Wastewater Surveillance Programs for Disease Outbreaks in Danger Due to Funding Uncertainty

Wastewater surveillance programs have been incredibly valuable in detecting surging infections and new variants of COVID-19 weeks before they are detected in hospitals.

But now, the long-term ability of these programs to protect public health is in danger, as funding uncertainty and uneven commitments from state health departments have raised concerns that these programs may shut down in the future, Scientific American reports.

Lack of Funding Could End Wastewater Testing Soon

The U.S. Centers for Disease Control and Prevention's National Wastewater Surveillance System (NWSS), which includes most of the wastewater testing sites in the country, is fully funded through 2025, according to Amy Kirby, director of the program.

However, Kirby says that after 2025, new sustainable funding sources are needed, ideally through the CDC's regular budget rather than resources tied to COVID-19.

Wastewater surveillance is really useful because it can collect information from thousands of people in just one sample. It does not rely on people going to the hospital to get tested for COVID-19, like the numbers we see in the news.

In 2022, when more people started doing at-home tests that health organizations don't track, wastewater surveillance became even more helpful.

But some state governments have hesitated to invest in the technology because of questions about funding, logistics, and how to interpret data from this relatively new source. This has led to an uneven national system.

How Wastewater Helps Prevent Disease Outbreaks

Some researchers and health officials are working on expanding their wastewater programs beyond COVID-19 and have found that the technology can track a wide variety of health threats. The WastewaterSCAN project, for instance, is testing for flu, respiratory syncytial virus (RSV), norovirus, human metapneumovirus (HMPV), as well as SARS-CoV-2.

Time reported in Sept. 2022 that a new program operated by academics at Stanford University, Emory University, and Verily, an Alphabet Inc. company, is monitoring monkeypox cases by analyzing sewage from 41 communities in 10 states - detecting mpox on 22 of the sites.

Meanwhile, the New York State Department of Health recently announced that it would broaden its wastewater program to include new diseases and add at least 90 new monitoring sites.

David Larsen, an epidemiologist at Syracuse University who runs the New York State program, says:

"Wastewater analysis has the potential to add major improvements to disease surveillance. Expansions to the New York State program, including COVID variant analysis and additional respiratory, gastrointestinal, and hepatitis pathogens, will facilitate their rapid detection across large sections of the population without having to test large numbers of individual patients."

Will the Initiative Receive Funding?

However, additional funding is needed to continue these projects at the national level, and there are signs that the federal government may be reluctant to provide it. The Biden administration's proposed 2024 budget does not include any mention of the CDC's wastewater surveillance system, and public health funding bills have repeatedly stalled in Congress.

The potential loss of funding and the uneven implementation of wastewater surveillance programs across the country could have serious consequences for public health. According to Kirby, "if we lose this, we're going to lose a really important tool in our toolbox."

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