Wastewater-based Disease Surveillance for Public Health Action (2023) / Chapter Skim
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4 Strategies for Achieving the Vision and Increasing the Public Health Impact of National Wastewater Surveillance
4 Strategies for Achieving the Vision and Increasing the Public Health Impact of National Wastewater Surveillance
Pages 77-98
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From page 77... ...
. The previous chapter described three substantive criteria for distinguishing among potential candidates: public health significance of the threat, analytical feasibility, and usefulness of community-level wastewater surveillance data in informing public health action.
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From page 79... ...
PUBLIC ACCEPTANCE: LEGAL AND ETHICAL CONSIDERATIONS The success of a national wastewater surveillance program relies on building public trust in the system (Hrudey et al., 2021)
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From page 80... ...
Even if courts did recognize a privacy interest in wastewater, they would still be unlikely to find that wastewater surveillance for infectious disease violates the Fourth Amendment. Provided that the wastewater data are used only for public health surveillance and not law enforcement, courts would probably hold that the search is legal under the "special needs" doctrine.
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From page 81... ...
It is reasonable to assume that at some point in the future, human reference databases will become robust enough to be able to identify particular genes that are more frequent for particular demographic groups, as well as genes that characterize particular individuals. For these reasons, assessment of the risk of identification PREPUBLICATION COPY
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From page 82... ...
A second dimension of the obligation to ensure appropriate use of data is preventing "function creep," or expansion of the purposes for which wastewater data are used. To maintain public trust in the wastewater-based infectious disease surveillance system, firewalls must be maintained that prevent transmission of data to aid in law enforcement efforts (Joh, 2021; Ram et al., 2022; Scassa et al., 2022)
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From page 83... ...
Fostering public acceptance necessitates that concerns about data sharing and potential expansions of the scope of wastewater surveillance are addressed and requires good governance, accountability, and transparency (WHO, 2017)
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From page 84... ...
could undertake is the development of a carefully crafted, standard data use agreement for academic and industry partners who wish to analyze wastewater data. By specifying ground rules for data users, such agreements can minimize the risk that data sharing will result in reidentification or unauthorized analyses.
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From page 85... ...
In summary, a national wastewater surveillance system can accommodate some degree of diversity in sampling and analytical approaches but only if additional investments are made in developing methods for standardizing data for purposes of comparison across geographic areas. Advancing Data Interpretation and Actionability In addition to generating reliable and comparable data, a national wastewater surveillance system needs to support timely interpretation of those data to support public health actions.
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From page 86... ...
In summary, additional investments to accelerate access to wastewater surveillance data and to continue to improve available data analysis methods and robust tools in the NWSS would improve interpretation and enhance the actionability of wastewater surveillance. BUILDING BROAD AND SUSTAINABLE CAPACITY Ensuring that wastewater surveillance data are useful for informing public health action requires not only appropriate methods and tools to generate reliable data and information but also sufficient capacity among the partners that make up the wastewater surveillance system and a reasonable expectation that this capacity can be sustained.
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From page 87... ...
CDC has established a national commercial testing contract to support those without public health laboratory capacity. Maintaining some level of baseline wastewater infectious disease surveillance, even at a low level, is important to ensure that the institutional framework will be in place to broaden and/or scale up efforts, as needed, in the face of new or re-emerging threats.
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From page 88... ...
Currently, local interpretation and use of wastewater surveillance data range widely, and a number of communities collect the samples but do not use the data for local decision making, largely due to limitations in workforce capacity and training. Guidance and training on the analysis and interpretation of wastewater data would help build understanding and confidence in evaluating wastewater data patterns and using that information for public health decisions.
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From page 89... ...
In summary, training public health practitioners and improving access to those with experience with wastewater surveillance implementation, analysis, and data interpretation is expected to increase the use of wastewater surveillance data for public health action. Expanding the Talent Pipeline Training within university programs in biomedical informatics, biostatistics, environmental engineering, epidemiology, microbiology, or other related fields is necessary to develop and maintain a workforce with the qualifications needed to continuously improve and execute wastewater surveillance in public health laboratories and departments.
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From page 90... ...
Robust health informatics support that can set up and maintain complex systems is needed for automating and disseminating wastewater data efficiently. A wide range of health informatics is involved in wastewater surveillance that, ideally, would be integrated with other data streams within the public health system.
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From page 91... ...
, and companies. Unpredictable funding makes it highly challenging to retain laboratory personnel, informaticians, PREPUBLICATION COPY
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From page 92... ...
This effort requires not only coordination with laboratories whose staff understand methodological constraints and utilities that provide analytical context and important expertise for working with the complex matrix of wastewater but also coordination within public health jurisdictions, including epidemiologists and practitioners who ultimately use the data to decide upon public health actions. Furthermore, to build out the system, innovation and progressive improvement of analytical methods, sampling approaches, and data analysis tools and methods are needed, which often fall upon academics and other entities within the scientific community that have expertise in moving analytical techniques and data analysis approaches from discovery to implementation.
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From page 93... ...
State public health agencies typically also coordinate with local public health departments, which serve as the frontline of public health response, The scientific community is critical for advancing wastewater surveillance for new technologies, research, and training. It is critical that the environmental and communicable disease arms of the public health system have close coordination with wastewater surveillance teams.
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From page 94... ...
The lead public health wastewater group should proactively invite wastewater utilities to participate beyond providing samples at the level that they are able given personnel and other capacity constraints. Additionally, some large utilities have research groups or extensive laboratory expertise that would be highly beneficial to draw upon for operating a wastewater surveillance program.
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From page 95... ...
Data analysis tools provided within this framework (with supporting guidance) will make public health actions more accessible for states, tribes, localities, and territories that do not necessarily have the internal expertise to contextualize wastewater data within other public health surveillance efforts.
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From page 96... ...
Looking forward, research laboratories, located in a diversity of health, engineering, and environmental science units both within and outside of academia, can provide an avenue for rapid method development for new pathogen targets, improvement of assays for low-level targets in wastewater, and advancement of modeling and data analysis for current and emerging microbial threats. Existing and new partnerships among the scientific community; analytical laboratories; wastewater utilities; and local, state, tribal, territorial, and national public health agencies provide mechanisms for identifying challenges that could be addressed through research and innovation as well as rapid translation of scientific advances into operations.
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From page 97... ...
The ethics committee, which could be modeled after existing data use committees, should create a formal process for executing data use agreements to help address privacy concerns and alleviate burdens in managing data sharing at a local level. Furthermore, if the prospects for identifying individuals in wastewater data strengthen over time, or if any agency or private-sector organization expresses interest in using wastewater data for purposes other than infectious disease surveillance, this body should re-evaluate the balance of health benefits versus risks associated with data sharing and any proposed expansions in data collection and data linkage.
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From page 98... ...
Because the function of the NWSS depends on the participation of wastewater utilities, CDC and local public health agencies should continue to strengthen relationships with wastewater partners. CDC should continue to work to improve the connections between wastewater utilities and local, state, tribal, territorial, and federal public health agencies, beyond what is currently provided in the Communities of Practice.
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