Background and key objectives:
Early in the pandemic, researchers in Lombardy, Italy pioneered the measure of SARS-CoV-2 load in wastewater (WW) as a strong correlate of SARS-CoV-2 case loads within the Lombardy region/population, a WW surveillance program that continued to present day. Starting in late 2020, the province of Ontario in Canada also established a comprehensive program to monitor SARS-CoV-2 in WW representing a population of 11 million (of 14 million in Ontario), similar in population size to Lombardy but across a sampled area the size of Italy. Ontario added next generation sequencing to the WW program to identify and monitor of the spread of specific SARS-CoV-2 variants of concern. During the pandemic, Public Health units in both Italy and Canada relied on individual case testing to determine SARS-CoV-2 load and variant type but this all changed in Ontario with the Omicron wave. In January 2022, to save costs, Ontario cancelled nearly all individual, PCR-based SARS-CoV-2 testing and switched to population-based monitoring of estimated SARS-CoV-2 case loads from the WW surveillance data. However, despite immediate data availability, estimated SARS-CoV-2 case loads from WW was slowly adopted by public health for SARS-CoV-2 prevention initiatives. · _For this workshop the first key objective is to determine how to remove barriers in using these alternative surveillance tools by Public Health professionals to respond to regional epidemics. _ As the pandemic progressed around the world, more countries established SARS-CoV-2 WW surveillance programs. However, there is little coordination between Public Health agencies around the world or by the World Health Organization (WHO) to share WW surveillance data which would inform recommendations for prevention and strategic distribution of vaccines in specific regions. Furthermore, the current WW surveillance is heavily reliant on well-maintained wastewater systems, often absent in low-income settings. Starting in June 2021, an international consortium piloted a WW surveillance program in Medellin–Columbia, Caracas–Venezuela, Ibadan–Nigeria, Kampala–Uganda, and Suva–Fiji using WW from open drainage systems in slum districts. An interdisciplinary team of health geographers, virologists, epidemiologists, and engineers are developing tools to monitor the load and type of pathogens in these low-income settings. · _For the second objective we will explore the feasibility, effectiveness, and cost to establish a global, coordinated WW surveillance program to monitor for new and re-emerging pandemics to help public health reduce or prevent the next global pandemic_ · _The third objective will involve a discussion of pros and cons of using individual case testing compared to using WW and environmental sampling for pathogen surveillance_ AGENDA Workshop will involve an open discussion to provide valuable insights into a working document to present as a future program to the WHO. 1) Introduction by panel members (biographies listed below) to frame the discussions. (15 mins) 2) Three breakout groups to discuss three main objectives of this workshop. (25 mins) 3) Summary overviewing key points from each of the three breakout groups. A final discussion to frame the utility and benefits of pathogen surveillance for public health at global and local level. (20 mins)