Wastewater surveillance for early pathogen detection in Asia

Wastewater surveillance (WS) has emerged as an important population-based surveillance tool for early pathogen detection to inform timely public health action. Despite global guidance to initiate WS programming in Asia, the priorities and needs in Asia remain poorly understood. To address this gap, we conducted a cross-sectional assessment of WS efforts in Asia. An institutional survey recorded 89 separate projects among 45 institutions in 19 countries in Asia. Financing for WS was equally split between domestic and external resources. Most projects were research-oriented, with one-fifth embedded within national surveillance systems. Influents from urban wastewater treatment plants were the most common sampling sources identified, with either monthly or weekly sampling frequencies. Most efforts were single-pathogen focused, with SARS-CoV-2, antimicrobial resistance (AMR) bacteria, enterovirus, influenza and poliovirus being the top five pathogens assessed. Despite challenges including limited funding and government support, there has been substantial recent progress on the adoption of WS across Asia. Opportunities to enhance sustainability and scale will depend upon efforts to document public health use cases, support national planning and budgeting, develop tailored protocols and regional guidance, and advance innovative multi-pathogen approaches that leverage innovations including pathogen genomics to advance cost-efficient WS systems for public health impact.