The Case For Sustaining Wastewater Surveillance Capabilities In The US

The National Wastewater Surveillance System (NWSS) was launched by the Centers for Disease Control and Prevention in September 2020 to connect independent, local wastewater efforts to form a robust, sustainable national system. But the funding supporting the NWSS will run out on September 30, 2025, raising the question of whether and how capabilities delivered by the NWSS will be sustained.

Between 2021 and 2024, the federal government invested more than $500 million in the NWSS, most of which was allocated to more than 50 state and local health departments to develop wastewater surveillance programs tailored to local needs while providing a comprehensive, national overview of disease transmission. The NWSS provided early warnings of community-level infection trends using data from more than a thousand sampling sites, leading to real-time public health action such as prioritizing resources, updating clinical guidance, issuing health alerts, and performing staff planning in clinical settings.

In the past four years, the NWSS expanded its scope to monitor seasonal influenza, respiratory syncytial virus, mpox, and H5 influenza. Public health decision makers and the public can access wastewater data and visualize community trends through dashboards that aggregate data collected across hundreds of sites. The NWSS has demonstrated its value as an essential public health tool through successful multipathogen surveillance and has shown that wastewater surveillance is a useful complement to clinical surveillance.

Wastewater surveillance offers several advantages over traditional surveillance methods: It tracks disease trends without relying on testing of individuals, provides an opportunity to detect asymptomatic disease before people seek treatment, and measures disease prevalence using a single sample. This capability is crucial to allow the US to retain situational awareness of potential threats to our health—without requiring millions of people to get tested for a disease that may or may not pose major risk to the population.