Opportunities and limits of wastewater-based epidemiology for tracking global health and attainment of UN sustainable development goals

Abstract

Wastewater-based epidemiology (WBE) emerged as a powerful, actionable health management tool during the COVID-19 pandemic. Hypothesizing future uses, we explored its potential for real-time, tracking of progress in attaining United Nations Sustainable Development Goals (SDGs) globally as a non-expensive method using existing infrastructure. We inventoried (i) literature-documented sewerage infrastructure, (ii) demographics of populations served, and (iii) WBE markers informative of 9 SDGs. Among the 17 different sustainable development goals listed by the UN 2030 agenda, more than half of these may be monitored by using WBE monitoring at centralized treatment infrastructure as tabulated in this study. Driven mainly by COVID-19, WBE currently is practiced in at least 55 countries, reaching about 300 million people. Expansion of WBE to 109,000 + treatment plants inventoried in 129 countries would increase global coverage 9-fold to 34.7% or 2.7 billion, leaving out 5 billion people not served by centralized sewerage systems. Associations between population demographics and present-day infrastructure are explored, and geospatial regions particularly vulnerable to infectious disease outbreaks are identified. The results suggest that difference in the differential outcomes in well-being is an outcome of the sanitation infrastructure inequalities and lack of sanitation infrastructure creates doubly disadvantaged populations at risk of poor hygiene and cut off from the early-warning benefits of conventional WBE. This is the first study to explore the feasibility and potential barriers to the use of WBE for tracking the attainment of SDGs globally with at least 9 out of 17 SDGs.

Keywords: Biomarkers; Centralized wastewater treatment plants; Global health; Sustainable development goals; WBE; Wastewater infrastructure.

Graphical abstract

Fig. 1

Horizontal bar plot showing (A) the number of countries represented from each source of data, (B) available data on a number of countries for each socio-economic and health indicator used in this study.

Fig. 2

Visual representation of the coverage of (A) number of municipal wastewater treatment plants (number), (B) people served by centralized wastewater treatment plants (percentage), (C) GDP per capita (US dollars per person), (D) life expectancy at birth (years), (E) DALYs - attributed to diarrheal diseases (years per thousand), (F) mortality due to unsafe water, sanitation and hygiene (number per million), (G) least basic sanitation services (percentage) and (H) mortality rate due to unintentional poisoning (number per million).