NEW YORK | September 8, 2022 — In a commentary published today in Nature Medicine, a group of public health leaders and academic researchers brought together by The Rockefeller Foundation’s Pandemic Prevention Institute outlines the urgent need to increase investments in wastewater surveillance to detect and contain health threats, such as monkeypox. As the authors demonstrate through three case studies on wastewater monitoring for Covid-19 variants, this type of surveillance can provide a powerful early warning system for outbreaks, but it is currently too limited in scope and is not yet fully integrated into public health systems – which severely impedes pandemic preparedness and response efforts.
“The science underpinning wastewater surveillance for disease outbreaks is settled – what’s missing is widespread and consistent implementation by public health authorities,” said Samuel V. Scarpino, PhD, co-author of the Nature Medicine paper and Vice President of Pathogen Surveillance at The Rockefeller Foundation’s Pandemic Prevention Institute. “Additionally, it is high time that we expand wastewater surveillance so that we are proactively scanning for a wider range of viral and bacterial threats. In the race against disease outbreaks, the speed of our response is key – and scaled-up wastewater monitoring could significantly accelerate detection and the subsequent global response.”
Wastewater monitoring has long been used in the global polio eradication campaign but over the past two years has gained increased recognition as a public health tool to respond to the Covid-19 pandemic. In Oklahoma, for example, researchers supported by The Rockefeller Foundation were able to detect the Omicron variant in the wastewater in Tulsa, which enabled the city’s health department to warn hospitals to immediately ramp up staffing and reconsider treatment approaches as they prepared for an unprecedented wave of Omicron infections.
However, the current response to monkeypox and polio in the U.S. highlights the hurdles to effective wastewater monitoring. For one, most global public health surveillance systems still rely heavily on clinically reported case data derived from healthcare settings and results from diagnostic tests, which can be in short supply. There also continues to be confusion on how to integrate wastewater data with traditional data sources, such as hospital bed capacity or local sales of in-home diagnostic tests, to provide public health officials with a more holistic measure of disease risk in their community. Additionally, despite the potential of wastewater surveillance as an early warning system for outbreaks, this type of data needs to be shared in near- ‘real time’ to detect outbreaks before cases are clinically reported, and much of the expertise on how to conduct this surveillance sits within academic research labs.
To overcome these challenges, the authors present three key recommendations, which serve as a roadmap for fully operationalizing wastewater surveillance:
- Greater funding and investment to support the required infrastructure, including wastewater-sampling equipment, lab testing supplies and trained personnel;
- Researcher expertise for deriving new assays, developing risk metrics, and communicating outbreak risk to non-technical audiences; and
- Community engagement, because the value of wastewater data is optimized when multiple stakeholders work closely together, and community leaders are engaged and consulted on the wastewater sampling process.
“Despite the coming of age of wastewater surveillance during the Covid-19 pandemic, much more can be done to make it a fully effective part of our public health arsenal,” said Megan Diamond, co-lead author of the Nature Medicine paper with Aparna Keshaviah from Mathematica, and Director, The Rockefeller Foundation’s Pandemic Prevention Institute. “As the monkeypox outbreak and reemergence of polio demonstrate, wastewater monitoring needs to be an always on, national system that scans for multiple health threats – which in turn will help policymakers and health systems be nimbler and more effective in detecting and containing outbreaks.”
The authors of the commentary represent the Wastewater Action Group, which was launched in fall 2021 to study approaches to translating wastewater data into public health action. The group includes individuals affiliated with more than 14 preeminent U.S. research institutions*, which are all grantees of The Rockefeller Foundation.
*The case studies in the paper were provided by: For Arizona and the Tribal Nations: Arizona State University; for Oklahoma: University of Oklahoma; for Texas: Rice University and the City of Houston Health Department. Other institutions affiliated with this research include AquaVitas, Emory University, Indiana University, Mathematica, Northeastern University, Northwestern University, Santa Fe Institute, The Rockefeller Foundation, University of Louisville and the University of Vermont.
About The Rockefeller Foundation’s Pandemic Prevention Institute
The Rockefeller Foundation’s Pandemic Prevention Institute (PPI) is mission-driven to contribute to the crucial work of building systems that detect, prevent, and mitigate pandemic threats, leading to rapid, effective containment. The PPI is pursuing its mission through the integration of cutting-edge technology and analytic approaches that turn data into action that drives life-saving decisions; a federated network of data users and holders with global representation; and collaborative leadership at the global level. For more information on partners, data solutions and more visit www.ppi.org and follow us on Twitter: @PPI_Insights and LinkedIn: The Pandemic Prevention Institute.
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VP, Communications and Advocacy
The Rockefeller Foundation
Pandemic Prevention Institute