Publication: Wastewater surveillance for early pathogen detection in Asia (International Journal of Environmental Health Research, 2025)

Why watch wastewater? Asia faces heightened outbreak risks due to factors including high population density and mobility, uneven health and sanitation systems, and diverse human–animal interfaces. Wastewater surveillance (WS) offers a low-cost, non-invasive early warning layer that can detect pre-clinical signals, variant emergence, and transmission intensity, complementing clinical systems — especially where they are less robust. The COVID-19 era showcased WS’s value, with variants detected 1–2 weeks ahead of clinical data. 

A new paper in the International Journal of Environmental Health Research (2025) by Assistant Professor Vincent Junxiong Pang et al. from the Duke-NUS Centre for Outbreak Preparedness explores current WS efforts in Asia and opportunities to enhance sustainability and scale. The 19-country assessment finds rapid uptake of WS in Asia: 89 projects led by 45 institutions, although with only 20% embedded in routine national surveillance systems. Most initiatives remain single‑pathogen and research‑oriented. To move from pilots to policy, the authors call for clear public‑health use cases, standardised protocols, sustained domestic financing, cross‑sector collaboration, and leveraging advances in genomics to enable multi‑pathogen monitoring.

• Funding source: There is high reliance on external funding to implement current WS projects.
• Integration gap: Most projects are research-oriented; only 20% are embedded in routine national surveillance systems.
• Pathogen focus: The majority of efforts are single pathogen-focused. Top targets are SARS-CoV-2, antimicrobial resistant bacteria, enterovirus, influenza, and poliovirus.
• Enablers needed: Nearly three-quarters of institutions cite sustained funding and government endorsement as top priorities. Harmonised technical protocols and stronger regional coordination also rank highly.
• Operational constraints: Access to laboratory capacity, sampling technology, and data-sharing agreements/platforms remains challenging; turnaround times and supply-chain reliability are additional pain points.

• Develop multi-pathogen detection capacity, moving beyond the use of single-pathogen PCR-based platforms to multiplex pathogen genomic tools.
• Utilise WS data for public health decision-making, including for vaccination strategies against vaccine-preventable diseases.
• Integrate WS within national surveillance systems via national strategic plans and investment cases.