Wastewater Surveillance Works: A new Pandemic Center report illustrates the uses, methods, and challenges

Wastewater surveillance is one of the most effective tools for monitoring pathogens, acting as an early warning system that detects their presence in a community before widespread transmission occurs.

Although historically used primarily to track enteric pathogens and poliovirus, the COVID-19 pandemic demonstrated the broader value of wastewater surveillance as a vital complement to traditional clinical testing. During this time, it captured populations missed by clinical tests and enabled earlier detection of shifts in transmission.

In the United States, several states have proactively used wastewater monitoring to respond to outbreaks. For example:

Idaho, Utah, and Oregon have utilized monitoring sites to track measles activity.
Texas successfully used this approach to track bird flu biomarkers weeks before clinical outbreaks.

Our new report, Wastewater Surveillance for Infectious Diseases: Use Cases, Practices, and Challenges which was made possible through the collaboration of partners at SICPA, Institut Pasteur de Dakar, and WHO Hub for Pandemic and Epidemic Intelligence, defines the most promising use cases for wastewater surveillance, provides a high-level overview of the current state of implementation, and identifies key challenges that must be addressed and opportunities to optimize its role in public health monitoring

"When used alongside traditional clinical disease surveillance, wastewater surveillance has immense potential to provide early warning signals to local and national health officials. Specifically, wastewater-based epidemiological methods have offered a real-time indication of when pathogens may be entering or spreading within a community or region and, conversely, when transmission may be decreasing. This effectively allows policymakers and health systems to scale up or scale down resources accordingly."

Jennifer Nuzzo DrPh Director of the Pandemic Center, Professor of Epidemiology at the Brown University School of Public Health

Jennifer Nuzzo smiles at the camera while standing in front of a book case.

From poliovirus to COVID-19 to measles, wastewater surveillance has transformed how we detect and respond to infectious disease threats. This report consolidates what we've learned across 11 countries and identifies what it will take to secure the future of this critical tool.

Despite its proven impact, the future of these programs remains at risk. Much of the current infrastructure relies on time-limited funding and philanthropic investments. To optimize this tool, we need a transition toward stable, long-term investment to ensure we don't lose this proven early-warning system just as its necessity becomes most clear.