The European Centre for Disease Prevention and Control (ECDC) has released a new framework to guide the integration of wastewater-based surveillance (WBS) into infectious disease surveillance.

The ECDC highlighted the following five key ways it aims to help countries implement WBS: supporting the development of a European Union/European Economic Area (EU/EEA)-level WBS system, offering lab support, identifying candidate pathogens, helping with data integration, and identifying the best database and reporting options.

The framework was published following EU legislation that introduced new national requirements for multiple activities related to wastewater monitoring.

“The new ECDC framework is crucial for unifying methodological and analytical procedures across the EU/EEA,” Pavel Březovsky, MD, of the Department of Soil and Waste Hygiene at the Center for Health and Environment, Prague, Czech Republic, told Medscape News Europe.

“This [framework] will ensure that data from different countries are comparable and usable for a pan-European risk assessment. The proposed establishment of a European WBS Network is particularly vital,” he added.

“WBS testing can add significant knowledge on the circulation of pathogens,” Marion Koopmans, PhD, scientific director of the Pandemic and Disaster Preparedness Centre in Rotterdam, Netherlands, told Medscape News Europe. “A key advantage is its representativeness. During the peak of the pandemic, when there was massive testing, the added value became less clear, but currently, WBS is a reliable source of information on how much COVID-19 is circulating,” she said.

How Effective Is WBS?

Not everyone is enthusiastic about WBS, however. Estonia introduced large-scale WBS during the COVID pandemic but has discontinued these efforts due to questions about the value of the data that they provide, Tanel Tenson, PhD, professor of antimicrobial technologies at the University of Tartu, Tartu, Estonia, told Medscape News Europe.

“The EU mandates are often fulfilled at the minimal level possible or even less, and this is currently happening or going to happen to wastewater surveillance,” he said.

For WBS to receive more investment, more data would be needed to analyze its real effects, such as how it affects numbers of new infections, or “how many lives it saves,” according to Tenson.

“Currently, if asked whether to use limited resources for improving the collection of patient information or WBS, I would recommend the first option.” he said, adding that Estonia “really doesn’t understand how to act on WBS surveillance data.”

Opponents of WBS usually don’t argue that WBS doesn’t detect the virus, but rather that the data it produces don’t change the public health response, Březovsky said.

“If the state does not have the capacity or political will to implement measures earlier than on the basis of full hospitals, then WBS is just an expensive thermometer.” It indicates that it’s hot outside when everyone already knows, he said.

In smaller countries like Estonia, he added, clinical systems can be so efficient and centralized that WBS provides less added value than it does in more fragmented countries, such as the Czech Republic, which takes a more “proactive path” to WBS.

Bottlenecks

The supporters of WBS recognize potential bottlenecks in its implementation. While Finland has a long tradition of implementing WBS for surveilling polio and enteroviruses, Tarja Pitkänen, PhD, of the Finnish Institute for Health and Welfare,Helsinki, Finland, told Medscape News Europe that attention is needed for integrating WBS as a supplemental data source.

“Question marks still exist on the actionability of wastewater data for multiple pathogens, and overall, resources for public health surveillance are scarce in many countries, including Finland,” she said.

Koopmans, who considers herself a “fan” of WBS, agreed that “learning to work with this type of data” and the “need for target validation” could “put the brakes” on WBS development.

Nevertheless, she stressed that WBS can be especially useful for pathogens that often “go under the radar” like polio. WBS might also help with locating mpox Clade Ib viruses, which have started to spread outside Africa.

ECDC Help

The European Commission has made significant investments in WBS and provides funding opportunities to member states, Daniel Palm, head of microbiology and bioinformatics at the ECDC, told Medscape News Europe. “The ongoing Joint Action EU-WISH brings together 25 member states and Ukraine to develop and strengthen wastewater surveillance systems at the national level,” he said.

“Establishing a network for sharing best practices and expertise, along with additional laboratory support activities such as external quality assessments, reference services, and training, will help ensure effective implementation, harmonization of methodologies, and robust data interpretation,” he concluded.

Březovsky, Koopmans, Tenson, and Pitkänen reported having no relevant financial relationships.

Annie Lennon is a medical journalist. Her writing appears on Medscape, WebMD, and Medical News Today, among other outlets.