Wastewater Surveillance of Pathogens can Inform Public Health Responses

Since the late 1930s, scientists have known that infectious poliovirus was present in the sewage of cities experiencing outbreaks. As a result, wastewater surveillance has played an important part in the polio-eradication campaign. Building from the work on poliovirus, data from wastewater have complemented clinical surveillance during the COVID-19 pandemic by offering a comprehensive view of infection burden and transmission — both symptomatic and asymptomatic — and information on which SARS-CoV-2 variants are circulating in a community (including so-called cryptic variants that have never been detected in clinical samples. Yet despite the established value of wastewater surveillance for monitoring poliovirus and its emerging importance during the COVID-19 pandemic, most global public health surveillance systems still rely heavily on medically attended case data. This needs to change to enable effective pandemic preparedness and response.