Wastewater and Environmental Surveillance (WES) In India: Financing/Costing and Cost-effectiveness modelling

Year: November 2024

Collaborator: Gates Foundation

Team: Sarang Deo, Sripad Devalkar, Shreejata Samajpati, Mayank Jha, Amrit Kaur Sandhu, Sruthi M P, Sam John

Managing Healthcare Delivery Systems

Background

Wastewater and Environmental Surveillance (WES) is a method of monitoring pathogens in community wastewater that is emerging as a crucial public health tool for disease surveillance. In low-and-middle-income countries (LMICs) like India, where healthcare access can be limited, WES provides an opportunity to detect disease outbreaks early and help in the timely adoption of targeted public health responses. Despite its promise, the approach faces operational challenges like the difficulty of sample collection from mixed sewerage systems, issues of determining an optimal number of sampling sites and sampling frequency needed to cover a certain amount of population, effectively translating WES data into public health action etc. Besides, given that the current WES initiatives in India are mostly in a project-mode, there is a crucial need for a programmatic approach to integrate WES with routine disease surveillance to make WES efforts sustainable in the long run.

About the Study

The project aims to

Map the current landscape of WES initiatives across India to understand the underlying operational models, financing mechanisms and identify best practices.
Develop a multi-city costing tool to estimate the resource requirements and costs of programmatically implementing WES across diverse geographies, pathogens, sampling conditions, and scales.
Estimate the cost-effectiveness of WES under different sampling strategies and outbreak scenarios.

Methodology

We will use primary data — collected from field visits to sampling sites and WES laboratories across India, and from stakeholder interviews with WES researchers, public health authorities, state and local government officials — as well as secondary data (on aspects like budgeted allocations for WES, sewage network maps, catchment area population, meteorological conditions, pathogen transmission parameters etc.), to identify the varied pathogens of interest currently being monitored under WES in India, the underlying operational models, support systems, and detailed WES process workflows. Using data on different WES parameters thus collected (viz. pathogens, sampling sites, sampling frequency, catchment area population, infrastructure etc.), the multi-city costing tool will help estimate the resource requirements and costs of implementing WES at scale. Once the costs of WES implementation are determined, the study aims to develop a detailed operational model, simulating WES in different configurations, and an epidemiological model as well, to simulate the spread of pathogens in the study population. Lastly, an integrated disease transmission and operational model will be used to evaluate the cost-effectiveness of a given WES strategy.

Intended Outcomes

The findings from the costing exercise will determine the costs of implementing WES to detect multiple pathogens at scale, thus potentially informing policy on the resource requirements for the programmatic implementation of WES. The landscaping analysis will generate policy-relevant information on the current WES initiatives in India, the underlying financing scenarios, and explore the prospects of long-run sustainability of WES initiatives in India. The integrated epidemiological-operational model will help evaluate the cost-effectiveness of WES under different sampling strategies and outbreak scenarios.