Ethics framework for wastewater and environmental surveillance

Overview

Wastewater and environmental surveillance (WES) is increasingly used to support public health decision-making by monitoring infectious diseases, antimicrobial resistance, illicit drug use and environmental toxin exposure. This ethics framework provides guidance for the design, implementation and governance of WES programmes, recognizing the growing use of these approaches following their application in poliovirus eradication efforts and during the COVID-19 pandemic. Developed through consultation with experts in public health ethics and wastewater surveillance, the framework is informed by WHO guidance on ethical issues in public health surveillance and addresses the distinctive ethical challenges associated with collecting and analysing population-level environmental samples.

The document presents seven key areas for ethical assessment: programme aims, potential public health benefits, potential harms and risk mitigation, proportionality, equity and justice, respect for persons, and data and sample stewardship. It examines issues such as privacy, stigmatization, community engagement, transparency, data sharing, public trust and the equitable distribution of benefits and burdens. The framework is intended to support policy-makers, public health authorities and practitioners in developing ethically appropriate WES policies and practices that promote public health while safeguarding the rights, interests and well-being of affected populations.