Optimising disease detection using wastewater surveillance

Genesis Analytics has partnered with the Gates Foundation to explore the value of introducing and/or scaling up Wastewater and Environmental Surveillance (WES) as part of broader disease surveillance strategies.

Our work focuses on five African countries: the Democratic Republic of Congo, Ghana, Mozambique, Nigeria and South Africa. The aim is to help these countries make informed decisions that will boost their capacities to detect, report, confirm and respond effectively to disease events.

Through strategic sampling and testing of wastewater in sewered and non-sewered systems, WES has shown promise in the early detection diseases. During the Covid-19 pandemic, it was used to monitor variants and predict waves. However, its context-specific and disease-specific utility, along with associated costs and benefits, needs to be understood in depth, particularly in resource-constrained settings.

Preliminary research by Genesis, under a previous project funded by the Gates Foundation, reveals that government funding for disease surveillance is often insufficient. External donors play a crucial role in covering additional activities such as sentinel surveillance and the development of data management systems. Budget decisions typically reside within national public health institutes and are guided by current need and financial feasibility. While stakeholders show interest in utilising WES, key information required to make strategic decisions is often lacking, including costs and optimal uses for WES.

Genesis’ role in the project involves producing evidence to assist priority setting in disease surveillance. This includes assessing funding models and dissecting ongoing disease surveillance activities. We aim to discern the distinctive constraints each country experiences with passive surveillance, which primarily relies on reported cases. Recognising that WES may offer different benefits to different countries, we intend to investigate how WES can complement these existing systems by introducing an active disease surveillance component at a community level. We plan to produce country-specific evidence for our five study countries and generate tools and frameworks that can be used in other settings.

The partnership with the Gates Foundation encompasses three discrete objectives:

• Identifying country-specific decisions that can be informed by WES, focusing on specifying priority diseases, defining WES functions, discussing alternative surveillance options and outlining decision criteria utilised in priority setting.
• Estimating the total costs of introducing and/or scaling up WES as part of existing surveillance systems, as well as exploring integration opportunities and potential economies of scale and scope.
• Exploring and, where feasible, quantifying the potential benefits of introducing and/or scaling up WES, and proposing a value framework within the broader context of priority setting in health that considers policymaker preferences.

This project, set to conclude in October 2026, promises to deliver cutting-edge insights into the future of disease surveillance that will be applicable across low- and middle-income countries in Africa and beyond.