Wastewater sampling has been a part of disease surveillance for centuries to detect outbreaks of polio. During the Covid-19 pandemic, wastewater surveillance reemerged as a valuable public health tool for tracking the burden and spread of other infectious diseases and other health threats.
By monitoring wastewater, public health officials gain early insights into pathogens circulating in a community – without solely relying on data from people using health services. Wastewater data has played a key role in the public health response to Covid-19 around the world, especially for monitoring SARS-CoV-2 trends and the real time tracking of variants. In early 2023, multiple countries instituted wastewater surveillance in aircrafts and airports as an approach to monitor for the spread of Omicron subvariants . Around the world, wastewater surveillance programs are now expanding beyond SARS-CoV-2, identifying flu, RSV, cholera, typhoid, antimicrobial resistance and other health threats.
Why wastewater?
Wastewater surveillance is a powerful public health tool that is:
- Timely – wastewater surveillance can provide early indications of community transmission of diseases and variants. It often foreshadows clinical data, picking up signal in mild cases, before people would present in a healthcare system.
- Cost-effective – wastewater sampling can often be done at a fraction of the cost of clinical testing. One sample at the population level versus a single clinical sample is a more efficient view into community health.
- Inclusive – traditional health surveillance tools often overlook populations that lack access to health services, despite being at the highest risk for poor health outcomes. Leveraging wastewater, public health officials can better understand disease burden in these vulnerable communities.
- Adaptable – when it comes to diseases surveillance, there is no ‘one size fits all’ approach. Wastewater sampling is highly flexible – location and frequency can change based on need – and it can be used in treatment plants to pit latrines, using a high tech autosampler to tampon.
Our Approach
At The Rockefeller Foundation, we are committed to a world without pandemics. In fall 2021, The Rockefeller Foundation convened the Wastewater Action Group – a network of leading researchers and public health officials from U.S.-based institutions from across the United States – to share best practices and overcome barriers to translating wastewater data into public health action. The 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 our efforts:
Reports:
- Wastewater monitoring can anchor global disease surveillance systems
- This study, published in Lancet Global Health, reviews 43 wastewater monitoring systems in 43 countries. The results uncovered the need for an integrated, sustainable network for disease surveillance—one that minimizes the risk of overlooking future global health threats.
- Transforming Disease Detection through Wastewater Surveillance
- Five briefs based on key insights, experiences and examples of best practices to inform and support public health decision-makers.
- The Role of Wastewater Data in Pandemic Management
- Results from a national U.S. survey that assessed the role of wastewater data in pandemic management.
- Tracking SARS-CoV-2 and Its Variants in Wastewater: An Old Technique Is Yielding Powerful New Insights in the Covid-19 Pandemic
- The history, scientific basis, applications, and future of wastewater monitoring.
- Wastewater Surveillance of pathogens can inform public health responses
- This commentary, published by the Wastewater Action Group in Nature Medicine, calls for increased investments in wastewater surveillance to detect and contain health threats.
Field Notes:
- Tackling the Complexities of Covid-19 Wastewater Surveillance
- An overview of the process of collecting wastewater samples and how this data can be used to inform public health decisions.
- Bringing Wastewater Monitoring to Rohingya in Bangladeshi Refugee Camps
- A case study on how wastewater surveillance can be used in humanitarian settings, providing critical information on disease burden, offering a model for non-traditional disease surveillance in other humanitarian settings, and contributing to future pandemic prevention efforts.
- Bringing Wastewater Tracking to Tribal Lands to Protect Families and Elders
- A partnership between Tribal Nations and Arizona State University, with support from The Rockefeller Foundation, uses wastewater monitoring to protect at-risk communities.
- Prioritizing Trust As Much as Technology to Prevent Pandemics
- A case study on the importance of stakeholder buy-in when developing a sustainable wastewater surveillance program.
Output from our partners:
- Wastewater surveillance of SARS-CoV-2 and influenza in preK-12 schools shows school, community, and citywide infections
- A study first published in Water Research found that wastewater surveillance is a passive and efficient way to monitor the spread of infectious diseases in large populations and high transmission areas such as preK-12 schools.
- SARS-CoV-2 infection dynamics and genomic surveillance to detect variants in wastewater – a longitudinal study in Bengaluru, India
- This study, first published in The Lancet Regional Health – Southeast Asia, found that environmental surveillance of SARS-CoV-2 contributed to nearly real-time viral circulation.
- India must scale up wastewater analysis for health surveillance
- A comment in Nature India notes that wastewater surveillance helped identify Covid-19 outbreaks weeks before clinical data.
- SARS-CoV-2 infection dynamics and genomic surveillance to detect variants in wastewater – a longitudinal study in Bengaluru, India
- A study first published in The Lancet Regional Health – Southeast Asia found that wastewater surveillance complemented routine SARS-CoV-2 viral surveillance in India
- Online dashboards for SARS-CoV-2 wastewater data need standard best practices: an environmental health communication agenda
- This preprint describes the need for standardizing dashboards that present SARS-CoV-2 wastewater data.
- SARS-CoV-2 wastewater concentration and linked longitudinal seroprevalence: a spatial analysis of strain mutation, post-COVID-19 vaccination effect, and hospitalization burden forecasting
- This preprint found that wastewater samples can be used to estimate the effects of Covid-19 vaccination and hospital burden, providing a proof of concept for environmental epidemiology monitoring.
- Nationwide public perceptions regarding the acceptance of using wastewater for community health monitoring in the United States
- An article in PLOS One assessed public perceptions of using wastewater surveillance as a public health tool.
- Combining Community Wastewater Genomic Surveillance with State Clinical Surveillance: A Framework for SARS-CoV-2 Public Health Practice
- This study in Food and Environmental Virology aimed to develop a framework for combining community wastewater surveillance with state clinical surveillance for SARS-CoV-2.
- Environmental health justice across the globe
- An article in the Journal of Epidemiology and Community Health on environmental health justice in traditionally underserved communities.
- The Detection of Periodic Reemergence Events of SARS-CoV-2 Delta Strain in Communities Dominated by Omicron
- This study in Pathogens found that continuing to surveil wastewater is important as Covid-19 enters an endemic phase.
- Advancing the Use of Fecal Sludge for Timelier and Better-Quality Epidemiological Data in Low- and Middle-Income Countries for Pandemic Prevention
- A study in Environmental Science Technology found a need to expand decentralized wastewater surveillance in low- and middle-income countries.
- Tracing the origin of SARS-CoV-2 Omicron-like Spike sequences detected in wastewater
- This preprint aimed to determine whether SARS-CoV-2 variants found in wastewater had a human or non-human origin.
- Wastewater-based Disease Surveillance for Public Health Action
- Published by the National Academies of Science, Engineering, and Medicine, this report features Foundation grantees from the University of Oklahoma, the University of Louisville, and Arizona State University. Two Foundation grantees from the Houston Health Department and Rice University and Spelman College also served on the committee that created this report.
In media:
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Institute of Epidemiology Disease Control And Research (IEDCR) launch environmental surveillance of Covid
- A press release announcing an initiative to undertake environmental surveillance of Covid-19 and enteric pathogens in Bangladesh.
- Ensuring Equity as Wastewater Testing Matures in the United States
- This podcast from Mathematica features members of the Wastewater Action Group.