Inside the wastewater travelling through our cities are traces of viruses and bacteria shed by entire communities. By collecting and analysing those traces, scientists can detect infectious disease threats, track how they are spreading, and spot signs of an outbreak before clinical testing catches up.
The approach has already demonstrated its value. During the COVID-19 pandemic, wastewater surveillance offered early warning signs of rising infections and transmission hotspots and helped monitor the emergence of new viral variants, sometimes days or weeks before clinical testing would catch up. It has also played an important role in polio eradication efforts by detecting silent transmission in communities where no symptomatic cases had been reported.
Wastewater surveillance can also capture signals from people without clinical signs and symptoms, including those who are ill but do not seek medical care. This gives public health authorities a broader view of what may be circulating within a population.
Combined with increasingly advanced genomics tools, wastewater surveillance can provide a timely snapshot of which infectious disease threats are circulating in a community. Targeted next-generation sequencing (tNGS) allows researchers to identify genetic sequences belonging to specific viruses or bacteria with high sensitivity, while metagenomics paints a broader picture by analysing all genetic material within a wastewater sample without requiring scientists to know in advance what they are looking for.
Together, these techniques enable scientists to detect a wide range of pathogens in wastewater, from familiar infectious diseases to newly emerging threats.
But turning this promise into practice is not simple. Not all regions have the infrastructure needed to collect and process wastewater samples, and interpreting complex data presents technical challenges. Some pathogens may not be shed in quantities high enough to be detected reliably, while expertise, funding, and resources remain unevenly distributed.
To address these gaps, the Duke-NUS Medical School Centre for Outbreak Preparedness (COP) was recently awarded a €2 million (SG$2.9 million) grant through the European Union’s EU4Health programme, managed by the European Health and Digital Executive Agency (HaDEA) on behalf of the Health Emergency Preparedness and Response Authority (DG HERA), to launch ADWANCE-Asia: Advancing Wastewater & Environmental Surveillance for Public Health Impact in Asia.
Working with regional and international organisations, including GLOWACON, the global consortium for wastewater and environmental surveillance, ADWANCE-Asia will focus on four key pillars:
- strengthening regional coordination and fostering cross-border information sharing;
- building laboratory, genomics, and bioinformatics expertise;
- supporting low- and middle-income countries to pilot and scale multi-pathogen surveillance;
- and developing practical tools, frameworks, and guidance to help national governments integrate wastewater surveillance into their public health strategies.
The goal is not simply to generate more data. It is to ensure that the information collected can support timely and appropriate public health decisions.
Building a regional network
The project officially launched with a kick-off meeting in Kuala Lumpur, Malaysia, in June, bringing together representatives from DG HERA, HaDEA, and COP, as well as wastewater surveillance experts from Asia and beyond. International speakers from the World Health Organisation, European Union, and Africa Centres for Disease Control and Prevention (Africa CDC) shared global perspectives, advances, and lessons learned.
Sessions explored how wastewater surveillance could be integrated into national public health systems, how multi-pathogen wastewater surveillance assays could be validated, and what would be required to build laboratory and analytical capacity.
Case studies from India, Pakistan, and the Philippines were examined to institutionalise wastewater surveillance and expand existing systems to monitor multiple pathogens. Experts from Australia, Bangladesh, Indonesia, Japan, Malaysia, Singapore, and Thailand also shared their experiences, underscoring the value of regional learning and collaboration.
The second day focused on practical questions, including how wastewater surveillance data could be translated into public health action and how appropriate costing frameworks and toolkits could be developed for Asia. These themes will be explored further as ADWANCE-Asia progresses
The discussions also created opportunities to forge new partnerships and exchange ideas, reflecting the collaboration required to build sustainable wastewater surveillance systems beyond any single outbreak.
"Wastewater surveillance isn't just about preparedness anymore. It is a real-time response tool,” said Laurent Muschel, Deputy Head of DG HERA.
“What excites me most is the regional approach: embedding wastewater surveillance systems into national preparedness and surveillance plans so they become part of routine public health infrastructure rather than stand-alone projects.”
Professor Chan Yoke Fun, Department of Medical Microbiology, Faculty of Medicine at the University of Malaya, said this regional momentum could help Malaysia expand its existing SARS-CoV-2 and polio surveillance into a sustainable, multi-pathogen national system.
“It is inspiring to see like-minded scientists come together to learn from one another and share their experiences,” she said. “Ultimately, our shared mission is to transform our science into actionable signals for public health decision-making.”