Mar 16, 2024 - Health

Funding crunch threatens a key virus-fighting tool: tracking America's poop

Illustrated collage of a pipe system schematic with images of a wastewater pipe, overlaid with rippling concintric circles.

Illustration: Aïda Amer/Axios

More of America's sewage systems are tracking viral risks beyond the coronavirus, but unpredictable funding threatens the future of what's become an important surveillance tool for cash-strapped public health departments.

The big picture: Wastewater testing — supercharged by the creation of a national surveillance system in 2020 — has been one of the more reliable metrics for tracking COVID-19 spread since other data, like daily case counts and testing, became much more scarce last year.

  • More than 1,400 sites nationwide can spot the coronavirus in people's feces before they've been tested or show symptoms.
  • Some communities are increasingly looking to use the technology to monitor other viruses — including mpox, the flu and RSV — as well as the use of deadly illicit drugs.

Yes, but: Limited funding has prevented more cities from expanding their wastewater surveillance programs beyond COVID.

  • When New York was able to identify polio in its wastewater in 2022, Washington state officials said they couldn't because federal grants didn't cover testing for other viruses.
  • San Francisco, hit hard by drug overdose deaths, has spearheaded testing for fentanyl and other substances via wastewater.
  • Virginia has a similar five-year plan to track fentanyl, but it's still trying to secure funding.

Zoom in: About $3.7 million from the Centers for Disease Control and Prevention for the Virginia Department of Health's wastewater program is set to expire in July 2027, spokesperson Cheryle Rodriguez told Axios.

  • The Virginia agency doesn't have additional funding to test for mpox like it did last year, either.
  • CDC dollars will also fund Colorado's state program through July 2027, but Denver's site is shutting down next month because the grant powering it is ending, said city health department spokesperson Courtney Ronner.
  • The CDC will still run a site in the city, but it covers fewer neighborhoods, Ronner noted.

What they're saying: The U.S. risks repeating the same mistakes that hampered the initial COVID response, said David Larsen, an environmental epidemiologist at Syracuse University.

  • "The pandemic, to me, highlighted our inadequate investment in infectious disease surveillance systems," Larsen, who helped expand wastewater surveillance across New York state, told Axios. "We need to learn from that and invest in them."

Zoom in: Wastewater surveillance remains an imperfect patchwork system.

  • The uneven coverage has been an issue nationwide, as more than 1 in 5 households use septic tanks not represented in the surveillance, per the Environmental Protection Agency.
  • And there's still a demand for national standardized sampling protocols to improve the program's effectiveness, said Rekha Singh, who oversees wastewater surveillance for Virginia's health department.

The bottom line: It will take more funding and more government buy-in for wastewater surveillance to become a permanent fixture of American public health.

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