Over the past year, we’ve been working with the National Collaborating Centre for Infectious Diseases (NCCID) to facilitate a peer learning program that builds knowledge and resources for effectively interpreting and communicating wastewater-based surveillance (WBS) data across Canada.

The program’s inaugural phase commenced in April 2023 and concludes in March 2024. During this period, it actively involved 28 public health practitioners from five provinces. These practitioners serve diverse communities, including both urban centers and Indigenous populations. Their responsibilities span a wide range, and their collective experience encompasses WBS for COVID-19 and other pathogens. Among the participants were medical officers of health, environmental health officers, epidemiologists, and other relevant experts.

Identifying practitioner needs

One of the first activities we conducted at the start of the program was an assessment to identify what practitioners need in terms of interpreting and communicating WBS data. Through the assessment, we found that practitioners need information related to:

• Finding a signal in the noise: Examining external data collection factors that influence trend analysis (e.g., behavioural, environmental, technical, methodological, etc.).
• Complementary data: How to use WBS data in conjunction with other public health surveillance streams, especially clinical data.
• Translating data trends into action: Identifying trigger points for action.
• Sampling solutions: Specific to remote and isolated Indigenous communities, sharing strategies to overcome challenges in obtaining, testing, and transporting samples.
• Ethical considerations: Examining privacy and data granularity in small communities, how to build relationships with communities, and understanding ethical principles of data governance.

Public health participants emphasized that wastewater surveillance significantly complements existing public health data. Unlike clinical data, which may lag behind, WBS provides an early warning signal to hospitals, public health and congregant settings by detecting the presence of pathogens in the community up to a week in advance.

Some remote Indigenous communities see great advantages to having WBS programs as an early warning system of new pathogens in the community. However, establishing and maintaining these programs presents significant challenges. There are logistical challenges associated with collecting samples from non-piped wastewater systems and transporting them thousands of kilometres away to laboratories. Training and maintaining skilled labour are also needed to run WBS programs. Recent innovations in automated samplers may address some of these challenges.

Most important in Indigenous communities is the ethical conduct of those involved in WBS. This starts with the community having direct sovereignty over the data, including ownership, control, access, and possession. Researchers or public health professionals entering Indigenous communities to collect wastewater data are counselled to follow Inuit Qaujimajatuqangit principles, First Nation principles of OCAP, and other appropriate ethical protocols.

At the local level, WBS dashboards and websites have emerged as effective tools for communication with the public. These tools can be quickly updated to present the latest results. The proliferation of public health dashboards has fuelled public demand for access to near real-time WBS data. Having unbiased, easy-to-understand WBS information and clear messaging on risk has been a game changer. They have proven critical for effective decision-making in weighing risk and taking appropriate protective measures by individuals in congregant settings like student dorms, long-term care homes, and religious institutions.

Facilitating ongoing conversations

The heart of the CWN-NCCID WBS program lies in its monthly virtual meetings. These sessions facilitate peer-to-peer learning and knowledge sharing among the public health practitioners. Additionally, the program benefits from the insights of invited guests. Notable experts, such as Dr. Amy Kirby from the Centers for Disease Control and Prevention (CDC) in the U.S., Dr. Gertjan Medema from the KWR Watercycle Research Institute in the Netherlands, and Dr. Doug Manuel from the University of Ottawa in Canada, contribute valuable perspectives. Their input is further informed by advice from an expert advisory group that includes Dr. Michael Becker from PHAC, Dr. David Patrick from the University of British Columbia, Kari Johnston from One Yukon Coalition, and Dr. Wendy Pons from Conestoga College.

Recognizing that rural, remote, and isolated Indigenous communities face unique challenges related to WBS, the program carves out dedicated space for these contexts. Public health providers serving these regions delve into their distinctive opportunities and obstacles. This exploration includes sampling solutions and ethical considerations surrounding wastewater surveillance. As part of this effort, participants have learned from Dr. Catherine Dickson and Reggie Tomatuk from the Cree Board of Health and Social Services, and engaged in a training session on Ownership, Control, Access & Possession (OCAP) principles, facilitated by the First Nations Information Governance Centre.

Looking ahead

CWN and NCCID are continuing the WBS program with new program participants in the 2024-25 fiscal year. The new program has a learning stream focused on Northern Indigenous communities. It also has a series of forums to build a dialogue amongst the provincial health authorities on their current experiences and future plans for centrally funded and coordinated WBS programs in their respective jurisdictions. For more information, please visit CWN’s website.