Experts identify three factors essential to make wastewater surveillance a pillar of regional pandemic preparedness

• The immense potential of wastewater surveillance as a public health tool was the focus when international experts gathered in Singapore in June to set an agenda to improve regional wastewater surveillance programmes.
• The experts showcased different use-cases of wastewater surveillance, including to provide early warning, situational assessments and guide vaccination and response strategies for a wide range of infectious diseases from SARS-CoV-2 to poliovirus, influenza, Hepatitis E and Zika virus.

Harmonised testing and reporting, more trained personnel and active community engagement—these three factors are essential for effective regional wastewater surveillance, agreed international experts who gathered in Singapore in June 2024 to discuss the topic and set an agenda to improve regional wastewater surveillance programmes.

Participants make the most of the five days of learning, brainstorming and building regional connections

The workshop, titled “Developing a Regional Agenda for Wastewater and Environmental Surveillance and Research for Epidemics and Pandemics”, saw 300 experts from more than 40 countries gather in what was a first-of-its-kind event for the region. Participants included representatives from government entities, academic institutions, public laboratories, industry and non-governmental organisations, showcasing the multidisciplinary and intersectoral nature of the work being undertaken. The workshop not only focused on identifying an action-based agenda to advance wastewater surveillance efforts in the region, but also offered participants from different fields an opportunity to expand their own expertise and know-how.

Organisers planned for the five-day hybrid event, which ran from 24 to 28 June 2024, to conclude with an agenda on how to improve cross-border surveillance and research for the early detection, monitoring and response to outbreaks—a goal that was achieved with agreement from all corners.

“Given the broad range of attendees, the diverse regional representation, and the high level of discussions, it is clear that this event was a resounding success. I look forward to staying closely connected with everyone as we work together to define and advance a regional agenda for wastewater and environmental surveillance and research in the context of epidemics and pandemics—an essential endeavour to enhance regional health security,” said Professor Wang Linfa from Singapore’s national Programme for Research in Epidemic Preparedness and REsponse (PREPARE) and a professor with Duke-NUS’ Emerging Infectious Diseases Programme.

Professor Wang Linfa during the workshop, where he noted that the broad range of attendees, diver regional representation and high level of discussions made this event a resounding success

From the outset, three key themes emerged as essential to this effort. Foremost among which was the need for a community of practice. Participants stressed the need to harmonise data sharing frameworks despite differences in sampling and testing methods so that cross-country comparisons can be carried out.

Upskilling workers was another major theme. A steady pool of trained health professionals is essential to ensure the sustainability of wastewater surveillance for pandemic preparedness.

“Capacity building is key to a successful wastewater surveillance programme,” said Professor Paul Pronyk, Director of Duke-NUS’ Centre for Outbreak Preparedness, which hosts the secretariat of the Asia Pathogen Genomics Initiative (Asia PGI). “Through Asia PGI, we focus on capacity development, sustainability, and scientific partnerships between countries in this work. We’ll move faster when we move together.”

Lastly, experts emphasised the importance of discussing the ethics of such programmes and involving the community. Working in tandem with community leaders will ensure that the community understands how their wastewater data will be used and its impact on public health.

Over the five days, participants also benefitted from various thematic expert sharing sessions, group discussions, an innovation hackathon and a regional dashboard mapping exercise, through which the workshop facilitated the strengthening of knowledge sharing and the investment case for incorporating wastewater and environmental surveillance into national infectious disease monitoring efforts.

“Wastewater environmental surveillance goes beyond the health sector,” said Associate Professor Ng Lee Ching, Group Director of the Environmental Health Institute at the National Environment Agency of Singapore, or NEA. “It is a multisectoral field of work in which we need to engage with a wide range of stakeholders – public health officials at the municipality level, wastewater management entities, educators, scientists, and community leaders, to name a few.”

Professor Paul Pronyk from Duke-NUS (left) and Associate Professor Ng Lee Ching from NEA (right) co-moderate an expert panel on the last day of the workshop discussing scale and sustainability in wastewater management. Among the panelists were Professor Wang Linfa from PREPARE (second left) and Dr Wolfgang Philipp from HERA (centre)

The workshop was jointly organised by institutions from Singapore, including PREPARE, NEA, Temasek Foundation and the Asia PGI; the European Union, through the Health Emergency Preparedness and Response Authority (HERA); and the Bill & Melinda Gates Foundation.

“Wastewater surveillance is a new frontier for a lot of us and everyone would benefit from a good view of efforts across the region,” said Prof Pronyk. To contribute to a comprehensive view and coordinated efforts around the region, participants had the opportunity to map out the current landscape of wastewater environmental surveillance projects in Asia, using an Asia PGI mapping platform.

By the end of the week, the participants had built new networks with experts from other fields and countries, as well as advocacy and philanthropy groups, which will facilitate the development of country-specific and regional agendas identified by the workshop participants.

“We might all have different priorities in wastewater and environmental surveillance, but early detection is the common thread,” said Dr Wolfgang Philipp, Principal Adviser – Chief Science Officer, HERA. “Collaboration is key.”

“While most of us may have resumed a ‘new normal’ in our lives, we also know that future epidemics are not a matter of “if” but “when”,” said Mr Ng How Yue, Permanent Secretary for Health Development with Singapore’s Ministry of Health, during his speech on Day One, highlighting the need to be ever ready. “It is but a matter of time before an unknown disease could emerge again and cause a serious international epidemic or pandemic.”