This month, we, with our colleagues at the Centers for Disease Control and Prevention and the University of Otago, published a new article in the Journal of Public Health Management and Practice titled “Development of a New Framework to Address Public Health Ethical Considerations in Wastewater Surveillance.” The article introduces an ethical framework to guide public health professionals in the responsible use of infectious diseases wastewater surveillance (WWS).

Why Ethics in Wastewater Surveillance Matters  

WWS has immense potential to contribute to public health surveillance — from monitoring respiratory viruses like influenza and RSV to tracking emerging threats like antimicrobial resistance — but can also raise complex ethical issues. As WWS scaled up for SARS-CoV-2 and other pathogens, public health practitioners and policymakers have sought guidance on its ethical dimensions.

In response, the Association for State and Territorial Health Officials (ASTHO), in collaboration with public health ethics experts and those implementing WWS, embarked on an initiative to understand ethical considerations in infectious diseases WWS, resulting in the “Framework for Addressing Ethical Considerations in Infectious Diseases Public Health Wastewater Surveillance.”

In addition to reviewing relevant grey and peer-reviewed literature, policy documents, and public health ethics frameworks, the framework was informed by engagement with epidemiologists, infectious disease experts, academics, utilities and water authorities, Tribal health professionals, and leaders from local, state and federal governments. Drawing from these sources, it provides tools for ethical analysis to support public health practitioners’ decision making, focusing on three areas of ethical concern in WWS: privacy, stigma, and data stewardship.

The framework is grounded in an applied public health ethics perspective and centers five ethical values:

• Trust and trustworthiness
• Reciprocity
• Justice, equity, and fairness
• Common good
• Privacy

Read the Article in JPHMP

Public health surveillance is an essential public health activity grounded in these values. The ethical justifications for WWS surveillance depend, in part, on its alignment with public health purpose such as protecting, enabling, or enhancing well-being or reducing illness and death. Ethical values can help to understand and address ethical concerns that arise in the design and implementation of WWS programs.

Ethical challenges routinely arise in the domain of public health, yet public health professionals may not have tailored tools to analyze and address them. By exploring ethical considerations relevant to WWS and providing practical tools for ethical analysis and decision-making, the framework aims to facilitate the integration of ethics as a critical component of WWS programs, helping to ensure its responsible use. It includes recommendations for strengthening public health ethics infrastructure as well as case studies and interactive questions to facilitate and practice ethical analysis and apply the insights to their daily work.

From Theory to Practice 

Wastewater surveillance programs must be equitable, transparent, and accountable. The framework is a step in that direction: an accessible tool to help teams make ethical decisions and strengthen relationships and build trust with the communities they serve. 

Ensuring the integration of public health ethics into everyday WWS practice promotes long-term success. Communities are more likely to support surveillance efforts when they know their data is respected, their voices are heard, and their well-being is prioritized. 

We invite you to explore the full article, “Development of a New Framework to Address Public Health Ethical Considerations in Wastewater Surveillance,” published in the July 2025 issue of the Journal of Public Health Management and Practice. We hope this framework serves as a catalyst for more community-centered conversations around using wastewater for public health good.  

Links/References

• Chillag K, Fenton E. “Framework for Addressing Ethical Considerations in Infectious Diseases Public Health Wastewater Surveillance.” ASTHO. https://www.astho.org/4934db/globalassets/report/framework-for-addressing-ethical-considerations-in-infectious-diseases-public-health-wastewater-surveillance.pdf. Accessed 6/4/2025
• US Centers for Disease Control and Prevention. “National Wastewater Surveillance System (NWSS).” cdc.gov/nwss. Accessed 6/4/2025

Erin Laird is the Director of Emerging Infections at the Association of State and Territorial Health Officials (ASTHO). Ms. Laird has experience working on emerging infectious diseases including COVID-19, Ebola, and Zika, at the local, state, and national levels. Her current work is focused on healthcare-associated infections and wastewater surveillance. Ms. Laird has a master’s in public health from the Johns Hopkins Bloomberg School of Public Health.