Why This Matters
Wastewater surveillance can be an efficient way to detect community-level disease outbreaks and other health threats. It has the potential to identify a COVID-19 outbreak 1 to 2 weeks sooner than clinical testing and allow for a more rapid public health response. However, the lack of national coordination and standardized methods pose challenges to wider adoption.
What is it? Wastewater surveillance, also known as wastewater-based epidemiology, is the monitoring of pathogens (e.g., viruses), as well as pharmaceuticals and toxic or other chemicals by testing sewage (see fig. 1). Public health officials can use this approach to monitor for outbreaks, identify threats (e.g., antibiotic-resistant bacteria), and, in response, support the mobilization of resources.
Figure 1. Uses of wastewater testing.
Pathogens and chemicals can enter sewer systems through human waste. Wastewater surveillance programs collect sewage samples from these systems and treatment plants and send them to laboratories for testing. Officials can use test data, for example, to assess whether there is a viral outbreak or increasing drug use and then decide what actions to take to protect public health. These actions might include increased clinical testing in an area, or alerting local clinics and hospitals to prepare for an increase in patients.
How is it used? For many years, the U.S. and other countries have used wastewater surveillance to monitor for pathogen and chemical levels in their communities. Australia, for example, is using a wastewater surveillance program to track the amounts of illicit drug use in the population to estimate the effectiveness of law enforcement efforts to seize drugs.
In the U.S., federal and local governments, universities, and companies have recently increased investments in wastewater surveillance in response to the COVID-19 pandemic. As of February 2022, health departments in 43 jurisdictions, representing about 16 percent of the U.S. population, were using funds distributed by the Centers for Disease Control and Prevention (CDC) to support wastewater surveillance efforts. The CDC works with these 43 jurisdictions to collect data that track SARS-CoV-2 levels and make these data publically available through its National Wastewater Surveillance System (NWSS) website. Nearly 80 percent of the U.S. population is served by municipal sewer systems that could be monitored through such programs.
Wastewater surveillance can serve many purposes (see fig. 2). For example, it can provide an early warning for infectious disease outbreaks so a community can take action. It can detect low levels of SARS-CoV-2 in human waste before symptoms appear, as early as 1 to 2 weeks before an infected person may seek clinical testing. It can also detect SARS-CoV-2 from asymptomatic individuals who make up about 70 percent of cases and may not seek clinical testing.
Figure 2. Wastewater surveillance benefits across different population sizes.
Some U.S. universities have used wastewater surveillance to identify buildings, such as dormitories, with potentially high or increasing infection rates among student residents and subsequently target clinical testing and quarantine efforts to avert outbreaks on campus. For example, in the fall of 2020, one university used wastewater surveillance to detect nearly 85 percent of COVID-19 cases that were later confirmed through clinical testing.
What are some gaps? Wastewater surveillance may have enormous potential as a public health tool, but some aspects of the science may need further development. For example, rainwater or industrial discharge can dilute wastewater samples, while contaminants such as animal waste can compromise sample origin or quality. In January 2021, for example, scientists identified a SARS-CoV-2 mutation in New York City wastewater, potentially signifying a variant, but are still trying to determine whether it has been circulating in humans.
Additionally, the potential cost-savings from wastewater surveillance are unclear. At least one study suggests that wastewater surveillance could save countries millions to billions in U.S. dollars, depending on several country-specific factors. However, the general lack of cost-benefit analyses makes it difficult to determine how and when to use it.
What are some concerns? Some scientists contend that the U.S. could benefit from a standardized approach to wastewater surveillance. For example, testing for different SARS-CoV-2 variants in wastewater is not a standard practice. Some state health departments are doing this, but the CDC is not using the NWSS to track variants found in wastewater. Further, the lack of a standardized approach complicates efforts to aggregate, interpret, and compare data across sites and develop large-scale public health interventions.
Some scientists suggest expanding the NWSS beyond SARS-CoV-2 to identify other pathogens and chemicals. For example, testing for chemicals, such as opioids, in wastewater requires different processes than testing for pathogens. A system like NWSS could be designed to identify a variety of health threats.
Finally, wastewater surveillance raises privacy and ethical concerns because wastewater contains not only a pathogen’s genetic data that allow public health officials to identify the pathogen, but also human genetic data that could potentially be misused. Additionally, communities may be stigmatized if wastewater surveillance data indicate pathogen spread or illicit drug use.
- Faster public health response. Health care providers and public health officials can use wastewater surveillance as an early warning for health threats, and use it along with other tools to predict, prepare for, and initiate a more rapid response to infectious disease outbreaks and other health threats.
- Community focus. Local testing could provide an opportunity to monitor and respond to pathogen spread and drug use, especially in areas with limited access to testing or health care.
- Affordability. Wastewater surveillance can be particularly useful when clinical testing is resource constrained, but it is difficult to quantify the value due to a lack of cost-benefit analyses.
- Coordination and standardization. Methods for sample collection, analysis, and data sharing are not currently standardized, making it difficult to compare sites and focus mitigation efforts.
- Sample integrity. Contaminants such as animal waste can compromise sample quality, and the origin of detected pathogens and chemicals may not always be clear.
- Privacy. Using wastewater data could pose privacy concerns when linked with identifiable data, especially in small communities.
Policy Context and Questions
- What steps might help to standardize wastewater surveillance programs in the U.S.?
- What can be done to promote cost-benefit analyses of widespread wastewater surveillance for public health threats?
- If costs and benefits are favorable, what policies would best facilitate the use of wastewater surveillance data while protecting individual privacy?
- How can wastewater surveillance data be used as a public health resource for policymaking?
For more information, contact Karen Howard at 202-512-6888 or HowardK@gao.gov.
- Secretary Blinken’s Call with Republic of Korea Foreign Minister Chung
February 4, 2022
- Coronavirus (COVID-19): Response and Recovery
In U.S CourtsJuly 2, 2020Federal courts are coordinating with state and local health officials and the Centers for Disease Control and Prevention (CDC) to obtain information about the coronavirus (COVID-19) to aid their response, recovery, and reopening efforts. Courts are regularly releasing orders to address operating status, public and employee safety, and other court business.
- Justice Department Settles with Microsoft to Resolve Immigration-Related Discrimination Claims
December 7, 2021The Department of Justice today announced it has reached a settlement agreement with Microsoft Corporation resolving allegations that the company discriminated against non-U.S. citizens based on their citizenship status during the early stages of Microsoft’s hiring process by asking them for unnecessary, specific immigration documents to prove they could work for the company without needing its sponsorship for work visas.
- Secretary Antony J. Blinken and UK Foreign Secretary Elizabeth Truss at a Joint Press Availability
March 9, 2022
- Marking One Year of Hong Kong’s National Security Law
July 16, 2021
- Macau Travel Advisory
March 24, 2022Do not travel [Read More…]
- United States and United Arab Emirates Sign Bilateral Agreement Enhancing Law Enforcement Cooperation
February 24, 2022On Thursday, the United States and United Arab Emirates (UAE) signed a mutual legal assistance treaty (MLAT) enhancing evidence sharing, judicial cooperation and assistance in criminal investigations and prosecutions.
- Columbia Class Submarine: Delivery Hinges on Timely and Quality Materials from an Atrophied Supplier Base
January 14, 2021The Navy’s schedule for constructing the first submarine of the new Columbia class is threatened by continuing challenges with the computer-aided software tool that Electric Boat, the lead shipbuilder, is using to design the submarine. These challenges will likely impede construction because the shipbuilder is late in completing design products used for building the submarine. To ensure construction begins on schedule, the Navy modified its design contract with Electric Boat to include an option for constructing the first two submarines and requested sufficient authority from Congress for fiscal year 2021 to exercise it. Navy officials stated, however, that the Navy’s budget request is lower than its current cost estimate, and it is not informed by an independent cost assessment. As a result, the program will likely need more funding to reflect the increased estimate. Quality problems with supplier materials caused delays during early construction. These quality problems included missile tubes (depicted below) with defective welds. As the shipbuilders expand outsourcing to suppliers, quality assurance oversight at supplier facilities will be critical for avoiding further delays. Quad Pack of Four Submarine Missile Tubes However, the Navy has not comprehensively reassessed when to seek additional inspections at supplier facilities that could better position it to identify quality problems early enough to limit delays. The Navy plans to invest about $128 billion in 12 Columbia class nuclear-powered ballistic missile submarines. The shipbuilders will construct the Columbia class at the same time as the Virginia class attack submarines. They plan to rely on materials produced by a supplier base that is roughly 70 percent smaller than in previous shipbuilding booms. Congress included a provision in statute for GAO to examine the program’s status. This report assesses the Navy’s efforts to complete the design for the lead Columbia class submarine and actions the shipbuilders and the Navy have taken to prepare for construction and ensure the lead submarine is delivered according to schedule and quality expectations. GAO assessed Navy and shipbuilder design progress against cost and schedule estimates, reviewed documents, and interviewed officials about supplier readiness and quality assurance. This is a public version of a sensitive report that GAO issued in November 2020. Information that the Department of Defense (DOD) deemed sensitive has been omitted. GAO recommends that the Navy (1) provide Congress with updated cost information, (2) include information on supplier readiness in its annual report to Congress, and (3) reassess when to seek additional inspections at supplier facilities. DOD concurred with the recommendations but disagreed with some of the report’s details. GAO incorporated DOD’s comments as appropriate and maintains the validity of the findings, as discussed in the report. For more information, contact Shelby S. Oakley at (202) 512-4841 or email@example.com.
- Secretary Antony J. Blinken And UK Foreign Secretary Elizabeth Truss Before Their Meeting
September 20, 2021
- Evidence-Based Policymaking: Survey Results Suggest Increased Use of Performance Information Across the Federal Government
November 3, 2021What GAO Found Performance information can help decision makers understand and improve results at federal agencies. GAO’s 2020 survey of federal managers showed that the reported use of performance information in decision-making generally increased across the federal government compared to prior surveys. For example, on an index that approximates such use with a single score, GAO estimates with 95 percent confidence that the 2020 government-wide result was statistically significantly higher than each prior score since GAO created the index in 2007 (see below). Managers’ Reported Use of Performance Information, as Measured by GAO’s Index Note: The index is an average of results from 11 related survey questions on agency and manager use of performance information. Scores range from 1, which reflects managers reported the use of performance information to “no extent,” to 5, which reflects to a “very great extent.” At a majority of agencies, managers reported statistically significant increases in performance information use. For example, index scores increased at 16 of the 24 agencies in 2020 compared to 2017, including at the National Aeronautics and Space Administration (NASA). Prior GAO work highlighted actions that NASA has taken since December 2018 to increase its use of performance information to improve the management of its acquisition projects, which have a history of cost growth and schedule delays. This includes having projects report relevant data to a central repository, which agency leaders review and discuss to help manage project performance. GAO’s analyses also found that key practices continue to be positively associated with greater reported use of performance information. For example: managers reported increases at a majority of agencies on actions related to leading practices identified by GAO’s past work that promote the use of performance information, such as providing relevant training and effectively communicating performance information; and managers whose programs were subject to data-driven reviews —regular reviews of progress toward select goals—to a greater extent also reported greater use of performance information. Why GAO Did This Study The GPRA Modernization Act of 2010 and the Foundations for Evidence-Based Policymaking Act of 2018 included requirements to enhance federal efforts to develop and use performance information and other evidence in decision-making. Both acts include provisions for GAO to periodically report on their implementation. This report assesses the extent to which (1) federal managers’ reported use of performance information changed in 2020, and (2) selected leading practices and data-driven reviews were associated with greater reported use of performance information. To conduct its work, GAO analyzed results from a survey it administered from July to December 2020 to a stratified random sample of about 4,000 managers at 24 major federal agencies. The survey had a 56 percent response rate. Results can be generalized to the population of managers government-wide and at each agency. GAO also reviewed relevant Office of Management and Budget (OMB) documents, interviewed OMB staff, and followed up on the implementation of prior related GAO recommendations. In response to a draft of this report, the Department of Veterans Affairs and the U.S. Agency for International Development provided comments that highlighted results from GAO’s survey and described efforts to improve the use of evidence in decision-making. OMB and the remaining 22 agencies did not provide comments. For more information, contact Alissa H. Czyz at (202) 512-6806 or CzyzA@gao.gov.
- Man Pleads Guilty to Attempting to Provide Material Support to Foreign Terrorist Organizations
April 23, 2021A New York man pleaded guilty to attempting to provide material support and resources to the Islamic State of Iraq and al-Sham (ISIS) and the al-Nusrah Front, both designated by the U.S. Secretary of State as foreign terrorist organizations.
- Today Is the Last Day to Vote for NASA’s 12 Webby Award Nominations
September 26, 2020You can cast your [Read More…]
- 2021 Annual Report: New Opportunities to Reduce Fragmentation, Overlap, and Duplication and Achieve Billions in Financial Benefits
May 13, 2021What GAO Found GAO identified 112 new actions for Congress or executive branch agencies to improve the efficiency and effectiveness of government. For example: The Office of Management and Budget should improve how agencies buy common goods and services—such as medical supplies and computers—by addressing data management challenges and establishing performance metrics to help save the federal government billions of dollars over the next 5 years, as well as potentially eliminate duplicative contracts. The Internal Revenue Service (IRS) could enhance third-party information reporting to increase compliance with tax laws and raise revenue. GAO has also previously suggested (1) providing IRS with authority—with appropriate safeguards—to correct math errors and to correct errors in cases where information provided by the taxpayer does not match information in government databases and (2) establishing requirements for paid tax return preparers to help improve the accuracy of tax returns they prepare. These actions could help reduce the substantial tax gap and increase revenues. The National Nuclear Security Administration could implement cost savings programs to operate more effectively at its nuclear laboratory and production sites to potentially save hundreds of millions of dollars over approximately a 5-year period. The Department of Defense’s payments to privatized housing projects have lessened the financial effects of the housing allowance rate reductions for these projects, but revising the calculation for these payments could potentially result in millions of dollars of savings. Federal agencies could improve coordination of fragmented cybersecurity requirements and related assessment programs for state agencies, potentially minimizing the burden on states and saving millions of dollars in associated federal and state costs. The Department of Health and Human Services (HHS) could improve coordination of its infectious disease modeling efforts to better identify any duplication and overlap among agencies, which could help them to better plan for and more efficiently respond to disease outbreaks. From 2011 to 2021, GAO has identified more than 1,100 actions to reduce costs, increase revenues, and improve agencies’ operating effectiveness. GAO’s last report in May 2020 said progress made in addressing many of the actions identified from 2011 to 2019 had resulted in approximately $429 billion in financial benefits, including $393 billion that accrued through 2019 and $36 billion that was projected to accrue in future years. Since May 2020, at least tens of billions of dollars in additional financial benefits have been achieved. For example, based on GAO’s updates for spring 2021, HHS’s changes to spending limit determinations for Medicaid demonstration waivers further reduced federal spending by about $30 billion in 2019. GAO estimates that tens of billions of additional dollars could be saved should Congress and executive branch agencies fully address open actions, including those that have potential financial benefits of $1 billion or more. Why GAO Did This Study The federal government has made an unprecedented financial response to the COVID-19 pandemic. Once the pandemic recedes and the economy substantially recovers, Congress and the administration will need to develop and swiftly implement an approach to place the government on a sustainable long-term fiscal path. In the short term, opportunities exist for achieving billions of dollars in financial savings and improving the efficiency and effectiveness of a wide range of federal programs in other areas. GAO has responded with annual reports to a statutory provision for it to identify and report on federal programs, agencies, offices, and initiatives—either within departments or government-wide—that have duplicative goals or activities. GAO also identifies areas that are fragmented or overlapping, as well as additional opportunities to achieve cost savings or enhance revenue collection. This report discusses the new areas identified in GAO’s 2021 annual report—the 11th in this series—and examples of open actions recommended to Congress or executive branch agencies with potential financial benefits of $1 billion or more. To identify what actions exist to address these issues, GAO reviewed and updated select prior work, including matters for congressional consideration and recommendations for executive action. For more information, contact Jessica Lucas-Judy at (202) 512-6806 or firstname.lastname@example.org or Michelle Sager at (202) 512-6806 or email@example.com.
- Freshwater Programs: Federal Agencies’ Funding in the United States and Abroad
August 25, 2021As the world’s population tripled during the past century, demand for the finite amount of freshwater resources increased six-fold, straining these resources for many countries, including the United States. The United Nations estimates that, worldwide, more than 1 billion people live without access to clean drinking water and over 2.4 billion people lack the basic sanitation needed for human health. Freshwater supply shortages–already evident in the drought-ridden western United States–pose serious challenges and can have economic, social, and environmental consequences. Multiple federal agencies share responsibility for managing freshwater resources, but consolidated information on the federal government’s financial support of these activities is not readily accessible. GAO was asked to determine for fiscal years 2000 through 2004 how much financial support federal agencies provided for freshwater programs in the United States and abroad. For the purposes of this report, freshwater programs include desalination, drinking water supply, flood control, irrigation, navigation, wastewater treatment, water conservation, water dispute management, and watershed management.Of the over $52 billion in total financial support provided by federal agencies for freshwater programs during fiscal years 2000 through 2004, about $49 billion was directed to domestic programs and about $3 billion supported programs abroad. Domestic program activities involved 27 federal agencies, but 3 agencies–the Environmental Protection Agency, the Army Corps of Engineers, and the Department of Agriculture’s (Agriculture) Rural Utilities Service–accounted for over 70 percent of the financial support. Eighteen agencies supported domestic drinking water supply programs and 16 supported domestic wastewater treatment and watershed management programs. Grant programs of over $22 billion and direct federal spending of about $22 billion accounted for most of the domestic financial support. In addition to the about $49 billion that directly support freshwater activities in the United States, some agencies also have programs that may indirectly support such activities, but it is difficult to determine the dollar value of this indirect support. For example, Agriculture’s Conservation Reserve Program supports multiple activities, including irrigation, but information on each activity supported by the program is not readily available. Also included in the domestic program is about $175 million that the United States provided to three commissions that conduct freshwater activities along U.S. borders with Mexico and Canada. Of the estimated $3 billion in total financial support directed toward freshwater programs abroad between fiscal years 2000 through 2004, about $1 billion was recently provided for freshwater projects in Afghanistan and Iraq. Most of the financial support for international freshwater programs was provided by the U.S. Agency for International Development. Foreign wastewater treatment and watershed management programs were the ones that most of the agencies supported. The vast majority of the U.S. support for international programs was provided through grants. Not included in the $3 billion for international support are the contributions that the United States made to the general budgets of numerous international organizations, such as the United Nations and the World Bank. The international organizations used some portion of the U.S. contributions to support freshwater activities around the globe.
- New Zealand Travel Advisory
September 26, 2020Exercise increased [Read More…]
- Secretary Antony J. Blinken’s Call with Iraqi President Salih
November 9, 2021
- Secretary Antony J. Blinken Opening Remarks at Ministerial on Afghanistan
September 8, 2021
- Attorney General William P. Barr Remarks at White House Roundtable on Housing Assistance Grants for Victims of Human Trafficking, Remarks as Prepared for Delivery
August 4, 2020Thank you for being here. The scourge of human trafficking is the modern-day equivalent of slavery. Eradicating this horrific crime and helping its victims are top priorities for President Trump’s Administration, including the Department of Justice. I thank the President for his steadfast commitment to this issue, and I thank Ivanka for her leadership and for hosting us today. I also thank all the survivors and their advocates here for their courage and determination to end this evil practice.
- Special Presidential Envoy for Climate John Kerry Travels to Europe
May 14, 2021
- Former Construction Executive Sentenced to 51 Months in Prison for Tax Evasion and Bribery Scheme
July 1, 2021A New York construction executive was sentenced today in Manhattan federal court to 51 months in prison for evading taxes on more than $1.8 million in bribes he received from building subcontractors.