235、e in drug development from“push-through”to“pull-through”systems(IG2-3)Drug development would change from a“push-through”to a“pull-through”system,and drug developers would act as contractors,instructed to develop drugs with the highest social interest.Participants commented that,to increase adoption,

236、procurement and funding should be improved.Further development of 3D-printed pills and polypills(IG2-4)Further development of 3D-printed pills would make medicines more readily available at points of care.Some of the experts considered that the time horizon for achieving this innovation would be lon

237、g,especially for polypills.173.Innovations for the future of global health3.2.3 Innovation group 3:Tissue engineering and regenerative medicineFig.10 represents the experts evaluation of innovations in tissue engineering and regenerative medicine in terms of potential impact and chance of adoption.P

238、otential impactChance of adoptionHighModerateNot significantModerateHighVery highLow-moderateHigh impacthigh chance of adoption areaIG3-10IG3-2IG3-8IG3-7IG3-5IG3-4IG3-9IG3-3-polylysine-incorporated nanofibre wound dressings BioprintingBio-adhesives for tissue adhesion,haemostatic agents and membrane

239、 transplantationExtension of age-related limits to health3D-printing of tissues or body parts Tissue-engineered medical productsElectrospun sio-membranes Neurotechnology(chips as brain parts)Stem-cell technology Regenerative medicineIG3-6IG3-1Fig.10.Innovation group 3:impact vs chance of adoption Lo

240、wThree innovations were considered to have a high or very high potential impact,with a high chance of adoption:Stem cell technology for replacement of muscles,organs and tissues Regenerative medicine with therapies involving proliferation and transplantation of cells Bio-adhesives for tissue adhesio

241、n,haemostatic agents and membrane transplantationMost of the experts considered that all these innovations could be adopted within 10 years(Fig.11).182023 Emerging technologies and scientific innovations:A global public health perspective Fig.11.Innovation group 3:time horizon for adoption IG3-1 3D-

242、printing of tissues and body parts IG3-2 Bio-adhesives for tissue adhesive,haemostatic agents and membrane transplantationaIG3-3 BioprintingIG3-4 Electrospun sio-membranes for wound dressings and protein immobilizationIG3-5 Neurotechnology(chips as brain parts or wireless brain computer interfaces)f

243、or cognitive enhancementIG3-6 Regenerative medicine with therapies involving the proliferation and transplantation of cellsIG3-7 Extension of age-related limits to healthIG3-8 Stem-cell technology for replacement of muscle,organs,tissues IG3-9 Tissue engineered medical productsb IG3-10-polylysine-in

244、corporated nanofibre wound dressings for skin regeneration 10 years510 years 5 yearsIG3-10IG3-8IG3-4IG3-5IG3-6IG3-7IG3-3IG3-2aIG3-1IG3-9ba The numbers of votes for 5 years and 510 years were very close.b The numbers of votes for 510 years and 10 years were equal.10 years 510 years 5 yearsFor each in

245、novation considered to have very high or high potential impact and a high chance of adoption,information is provided below from the literature review and the input of participants in the horizon scan.Full descriptions of each innovation are provided in Annex 1.Stem-cell technology(IG3-8)This innovat

246、ion refers to stem cell technology for replacement or regeneration of muscle,organs(eyes,ears),bone,teeth and,later,heart,brain and neural tissues,such as transplantation of retinal cells to treat blindness.It is part of regenerative medicine.Stem cells are those from which cells with specialized fu

247、nctions are generated.Stem cells then divide to form daughter cells,which become either new stem cells or are differentiated into cells with more specific functions,such as blood,brain,heart muscle and bone cells(17).Stem-cell technology can be combined with gene editing.Advances in stem-cell techno

248、logy could allow testing of new drugs for safety and efficacy.The technology is available,and most of the experts considered that it could be widely adopted in 510 years.Regenerative medicine(IG3-6)Regenerative medicine,involving the proliferation and transplantation of cells to improve the function

249、 of cells,tissues or organs,holds promise for treatment of diseases such as diabetes and nervous system and cardiovascular disorders.For global health,regenerative medicine offers a potentially curative option,which could reduce the burden on health-care systems.Several barriers remain before regene

250、rative medicine becomes widely adopted.One is incomplete understanding of how to alter cellular systems to enable regeneration,which still contributes to a high failure rate.The second is that regenerative medicine is expensive,as it is in its infancy,limiting its uptake.The third is the manufacture

251、 of regenerative medicines,which is complicated by the living nature of the biological products and will limit distribution to some regions.193.Innovations for the future of global healthBio-adhesives for tissue adhesion,haemostatic agents and membrane transplantation(IG3-2)The clinical applications

252、 of bio-adhesives appear to be multiple,including as tissue adhesives,haemostats and tissue sealants.They have been applied in various fields,such as functional wound dressing,factor delivery vehicles and medical device fixation(18).Bio-adhesives are also promising for amniotic membrane transplantat

253、ion in ophthalmological surgery(19).Innovations with a high or very high potential impact but less chance of adoptionBioprinting(IG3-3)Bioprinting would enable standardized production,parallelization and tailored design of human tissue,human disease models and patient-specific tissue avatars.Partici

254、pants noted that bioprinting has already shown wide potential and is already being adopted.The category is broader than 3D-printing of tissues and body parts,which it encompasses.Tissue-engineered medical products(IG3-9)Tissue-engineered products require substantial manipulation to regenerate,repair

255、 or replace human tissue.A tissue-engineered product may contain cells or tissues of human or animal origin,or both.Electrospun sio-membranes(IG3-4)This innovation concerns use of electrospun sio-membranes for wound dressings.Neurotechnology(chips as brain parts)(IG3-5)Neurotechnology,including chip

256、s as brain parts and wireless brain computer interfaces,could increase cognitive functions such as learning capacity and memory in ageing people who experience changes in memory and brain function.The experts considered that the existence of external aids and tools to lengthen healthy life would sup

257、port adoption of this innovation.Consensus was,however,low,mainly because this innovation will become available only in 10 years.3D-printing of tissues and body parts(IG3-1)The experts considered that 3D-printing of tissues or body parts(such as arms and legs)or for organ function would be adopted a

258、t the same pace.Printing of tissues and some small parts might become available sooner.The complexity depends on the body part(e.g.leg and liver are of different complexity).Extension of age-related limits to health(IG3-7)As people are living longer,innovations that can extend the limits were consid

259、ered promising,although the chance of adoption was considered low.202023 Emerging technologies and scientific innovations:A global public health perspective 3.2.4 Innovation group 4:Molecular biology,cell,immune and gene therapyFig.12 represents the experts evaluation of innovations in molecular bio

260、logy and cell,immune and gene therapy in terms of potential impact and chance of adoption.Potential impactChance of adoptionHighModerateNot significantModerateHighVery highLow-moderateHigh impacthigh chance of adoption areaIG4-9IG4-6IG4-11IG4-12IG4-2IG4-18IG4-19IG4-13IG4-8IG4-15IG4-17IG4-1IG4-4IG4-7

261、IG4-14IG4-3IG4-10Improving the immune system by cell engineeringMicrobiome analytical toolsRedox state assessment for diseases and creation of a biosensor for its assessmentAffordable personal genomic sequencing in health-care settings available around the worldNovel transcriptomics(e.g.mRNA,non-cod

262、ing RNA)Epigenomics for womens healthSynthetic genomes for biomolecule productionSomatic gene editing Adaptive platform for clinical trials Biobanks for biomarker discovery and for monitoring,surveillance and otherUse of combined stem cells and gene editingCRISPR/gene editing for diagnosis and corre

263、ction of genetic abnormalitiesBiomarkers,genomic scoring systems Full human genome sequencing of underrepresented populationsSynthetic biology and engineering of viruses de novoRNA-encoded therapeuticsIn-vivo cell reprogrammingOrganoid technology for drug testing and personalized medicinemRNA vaccin

264、e platforms IG4-5IG4-16Fig.12.Innovation group 4:impact vs chance of adoption LowFour innovations were considered to have a very high or high potential impact and a high chance of adoption:Biobanks for discovery of biomarkers and for monitoring,surveillance,testing,diagnosis and improving the respon

265、se to pandemics mRNA vaccine platforms as a new way of programming for antigenic stimulation,which could result in new vaccines for tuberculosis,HIV,syphilis,hepatitis B,cancer and other diseases with complex immunology Adaptive platform trials in which several interventions are studied together Mic

266、robiome analytical tools for research,clinical prevention and treatmentThe time horizon for adoption(Fig.13)was shorter for the innovations considered to have a high potential impact and a high chance of adoption(IG4-5 and IG4-19).Most of the experts considered that all four innovations could be ado

267、pted within 10 years.213.Innovations for the future of global healthFor each innovation considered to have very high or high potential impact and a high chance of adoption,information is provided below from the literature review and the input of participants in the horizon scan.Full descriptions of

268、each innovation are provided in Annex 1.Biobanks for biomarker discovery and for monitoring and surveillance(IG4-5)Biobanks and associated meta-data are proposed for biomarker discovery and for monitoring,surveillance,testing,diagnosis and improving the response to pandemics.Malsagova et al.(20)note

269、d that collections of biological material are necessary for finding biomarkers of pathological conditions,identifying new therapeutic targets and validating the findings in samples from patients and from healthy people.They noted the growing importance of biobanks during the past few decades,with la

270、rge national and international biorepositories replacing small collections of biological samples.They commented that the ability to compare data and biological samples from different biobanks is critical to accelerating translational research.mRNA vaccine platforms(IG4-19)mRNA vaccination platforms

271、represent a new way of programming for antigenic stimulation,and this innovation could result in new vaccines and therapeutics for tuberculosis,HIV,syphilis,hepatitis B,cancer and other diseases such as malaria,autoimmune diseases.As expressed by one expert,reflecting on possible future,innovations

272、may be driven from various regions of the world:We are going to see innovative work around durability of these mRNA vaccines,we are going to see innovative work around their stability.Moving away from cold chains that require minus 20 and minus 10 and minus 80,which is fine for the“global north”,but

273、 not practical for the“global south”so that innovation is going to be stimulated by the need to reach the last mile.We are going to see innovations around the cost of goods,we are going to see innovations around the supply of raw materials.We are going to see innovation driven by the need to have he

274、alth security and by the need to be sustainable,more than ever.Fig.13.Innovation group 4:time horizon for adoption IG4-15IG4-14IG4-8IG4-1IG4-1 Affordable personal genomic sequencing in health-care settings available around the world IG4-2 Adaptive platform trials in which multiple interventions are

275、studied continuouslyIG4-3 Organoid technology for drug testing and personalized medicineIG4-4 Epigenomics for womens health IG4-5 Biobanks for biomarker discovery and for monitoring,surveillance,testing and diagnosisIG4-6 CRISPR/gene editing for diagnosis and correction of genetic abnormalitiesIG4-7

276、 Redox state assessment for diseases and creating a biosensor for its assessmentaIG4-8 Full human genome sequencing of underrepresented populations IG4-9 Further genomic tools,including biomarkers,genomic scoring systems IG4-10 Improving the immune system by cell engineeringIG4-11 Microbiome analyti

277、cal tools for research and clinical prevention and treatmentsIG4-12 Novel transcriptomics(mRNA,non-coding RNA)associated with new nano toolsIG4-13 RNA-encoded therapeuticsIG4-14 In vivo cell reprogrammingIG4-15 Somatic gene editingIG4-16 Synthetic biology and engineering of viruses de novo IG4-17 Sy

278、nthetic genomes for biomolecule productionIG4-18 Use of stem cells,cellular senescence and gene editingIG4-19 mRNA vaccine platforms 10 years510 years 5 yearsIG4-7aIG4-11IG4-10IG4-3IG4-6IG4-19IG4-4IG4-9IG4-2IG4-5IG4-12IG4-18IG4-16IG4-17IG4-13 10 years 510 years 5 yearsa The numbers of votes for 510

279、years and 10 years were equal.222023 Emerging technologies and scientific innovations:A global public health perspective The expectations are high;however further research on and investment in this technology are anticipated.It will be difficult to make mRNA vaccines against some viral,bacterial and

280、 protozoal diseases,although the field may progress.A participant in the horizon scan reflected on how mRNA technology could be extended to other diseases:We are generating through mRNA technology a whole new way of programming for antigenic stimulation.And I anticipate that we are likely to see in

281、the next five years an explosion of new vaccines based on mRNA technology.So neglected diseases are going to get a big shot in the arm because of mRNA technology.mRNA-based therapeutics thus could lead to promising therapeutics for infectious diseases such as malaria and tuberculosis and also for ca

282、ncer.Regarding the horizon time,one participant said:I foresee vaccines against cancers of various types.These have been talked about for many decades.But I think,technology is just now coming to the point where these would be possible.Microbiome analytical tools(IG4-11)Microbiology-based research a

283、nd other applications for wellness,prevention and treatment have a high potential impact for health care and for personalized medicine.The microbiome plays an important role in human health and disease,with possible investigations for the development of innovative treatment strategies,using advances

284、 in next-generation sequencing to identify and quantify the microorganisms in human specimens(21).Adaptive platform trials(IG4-2)Adaptive platform trials in which several interventions are studied continously,and for people with multi-morbidity,are required by many stakeholders in clinical trials of

285、 innovative molecules and devices in order to compare interventions in subgroups of patients with related conditions or clinical features.In an adaptive platform trial design,several interventions may be investigated continuously,with interventions entering and leaving the platform according to a de

286、cision algorithm(22).For example,the“randomized,embedded,multifactorial adaptive platform trial for community-acquired pneumonia”is an international,phase-IV clinical trial of combinations of conventional care and experimental treatment for adults with severe community-acquired pneumonia(22).Innovat

287、ions with a high or very high potential impact but less chance of adoptionUse of stem cells,cellular senescence and gene editing(IG4-18)Stem cells provide two main benefits for gene and cell therapy.First,they can self-renew and may survive the lifetime of the patient.Secondly,they provide daughter

288、cells that mature into the specialized cells of each tissue.Reference to stem-cell technology is also made in IG3-8.CRISPR/cas gene editing for diagnosis and correction of genetic abnormalities(IG4-6)This innovation refers to use of CRISPR/cas gene editing for diagnosis and correction of genetic abn

289、ormalities such as sickle-cell disease.Gene editing might make it possible to eliminate diseases such as HIV infection,by taking out part or all of the CCR-5 gene to cure or prevent disease.As an imagination of a possible future,one participant commented:“Itll be a cure and itll be a prevention.So,e

290、verybody whos at risk can just take their CRISPR and avoid getting HIV”.Improving the immune system by cell engineering(IG4-10)An example of this innovation is use of chimaeric antigen receptor T cells(CAR-T cells)against blood cancers.233.Innovations for the future of global healthExploitation of f

291、urther genomic tools,including biomarkers and genomic scoring systems(IG4-9)This innovation refers to further genomic tools,including biomarkers,genomic scoring systems for precise prevention and diagnosis and personalized therapies.Synthetic genome for biomolecule production(IG4-17)Construction of

292、viruses,bacteria and eukaryotic cells with synthetic genomes would provide new opportunities for medicine,industry and research,such as next-generation vaccines.Full human genome sequencing of underrepresented populations(IG4-8)This innovation refers to a human“pangenome”that would represent almost

293、the entirety of human genetic variation(23).The experts considered this an important step,as sequencing of the full human genomes of underrepresented populations would provide much-needed data for research on diseases.Somatic gene editing(IG4-15)Somatic gene editing of sperm,eggs and embryos for pre

294、vention and treatment would allow,for example,heritable gene editing to prevent genetic diseases such as sickle cell disease and thalassaemia.Synthetic biology and engineering of viruses de novo(IG4-16)This innovation in synthetic biology would permit engineering of viruses de novo from publicly ava

295、ilable sequence data.The possibility of rapid construction,synthesizing and editing genes and genomes would provide numerous socially useful applications,such as new therapies(24).RNA-encoded therapeutics(IG4-13)This innovation refers to RNA-based formulations emerging as potential treatment options

296、 for many diseases,including COVID-19 and acute hepatic porphyria.In-vivo cell reprogramming(IG4-14)Direct,in-vivo reprogramming for local conversion of cells in situ is emerging as an alternative to regenerative medicine that would not require cell transplantation.Organoid technology for drug testi

297、ng and personalized medicine(IG4-3)Organoids that resemble organs could be grown from adult stem cells or pluripotent stem cells(25),representing promise for use in clinical research and in the development of new treatments for personalized medicine(e.g.inflammatory bowel disease)(25).This innovatio

298、n was proposed by experts during a roundtable.Making an organ such as a pancreas to study diseases such as cancer or to develop drugs was cited as an example.One participant described an example of the use of organoids:For Zika virus,people have made brain organoids to study what damages the brain.I

299、n infectious disease,people are trying to see what is happening in the infected tissue,because you might not get every time the infected tissue from the body.Affordable personal genomic sequencing for health-care settings globally(IG4-1)Genomic research is still not translated equitably into patient

300、 care,particularly in LMIC.Some recent initiatives to promote capacity-building and infrastructure development include the Human Heredity and Health in Africa(H3Africa),the Qatar Genome Project and the Mexico National Institute of Genomic Medicine(26).242023 Emerging technologies and scientific inno

301、vations:A global public health perspective 3.2.5 Innovation group 5:Public health:environment,climate change,epidemiology and surveillance,nutrition and health Fig.14 represents the experts evaluation of innovations in public health in terms of potential impact and chance of adoption.Potential impac

302、tChance of adoptionHighModerateNot significantModerateHighVery highLow-moderateHigh impacthigh chance of adoption areaIG5-4IG5-3IG5-13IG5-1IG5-12IG5-6IG5-8IG5-10IG5-15IG5-9IG5-14IG5-2IG5-11IG5-7Biosensors for early detection of zoonotic pathogens and toxic metals Use of genomics and proteomics data

303、to contextualize disease etiology,disease prediction and treatment of chronic conditionsPrevention and reversion of chronic diseases linked mainly to lifestyle Population-wide screening of genomic variants associated with relevant diseases Use of social media and IT platforms to improve food choices

304、 and food diversityDrones combined with real-time sequencing of environmental samplesSocial innovation and new approaches to the prevention and reversion of cognitive declineGlobal early warning systems and solutions for global infections Real-time pathogen sequencing Machine learning-powered survei

305、llance tools based on symptom data Use of digital technologies to automate workflows for health and environment managementStorage of clean water in countries prone to flooding Monitor and predict new and recurring pandemics through analyticsPlastics without harmful chemicals and contaminantsUse of m

306、obile phones to improve human healthIG5-5Fig.14.Innovation group 5:potential impact vs chance of adoption LowEight innovations were considered to have a very high or high potential impact and a high chance of adoption:Global early warning systems and solutions for global infections Real-time pathoge

307、n sequencing Machine learning-powered surveillance tools based on symptom data Use of digital technology to automate workflows in health and environment management Monitoring and predicting new and recurrent pandemics with analytics Storage of clean water in countries prone to flooding Plastics with

308、out harmful chemicals or contaminants Use of mobile phones to improve human health The time horizon for adoption(Fig.15)is short for five of the eight innovations considered to have a high potential impact and with a high chance of adoption(IG5-6,IG5-5,IG5-10,IG5-15 and IG5-4).Most of the experts co

309、nsidered that all the innovations in this group could be adopted within 10 years.253.Innovations for the future of global healthMany of the innovations that were considered to have a high potential impact and a high chance of adoption are for surveillance and real-time monitoring.Full descriptions o

310、f each innovation are provided in Annex 1.One participant commented that several innovations in this group are linked:I think consistent surveillance systems tailored towards real time is one of the areas that many of these other factors can build on,including monitoring,predicting new pandemics and

311、 global early warning system.For each innovation considered to have a very high or high potential impact and a high chance of adoption,information is provided below from the literature review and the input of participants in the horizon scan.Global early warning systems for global infections(IG5-6)G

312、lobal early warning systems and solutions for monitoring the conditions related to the emergence of global infections and for disease monitoring include genomic surveillance of pathogens and information technology to identify potential zoonoses.Consensus on the potential impact of this innovation wa

313、s strong,and the timeframe for adoption was within 5 years.This innovation could therefore contribute to surveillance and outbreak detection.As information accumulates,its use for prediction will increase.These warning systems depend on people sharing data,which will be more likely if they know that

314、 their data are protected and if they have incentives.During the COVID-19 pandemic,data-sharing increased substantially.Reflecting on possible future,one participant said:Fig.15.Innovation group 5:time horizon for adoption 10 years510 years 5 yearsIG5-13aIG5-14IG5-7IG5-9IG5-8IG5-12IG5-3IG5-6IG5-5IG5

315、-10IG5-4IG5-11IG5-2IG5-15IG5-1 10 years 510 years 5 yearsIG5-1 Use of social media and information technology platforms for improving food choices and food diversity IG5-2 Biosensors for early detection IG5-3 Population-wide screening of genomic variants associated with relevant diseases IG5-4 Use o

316、f mobile phones to improve human health IG5-5 Global capacity for infectious disease outbreak response through real-time pathogen sequencing IG5-6 Global early warning systems for global infections and disease monitoring IG5-7 Leveraging genomics and proteomics data to contextualize disease etiology

317、,disease prediction and treatment of chronic conditionsIG5-8 Machine learning-powered surveillance tools for symptom data IG5-9 Making plastics without harmful chemicals and contaminantsIG5-10 Monitoring and predicting new or recurring pandemicsIG5-11 Prevention and reversion of chronic diseases lin

318、ked mainly to lifestyle IG5-12 Drones combined with real-time sequencing of environmental samplesIG5-13 Social innovation and new approaches for the prevention and reversion of cognitive decline,with home careaIG5-14 Use of digital technologies to automate the workflow for health and environment man

319、agementIG5-15 Water storage for clean water in countries prone to floodinga The numbers of votes for 5 years and for 510 years were equal.262023 Emerging technologies and scientific innovations:A global public health perspective With climate change going on,the environment will change,and diseases w

320、ill change,too.So,monitoring of the environment is important.There will be more tropical diseases,even in the cool countries.So,there would be new potential for what we call zoonosis or zoonotic diseases.So,we can predict or monitor the environment using genomics and various information technology t

321、ools.It is now very easy to have genomics,through the nanopore technology,very quick and very cheap.So,you can really sense the genomes of various microbes and others in the environment.Real-time pathogen sequencing(IG5-5)The innovation would increase global capacity for rapid responses to infectiou

322、s disease outbreaks through real-time pathogen sequencing for surveillance,with equitable sharing and distribution of countermeasures.There was strong consensus on the potential impact of this innovation for global health.Some experts considered that the chance of adoption was low,mainly because the

323、 innovation would be difficult for lower-income countries to adopt.Finding methods for real-time pathogen sequencing in LMIC is a key consideration.Use of portable genomic sequencers might be possible to enable rapid in-situ diagnosis through amplicon-based or metagenomics approaches,creating a stre

324、am of genomic data that reveal critical epidemiological aspects of the dynamics of an outbreak or epidemic.Machine learning-powered surveillance tools with data on symptoms(IG5-8)Machine learning-powered surveillance tools with data on symptoms,interpretation of in vivo diagnostic tests(e.g.imaging,

325、electrocardiograms)and algorithms for selecting further testing would provide data for improved clinical management and public health surveillance.Early,accurate,reliable signals of disease outbreaks from a heterogeneous collection of data are essential for public health surveillance.Data must be id

326、entified to obtain useful signals,with analytical methods to extract and interpret the data.Machine learning,like AI,requires good data.The experts commented that,in many countries,data are still difficult to obtain,and few countries use electronic health records.Both machine learning and AI require

327、 systems for collecting and analysing data.Use of digital technology to automate the work flow for health and environment management(IG5-14)Digital technology would be used to automate collection and analysis of data on health and the environment to better predict,prevent and reduce environmental ri

328、sks to health,combining human and animal health,environment and climate data.Modifiable environmental risks cause about one fourth of global deaths(27).Understanding the role of the environment in public health often requires collection and analysis of complex data sets(28).Digital technologies that

329、 automate the analysis of environmental data to better predict environmental risks to health are valuable,as they can save lives.Like other innovations,this one depends on collection of data for algorithms to predict environmental risks.The most important technical challenge is a lack of people trai

330、ned to use such models systematically in public health.Even when data are available,the technical skills to create,analyse and draw conclusions from the data with tools such as AI and machine learning are not currently available in all research hubs and academic institutions.Collaborative data curat

331、ion and storage,scientific computing and training are essential to empower researchers to realize the full potential of AI approaches(28).Monitoring and predicting new and recurrent pandemics with analytics(IG5-10)New and recurrent pandemics could be further monitored and predicted by analysing medi

332、cal records,mobile phone traffic,social media and other sources.Advanced data analytics can be used in the detection of outbreaks and in predicting future outbreaks from data on risk factors and context.Data on population mobility and data mining in search engines and social media could be used to f

333、ind timely information on where diseases are occurring and where they might occur next(29).More and more people use mobile phones,and the technology is also accessible in lower-income countries.Tracking is best conducted by integrating data from diverse data sources,not only from social media but also from public 273.Innovations for the future of global healthvoluntary and participatory sources,he