The urban politics of wastewater-based epidemiology: transforming the relationship between waste, health, and urban governance

Blog 27th June 2024

In this guest post, Drs Mohammed Rafi Arefin, Carolyn Prouse, and Josie Wittmer discuss their collective research on wastewater-based epidemiology, urban politics, and COVID-19, which was supported by a Pandemics and Cities grant from the USF. They explore the socioecological and biosurveillance effects of wastewater-based epidemiology, departing from the question: “How is wastewater-based epidemiology transforming municipal governance mechanisms and becoming a new site of capital accumulation, and with what effects on whom?”

With the outbreak of the pandemic, public health authorities sought new ways to monitor and manage urban health and disease. It was at this moment that a technique that had been around for decades saw rapid uptake: the sampling of wastewater to surveil public health. Consolidated in a global crisis, wastewater-based surveillance is transforming the relationship between waste, health, and urban governance. Our team–with long-standing interests and expertise in urban political ecology and political economy, science and technology studies, and the urban politics of waste and sanitation–sought to study this emerging reservoir of vital and potentially valuable public health data derived from urban sewage. Together in a joint project between the University of British Columbia and Queen’s University, we ask: how is wastewater-based surveillance transforming municipal governance mechanisms and becoming a new site of capital accumulation, and with what effects on whom? 

Open drains in Devanahalli, Bengaluru, India.
Open drains in Devanahalli, Bengaluru, India. (Credit: Josie Wittmer)

Supported by the Urban Studies Foundation, we traced the networks of scientists and policymakers in foundations, government, and the life sciences industry across North America, the Middle East, and South Asia that have positioned wastewater surveillance as the future of managing health in cities. Our partnership was vital to this work as our team had distinct interests in urban geographies of waste and sanitation (Arefin and Wittmer) coupled with experience researching the life sciences industry and biosecurity (Prouse). Together, we were able to bring together often siloed frameworks to research an emerging issue in urban health. Additionally, each team member had prior global research experience, which enabled our project to be international in scope, with over 30 interviews across the world.

As the field of wastewater surveillance continues to undergo rapid transformation and expand its scope to other markers of health and disease, our research is ongoing. But so far, we have three major sets of findings. First, we found that the rapidly expanding field of wastewater surveillance is characterized by multi-institutional interfaces where private and public entities are pushing the bounds of public health science while also pushing the frontiers of accumulation by transforming sewage into a valuable reservoir of bioinformation. The growth of private wastewater surveillance firms represents an unprecedented shift in who carries out and governs surveillance in sewers. Our research has shown that this shift presents concerning transformations in governance, often recognized by those in the industry, including profits displacing public health needs, the rise of blackboxed proprietary technologies, and the experimental rollout of prototyped technology among vulnerable populations. 

Second, we found that the emergence of wastewater surveillance reflects larger neoliberal governance trends whereby digitalizing states increasingly rely on producing big data as ‘best practices’ to surveil various aspects of everyday life. Our research investigates the transnational pathways through which wastewater-based surveillance data is produced, made known, and operationalized in ‘evidence-based’ decision-making in a time of crisis.  We argue, based on research in South Asia, that wastewater surveillance data is actively produced through fragile but power-laden networks of transnational and  local knowledge, funding, and practices. Using mixed qualitative methods, we found these networks produced artifacts like dashboards to communicate data to the public in ways that enabled claims to objectivity, ethics, and transparency. Interrogating these representations, we demonstrate how these artefacts open up messy spaces of translation that trouble linear notions of objective data, informing accountable, transparent, and evidence-based decision-making for diverse urban actors. 

Josie Wittmer (co-PI) with Vishwanath Srikantaiah, a local wastewater engineer/planner and participant in our team's USF-funded workshop, meeting in person to explore the geographies of Bengaluru's wastewater production and reuse in May 2024.
Josie Wittmer (co-PI) with Vishwanath Srikantaiah, a local wastewater engineer/planner and participant in the team’s USF-funded workshop (Credit: Josie Wittmer)

Finally, we worked closely with public health officials, utilities engineers, planners, community-based science practitioners to think through the ethical and justice implications of wastewater-based surveillance. To this end, we held an international, interdisciplinary and multi-sectoral workshop titled “Moving from Privacy to Justice in Wastewater Surveillance”. Based on that discussion, we co-wrote, with over 15 panellists, a publication arguing that ethics initiatives to date have focused primarily on privacy, legality, and institutionalised research ethics reviews, often, if not exclusively, in North America and Western Europe. While such work is important, our group argued it overlooks how wastewater-based surveillance is embedded in global and geographically specific inequalities that could marginalise and discriminate against certain populations. We identified the need for a common framework of justice rather than specific regulations for governing wastewater surveillance across different and unequal contexts. To develop this justice-centred approach, we build on a framework by political theorist Nancy Fraser. Fraser’s integrated framework offers an approach through which programs and practices can be evaluated for their efficacy in identifying maldistribution, misrecognition, and exclusion and strengthening the capacity to change these unjust dynamics. 

Currently supported by the Social Sciences and Humanities Research Council of Canada, we plan to continue this work by expanding our regions of geographical focus and following up on these trends in urban health surveillance with more site-specific research.