Context:

A recently published study in The Lancet Global Health reiterated the promise of using wastewater for public health surveillance. 

• It gained relevance during the COVID-19 pandemic, when it was identified as an approach for tracking the spread of SARS-CoV-2.

About Wastewater surveillance:

• It is the process of monitoring wastewater for contaminants. 
• It involves systematic sampling and analysis of samples from varied sources such as wastewater ponds in rural areas and centralized sewage systems in urban localities. 
• These samples would undergo testing at designated laboratories to identify markers of disease-causing agents, such as genetic fragments of bacteria or viruses. 
• These data could be compiled together with other sources of health data to provide real-time insights into community-level disease patterns, sometimes earlier than clinical data.

Benefits of Wastewater Surveillance:

• Cost Effective: It is a cost-effective approach that does not rely on invasive samples from individuals with clinical symptoms.
• Early Detection: It detects disease-causing agents before clinical cases are reported and containment measures.
• Early Warning System: Specific genetic markers or pathogen fragments found in wastewater samples can serve as an alert for potential disease outbreaks.
• Community Monitoring: Analyzing wastewater samples offers insights into overall community health, helped in disease identification and curing.
• Monitoring in Limited Health Access Areas: It helps in monitoring diseases occurrence in areas where healthcare access is limited.

Challenges with Wastewater Surveillance:

• Inaccurate Prediction: It is not possible to reliably and accurately predict the number of infected individuals in a community based on wastewater testing.
• Less Inclusion: Community-level wastewater surveillance at a treatment plant will not capture homes on a septic system.
  • Community-level wastewater surveillance at a treatment plant also will not capture communities or facilities served by decentralized systems, such as prisons, universities, or hospitals, that treat their waste.
• Low Capturing: Low levels of infection in a community may not be captured by wastewater surveillance. The lower limits of detection for wastewater surveillance are not yet known. 
• Uneven Coverage: Rural and remote areas lack adequate surveillance infrastructure and resources, resulting in limited data collection and monitoring capabilities.
• Inadequate Data Sharing: In India, there are challenges in sharing data between different levels of government and across departments, hindering the seamless flow of information necessary for early detection and response.
• Limited Diagnostic and Laboratory Capacity: In India, inadequate resources, outdated equipment, and a shortage of trained personnel can hamper timely and accurate testing.
• Limited Use of Advanced Technologies: The adoption of advanced technologies, such as real-time data analytics, machine learning, and artificial intelligence, is limited in India’s public health surveillance system.

Way Forward:

• Integrating Mechanism: The integration of wastewater surveillance with existing surveillance mechanisms could help amplify India’s epidemiological capabilities. 
• Trained Professionals: Successful integration will rely on public health professionals trained not only in traditional epidemiological methods, but also in the management and interpretation of data derived from wastewater surveillance.
• Strengthen Public Health Laboratory Networks: Efforts needed to strengthen public health laboratory networks, which could strengthen the capacity to detect diseases at an early stage.
• Use of the Ayushman Bharat Digital Mission: It aims to create a seamless online platform for healthcare services, offering an opportunity for the integration of wastewater surveillance. 
• Development of Robust Data Management Systems: There is a need to collect, store, and analyze wastewater surveillance data. 
  • This may involve creating dedicated databases or integrating wastewater surveillance data into existing surveillance information systems.
• Driving Implementation: There is a need for a dedicated public health and management cadre driving implementation.
• Political backing and funding should be increased.
• 3P Model: There is a need to take steps for enhancing the public-private partnership (PPP Model).

Conclusion:

• India’s leadership at international platforms like the G20 could serve as an opportunity to elevate the significance of innovative approaches to disease surveillance. 
• With the world’s attention focused on global health security in the wake of recent pandemics, these forums provide an opportunity to advocate for enhanced public health surveillance that integrates wastewater sampling as an essential component of health infrastructure. 

News Source: The Hindu