Wastewater surveillance poised to become an important component of global health security infrastructure

December 01 2023

The Ginkgo Biosecurity team was honored to participate in the International Conference “Towards a Global Wastewater Surveillance System for Public Health” in Frankfurt, Germany. This conference was a unique opportunity to gather a highly multidisciplinary group of more than 300 professionals from public health, policy, research, and the private sector, to discuss the role of environmental testing in public health and build support for the creation of a consortium for pathogen surveillance. In an increasingly interconnected world, in fact, the need for globally coordinated pathogen monitoring and public health action is more important than ever. 

The event was co-organized by the EU’s Health Emergency Preparedness and Response Authority (HERA) and Joint Research Center (JRC), as well as the Bill & Melinda Gates Foundation, the World Health Organization (WHO), and the German Ministry of Health.

“Wastewater surveillance has emerged as a powerful, cost-effective, and timely tool that complements clinical data, offering unique insights into the presence and dynamics of pathogens and other information relevant to public health,” the European Commission’s HERA wrote in a news announcement. “The vanguard of a new, global early warning system, [wastewater surveillance] provides crucial evidence to decision-makers and has the potential to greatly enhance collaboration for pandemic preparedness.”

Particular attention was put on two monitoring settings where Ginkgo is active: Airports and community surveillance. Airports were identified as strategic nodes for pathogen monitoring, given the role of passengers as sentinels for early warning, and their potential to close gaps in global surveillance by providing insights into movements of pathogens, data on persons that may not otherwise be tested, and geographies where pathogen monitoring is limited. Airport surveillance can also be a useful adjunct to environmental surveillance in communities, and should be incorporated into national routine surveillance activities for the long term. 

Ginkgo has been a pioneer in this field, working with CDC to launch their traveler-based pathogen genomic surveillance (TGS) program in 2021 and develop a protocol and device to safely collect, test, and sequence wastewater from aircraft. Recognizing the value of this approach, we are working to replicate the program globally, helping countries build the end-to-end capabilities needed to collect, process, and analyze samples, as well as use the data to inform public health decision making. 

Participants at the conference demonstrated a strong commitment to wastewater testing as an important part of public health infrastructure, with aircraft wastewater being a key component. Wastewater surveillance is poised to become a permanent fixture of national health security, and keynote speaker Peter Piot, Special Advisor on COVID-19 to the President of the European Commission, emphasized this point, as well as the importance of air travel as the next frontier, as it will allow the early detection of pathogens, enabling earlier response and development and deployment of countermeasures.

Participants from all sectors were very clear about the role of the private sector in these surveillance activities, and the importance of public-private partnership, emphasizing that the private sector must play a role in developing this infrastructure. At Ginkgo, we look forward to contributing to the development and work of the Consortium.

The conference had an important data presentation aspect, and there were excellent studies and evaluations demonstrating valuable learning and impact of environmental and airport/aircraft surveillance activities around the world. This provided an opportunity to report findings from a pilot pathogen monitoring exercise that we conducted in collaboration with the European Commission Joint Research Center (JRC) and EU partners to demonstrate what a European aircraft and airport wastewater surveillance network might look like. 

For this pilot, which involved conducting simultaneous sampling at airports across Europe, we worked with the JRC to operationalize sample collection at six airports— Schiphol (AMS), Brussels (BRU), Frankfurt (FRA), Milan Malpensa (MXP), and de-identified airports in France and Italy. The exercise demonstrated the feasibility of performing collection and testing across multiple European airports in a coordinated fashion and creating a consolidated data reporting and storage mechanism. It also showed the power of this technology, which returned detailed lineage reports with high epidemiological value. Our partners provided 23 wastewater samples over two weeks, six from aircraft and seventeen from airport triturator sewage. These samples underwent processing, nucleic acid extraction, PCR testing, and whole genome sequencing at the National Center for Public Health and Pharmacy in Budapest, Hungary. We analyzed sequencing data using our bioinformatics pipeline and reported results to participating countries. The full results, presented by Ginkgo’s Head of Biosecurity Solutions, Robert Morfino, are reported below. 

Nita Madhav, our Head of Epidemiology and Risk Modeling Analytics, gave a talk that focused on Ginkgo’s work using epidemiological modeling techniques to identify high-risk locations of potential infectious disease threats to inform and optimize the selection of airports for sampling. This involves the steps of determining risk scoring factors relevant to the emergence of a new unreported outbreak and using air travel data to identify travel hubs that provide an early detection advantage due to their placement in the network.

We reported in our findings that the majority of positive samples included EG.5 as the predominant SARS-CoV-2 variant, which is the current top circulating variant globally and one which the WHO has deemed a Variant of Interest. There was also a large diversity of lineages present in the samples, including 8 lineages and sublineages, which were present in multiple samples. These lineages, which were found in samples from flights originating in the US, China, and the United Arab Emirates, among others. 

This small scale exercise was meant to show feasibility. All airport samples were positive,which makes sense given the catchment area/population. Only 66 percent of aircraft samples were positive on the other hand – reflecting the smaller catchment.
The majority of samples have EG.5* as the predominant variant. This is the top circulating variant and a WHO Variant of Interest. There was a large diversity of lineages present in the samples; 8 lineages and sublineages, with many samples having multiple lineages

The pilot program provided valuable insights into how to launch a future European pathogen monitoring network that is capable of tracking infections on inbound flights from multiple continents. It demonstrated how a wastewater surveillance program can be a catalyst to build local capacity and maintain a “warm” infrastructure — that is, a system that is always active, flexible, and ready when needed. 

Critically, this pilot demonstrated that public-private partnerships are an effective tool to ensure rapid implementation and scalability, as well as to encourage continuous technological innovation. We hope to continue to be an important partner as this work develops, from conception and research to implementation and scale-up. 

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