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New Lancet Global Health Study Finds Wastewater Surveillance Poised to Anchor Public Health Disease Surveillance Worldwide

NEW YORK | June 16, 2023First-ever multi-country survey of wastewater monitoring programs in 43 countries sheds new light on the richness of the existing wastewater monitoring ecosystem and its high-potential to anchor and advance disease surveillance worldwide. Published in The Lancet Global Health, the peer-reviewed findings point to the need for leadership, funding, and implementation frameworks to strengthen wastewater monitoring for worldwide pandemic preparedness. The study was conducted by the Wastewater Action Group, an ongoing partnership between The Rockefeller Foundation, Mathematica, Northeastern University, and the United Kingdom’s Health Security Agency.

“Spotting and stopping the next pandemic is possible with visibility, but most disease detection systems currently rely on testing and other clinical data — which means they miss millions of people,” said Megan Diamond, co-lead author of the Lancet Global Health paper and Director, The Rockefeller Foundation’s Health Initiative. “Monitoring wastewater offers a more complete picture of local health, and this survey demonstrates it’s being used effectively in some of the world’s most vulnerable communities.”

Among the key findings:

  • Wastewater programs operate differently in high-income countries (HICs) compared to low- and middle-income countries (LMICs) but can be adapted for both. In HICs, composite sampling at centralized treatment plants was most common, whereas grab sampling from surface waters, open drains, and pit latrines was more typical in LMICs.
  • Most programs share their wastewater data internally and with partner organizations, but not publicly. Although 87 percent of LMICs and 100 percent of HICs surveyed share their wastewater data in some capacity, most do not share the data publicly.
  • While countries are not currently sharing wastewater data publicly, almost all were open to doing so. Even though only about a third of countries surveyed share their wastewater data publicly, almost all would be willing and able to share aggregate data with outside organizations to increase the visibility of wastewater monitoring for public health globally.
  • There are currently no comprehensive guidelines to promote the ethical practice of wastewater monitoring. The survey results indicate the need to engage a diverse panel of experts to inform how programs should communicate with the public, engage and protect vulnerable populations, and facilitate data sharing.

With many wastewater programs currently relying on donor funding or short-term government aid, the findings highlight the need for substantial financial investments to sustain wastewater monitoring into the future as global COVID-19 funding declines. The study suggests that future funding for wastewater monitoring should be flexible to account for diverse program needs, infrastructure, and priorities. Funds should support research and innovation, as well as activities that increase capacity, such as hands-on training of health and water professionals, and mapping of the locations and service populations of sanitation systems.

“Despite the coming of age of wastewater monitoring during the Covid-19 pandemic, much more can be done to make it a fully effective part of routine public health surveillance,” said Aparna Keshaviah, co-lead author and Director of Wastewater Research at Mathematica. “With additional leadership and investments to connect disparate efforts and develop adaptable implementation frameworks, the many individual wastewater initiatives that now exist can coalesce into an integrated, sustainable network for disease surveillance that minimizes the risk of overlooking or underestimating future emerging global health threats.”

Wastewater sampling was first used to detect polio outbreaks in the 1940s. Since then, scientists have developed tests to detect other illness-causing viruses and bacteria in sewage. During the Covid-19 pandemic, wastewater surveillance reemerged as a valuable public health tool for tracking the burden and spread of SARS-CoV-2 and other health threats. In fall 2021, The Rockefeller Foundation convened the Wastewater Action Group – a network of leading researchers and public health officials from across the United States and the United Kingdom – to share best practices and overcome barriers to translating wastewater data into public health action. The Rockefeller Foundation is also working with partners around the world, including in India, Ghana, and Bangladesh, to enhance local wastewater surveillance capabilities and create a global network of experts.

Learn more about The Rockefeller Foundation’s Wastewater Surveillance initiatives here.

About The Rockefeller Foundation

The Rockefeller Foundation is a pioneering philanthropy built on collaborative partnerships at the frontiers of science, technology, and innovation that enable individuals, families, and communities to flourish. We make big bets to promote the well-being of humanity and make opportunity universal and sustainable. Our focus is on scaling renewable energy for all, stimulating economic mobility, and ensuring equitable access to health care and nutritious food. For more information, sign up for our newsletter at and follow us on Twitter @RockefellerFdn.

About Mathematica

Mathematica applies expertise at the intersection of data, methods, policy, and practice to improve well-being around the world. We collaborate closely with public- and private-sector partners to translate big questions into deep insights that improve programs, refine strategies, and enhance understanding.

Media Contacts

Davina Dukuly
The Rockefeller Foundation 

David Roberts
Mathematica, Inc. 

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