The growing need to establish a global wastewater surveillance consortium for future pandemic preparedness

The paper highlights the risk that deregulation of COVID-19 measures and incomplete clinical surveillance in parts of Asia could obscure true infection levels and delay detection of novel variants. It argues that wastewater surveillance is a cost-effective, scalable tool for population-level monitoring of SARS-CoV-2 and other pathogens, offering early warning and variant tracking capabilities. The authors propose integrating wastewater surveillance into international public health surveillance frameworks to enhance global pandemic preparedness.

The authors reference prior work demonstrating: (1) the value of wastewater surveillance for public health; (2) wastewater-based prediction of COVID-19 cases using highly sensitive SARS-CoV-2 RNA detection with mathematical modeling; (3) wastewater sequencing revealing early cryptic transmission of SARS-CoV-2 variants; (4) detection of SARS-CoV-2 RNA in aircraft and cruise ship wastewater as a tool to assess infected travelers; and (5) contemporary reports on expanding wastewater testing at airports. These works collectively support wastewater monitoring as an early, cost-effective indicator of infection trends and variant emergence, including in travel hubs.

- Wastewater surveillance can detect SARS-CoV-2 at low community incidence: in Japan, SARS-CoV-2 was detectable in 50% of wastewater samples when newly reported cases were 0.69 per 100,000 inhabitants; wastewater RNA concentrations correlated strongly with reported cases (r = 0.94). - Viral genome sequencing of wastewater enables identification of specific variants. - Aircraft wastewater monitoring is being implemented (e.g., for flights arriving from China/other countries) in the USA, Australia, and the EU to assess infection importation and emerging variants. - Wastewater surveillance is applicable to multiple pathogens (e.g., poliovirus, mpox, influenza), broadening its public health utility. - The EU, with partners including Canada, the USA, the UK, Malaysia, and Australia, is establishing an international consortium for open data sharing on SARS-CoV-2 in urban and aircraft wastewater (https://wastewater-observatory.jrc.ec.europa.eu/). - The authors call for broader participation across diverse regions and economies (e.g., under G7 initiatives and potentially WHO) to create an effective global consortium that supports protocol sharing and capacity building, especially in low-income countries.

The findings and cited evidence underscore wastewater surveillance as a robust, early indicator of infection dynamics and variant emergence, complementing clinical surveillance that may be delayed or incomplete. Integrating wastewater data into international regulatory frameworks (aligned with the International Health Regulations) could enable earlier detection of transboundary transmission and inform proactive public health responses across regions. Aircraft wastewater genomics can map pathways of emerging viruses, while city-level monitoring can inform timely interventions locally and abroad via shared data.

The paper advocates establishing a global wastewater surveillance consortium to strengthen pandemic preparedness. By promoting open data sharing, harmonized protocols, and inclusion of low-income countries, such a consortium would enhance early warning, track variant spread, and support coordinated international responses. Future efforts should focus on expanding country participation, standardizing methods and data reporting, and embedding wastewater surveillance within WHO-aligned global health surveillance systems.