A boy leans on a fence in a rural setting

Wastewater monitoring could act as an early warning system to help countries better prepare for future pandemics, according to a new study.

An international collaboration involving Murdoch Children’s Research Institute, The Rockefeller Foundation, Mathematica and the United Kingdom’s Health Security Agency has shed light on how different countries monitor wastewater during infectious diseases outbreaks and where improvements could be made.

For the study, samples from treatment plants, rivers, wetlands and open drains were reported from 43 nations, spanning six continents, during 2022.

Wastewater sampling 1

A worker tests wastewater for infectious diseases

Murdoch Children’s and University of Melbourne Professor Julie Bines, who worked with colleagues from Universitas Gadjah Mada in Yogyakarta, said the ongoing COVID-19 pandemic highlighted the need for robust and resilient disease surveillance systems.

“Despite decades of funding being directed into global infectious disease surveillance and warning signs that came from both traditional and non-traditional data sources, much of the world was caught off-guard by the rapid spread of SARS-CoV-2,” she said.

“The pandemic could potentially have unfolded differently if there had been a dedicated surveillance system that was on constant alert, transmitting information about pathogens circulating in the environment across the globe. With such a system in place, experts may have identified SARS-CoV-2 far more quickly. Even if pandemic spread was inevitable, health-care systems could have better prepared for the fallout with more advanced notice, saving many lives.”

The research, published in The Lancet Global Health, found monitoring for SARS-CoV-2 variants was more common in high income countries (59 per cent) than lower middle-income countries (13 per cent). Most data was shared internally and with partner organisations but not publicly and there were no comprehensive guidelines to promote ethical wastewater monitoring practices.

A man testing wastewater for infectious diseases

Workers tests wastewater for infectious diseases

“We found testing for COVID-19 in wastewater was an effective and objective way to measure where the disease was spreading, with most samples processed in less than four days,” Professor Bines said.

Professor Bines said with ongoing attention and investment, wastewater surveillance could be used as a global early warning system for outbreaks of infectious disease.

“To truly advance wastewater monitoring, we need a global framework that includes flexible testing, enhanced data capture and reporting, as well as ethical monitoring that does not further marginalise disadvantaged communities,” she said.

“This way we could identify a range of current and future health threats like cholera, mpox (formerly monkeypox), influenza and typhoid, before they take hold of a community. But we need support to develop systems that can accurately capture, interpret and communicate data from different regions, especially vulnerable communities with limited infrastructure.”

Publication: Aparna Keshaviah, Megan B Diamond, Matthew J Wade and Prof Samuel V Scarpino on behalf of the Global Wastewater Action Group. ‘Wastewater monitoring can anchor global disease surveillance systems,’ The Lancet Global Health. DOI: 10.1016/S2214-109X(23)00170-5

Available for interview

Professor Julie Bines, Murdoch Children’s, Group Leader, Enteric Diseases

Media contact for Murdoch Children's 

Phone: +61 457 365 848

About Murdoch Children’s Research Institute

Murdoch Children's Research Institute is the largest child health research institute in Australia committed to making discoveries and developing treatments to improve child and adolescent health in Australia and around the world. They are pioneering new treatments, trialling better vaccines and improving ways of diagnosing and helping sick babies, children and adolescents. It is one of the only research institutes in Australia to offer genetic testing to find answers for families of children with previously undiagnosed conditions.


The research was funded by The Rockefeller Foundation, with additional funding provided by Mathematica to support manuscript development, data collection, analysis, interpretation, writing and Northeastern University to support manuscript writing and publication.