Looking ahead:
Wastewater-based epidemiology

Wastewater is a valuable source of information

Wastewater monitoring can provide reliable data on a variety of chemical and biological parameters that can be integrated into wastewater-based epidemiology to support public health. One of the first cross-city applications of wastewater-based epidemiology is the measurement of drug use. Studies on legal (nicotine, alchohol) and illegal substances are being conducted worldwide. You can find out more HERE. The data collected will be used to understand where to focus public health interventions or to assist law enforcement agencies in tracking down drug production sites.

Another application of wastewater-based epidemiology is the measurement of concentrations of pharmaceuticals in wastewater. These data are used for various purposes, one of which is as an indicator for the spread of diseases. For example, the prevalence of gout has been estimated by measuring oxypurinol in wastewater, which is a metabolite of allopurinol (a substance used to treat gout) in urine. A similar approach has been applied to estimate the prevalence of type II diabetes by measuring metformin, a commonly used therapeutic agent for this disease, in wastewater.

The emergence of antibiotic resistances poses a significant global health threat. Antibiotic-resistant microorganisms find their way into the environment mainly via wastewater. Analyzing wastewater for the presence and diversity of antimicrobial resistance genes for various drugs could provide information on where and to what extent resistant bacteria pose a threat to a population.

The population may be exposed to various chemical substances (pesticides, surfactants, etc.) through food, water, air or direct contact with household or personal care products. Wastewater-based epidemiology can also provide information on these levels of exposure in order to take targeted measures to identify sources and reduce their impact.

Our statement

The world's population is growing explosively. While four billion people inhabited the blue planet in the 1970s, by 2023 this number will already have risen to eight. This means that the global human population has doubled in just over 40 years. The number of bacterial and viral infections has also increased. This is only natural, as the exchange of viruses and bacteria increases when more people live together, especially in so-called "mega cities", and when they travel around the world. However, humans have a weapon that has been tried and tested for hundreds of thousands of years: their immune system. In the vast majority of cases, this enables us to adapt autonomously to a pathogen and to fight it successfully.

The goal of a modern health management must be to follow these developments and provide the best support possible. The focus should be on the natural support of the immune system in the form of exercise and nutrition. These are priorities that have been pushed into the background in our "I must have everything immediately" society. The task of the public sector is to create opportunities for people to get enough exercise and fresh air even in the face of industrialisation. Green areas in cities, easier access to sports facilities, incentives for exercise, education - the public sector can and should provide all of these.

It is also the duty of the public sector to ensure that as few toxic substances as possible end up in our food. This requires effective food monitoring as well as a ban on certain chemical additives. However, it is not the duty of the public authorities to "force-feed" people. The final decision on whether to exercise or what to eat must remain with the individual.

Therefore, we see wastewater-based epidemiology as a great opportunity for public authorities to take a back seat and still provide society with the best support possible. Measures for efficient health monitoring already in place today, such as surveys or sentinel surveillance, can be significantly strengthened or even replaced by a wastewater-based epidemiological system. Ideally, monitoring should take place in the background, without burdening the population and without interfering with fundamental rights.

As microbiologists, we see a wastewater-based epidemiological system as a real opportunity to help steer society's health in the right direction. A wastewater monitoring system running in the background provides important data on the health of the population and, if used correctly, can have a positive impact. It is important to move away from the idea that the state must actively intervene in the personal rights of individuals. Instead, it should act as an "enabler", as an institution that enables society to optimize its health. This can be achieved through education, but also through ensuring the availiability of appropriate resources. However, individuals have to take action themselves. Personal responsibility is called for in this respect. The state must not become too present and should serve the people - in accordance with the electoral mandate - and not command them.

The beauty of a wastewater-based epidemiological system is the ability to monitor multiple parameters, as this is the only way to reveal the full potential of such a system and to identify complex relationships. Many European countries have already adopted this approach.

We therefore support the introduction of nationwide wastewater monitoring throughout Germany. A complete analysis of the most important health trends will allow optimal preventative healthcare. In addition, we recommend avoiding personalized rapid tests – irrespective of the pathogen. The costs incurred by this type of testing are enormous and the environmental burden is considerable. That’s not what sustainability looks like! If a disease is suspected, a doctor should be consulted as in previous decades and contact with other people should be restricted as a matter of course. An additional self-test was not necessary in the past and is still not necessary today. Media scaremongering is a bad counsellor.

As microbiologists, we consider it our task to provide the necessary information in factual and scientifically sound manner in order to enable each individual to make the best possible decision for the preservation of their health. After all, personal responsibility is the measure of all things when it comes to preserving individual health."

Dr. Jiri Snaidr, CEO and founder, vermicon AG