Optimizing Spatial Distribution of Wastewater-Based Disease Surveillance to Advance Health Equity
In 2022, the US Centers for Disease Control and Prevention commissioned the National Academies of Sciences, Engineering, and Medicine to assess the role of community-level wastewater-based disease surveillance (WDS) beyond COVID-19. WDS is recognized as a promising mechanism for promptly identifying infectious diseases, including COVID-19 and other novel pathogens. An important conclusion drawn from this initiative is that it is crucial to maintain equity and expand access to maximize the advantages of WDS for marginalized communities. To address this need, we propose an optimization framework that focuses on the strategic allocation of wastewater monitoring resources at the wastewater treatment plant (WWTP) level. The framework's purpose is to obtain a balanced spatial distribution, inclusive population coverage, and efficient representation of vulnerable communities in allocating resources for WDS. This study offers an opportunity to improve wastewater surveillance by tailoring location selection strategies to address specific priorities, improving decision-making in public health responses. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The data used in this study were publicly accessible prior to the initiation of the study. Specifically, we sourced data from the California Open Data COVID-19 Wastewater Surveillance dataset, available at https://data.ca.gov/dataset/covid-19-wastewater-surveillance-data-california, and WastewaterSCAN, accessible at https://data.wastewaterscan.org. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript.
