Leveraging Potable Reuse to Bolster the Long-Term Sustainability of Wastewater-Based Surveillance

Recommendations P andemic-related investment and cross-disciplinary inter- agency collaborations have fueled a rapid expansion of wastewater-based surveillance (WBS).Partnerships between utilities and commercial or government laboratories helped scale WBS programs across the world by streamlining site onboarding, sample logistics, and data sharing.Examples of large-scale WBS initiatives include the National Wastewater Surveillance System (NWSS) and WastewaterSCAN in the United States, the EU Wastewater Observatory for Public Health in Europe, and the National Wastewater Surveillance Program in Australia.Researchers continue to refine methodologies for an ever-expanding list of priority chemical and microbiological targets, and public health partners are exploring novel applications of these data to supplement traditional surveillance activities, including monitoring disease trends, modeling health outcomes, and informing public health responses.1 Despite the intense focus on the pandemic in recent years, the value of WBS extends well beyond the COVID-19 public health emergency, evidenced by historical use (e.g., polio) and recent novel applications (e.g., mpox).WBS is being conducted in a growing number of settings beyond municipal wastewater systems, including university campuses, healthcare and congregate living facilities, and within the agricultural industry (e.g., H5N1 in livestock).Even these few examples highlight the vast potential of WBS across One Health and One Water.In fact, the long-term sustainability of WBS across the globe likely depends on our ability to fully realize its potential by casting an increasingly wider net and clearly demonstrating cross-sector value.These objectives can be accomplished by rebranding the concept; attracting new collaborators, end users, and resources; and actively engaging key stakeholders.We recommend an evolution from "wastewater-based surveillance" to a broader "wastewater analytics" paradigm at the nexus of One Health and One Water.We realize that fully achieving this goal will require a comprehensive approach and long-term strategic planning, but each new application bolsters the long-term sustainability of wastewater testing infrastructure, ensuring resilience to cyclical funding pressures and preparedness for the next public health emergency.Here we provide one example of how wastewater analytics can be extended to a new application�potable reuse�and discuss the corresponding benefits to utilities, regulators, and the public (Figure 1), particularly as direct potable reuse (DPR) is being considered in more communities worldwide.