Key Takeaways
- The Surveilling Effluent Wastewater for Epidemic Response (SEWER) Act is a significant development in the process of effluent wastewater surveillance
- Wastewater surveillance was well-utilized during the COVID-19 pandemic, as well as other outbreak situations, and many supporters would want its expansion
- Opponents of wastewater surveillance cite ethical concerns, including a limited set of regulations
What is the SEWER Act?
In early 2025, a bill was proposed that sought to improve a wastewater surveillance system created by the Centers for Disease Control and Prevention (CDC) in 2020 and enhanced during the COVID-19 pandemic. H.R. 766, the Surveilling Effluent Wastewater for Epidemic Response (SEWER) Act, sought to expand and strengthen the practice known as effluent wastewater surveillance, the main use of the National Wastewater Surveillance System (NWSS). Effluent wastewater surveillance is the sampling of a population’s wastewater to determine the concentration of infectious diseases present in the water.
How has the SEWER Act Become Relevant?
In the last few months, conflict has arisen between the CDC and the current Department of Health & Human Services (HHS) Secretary Robert F. Kennedy Jr. due to the dismissal of CDC Director Susan Monarez less than a month after she started the position. This unanticipated dismissal also led to the resignation of many senior-level staff members at the CDC, who indicated in post-resignation interviews that their scientific opinions did not align with those of Kennedy. The lack of cohesion between Kennedy and many former members of the CDC has contributed to widespread uncertainty about the future of the agency. This tension between the CDC and the HHS secretary mimics recent policy trends that seek to limit the regulatory and initiative capacity of government agencies like the CDC.
The SEWER Act seems to be a product of this trend, as it has remained stuck in its congressional committee since January, a few days after it was proposed. Being stuck in committee means that a piece of legislation was referred to and has not come out of the committee a long enough time that many are unsure if the bill will move forward. The stalling of this bill, which seeks to expand the activities of the CDC, corresponds with the proposals of other bills that seek to reduce the capacity of the CDC. These policy trends also correspond with the conflict between Kennedy and leaders of the CDC. The lack of action on H.R. 766 seems to be tied more to conflicts between policymakers and the CDC rather than issues associated with the bill itself.
To better understand the connection between the SEWER Act and the CDC, it is best to first discuss the current status of the NWSS. The NWSS program allows the CDC to monitor wastewater for infectious diseases. Based on the concentration of an infectious disease in the wastewater, the CDC can then determine how a disease is spreading and where to distribute resources to reduce its spread. Currently, the NWSS covers about 44 percent of the population, and the SEWER Act would increase coverage and improve efficacy by expanding coverage, coordinating state reporting through the CDC to better understand national trends, and expanding funding for program activities.
Argument in Favor of the SEWER Act
Wastewater surveillance was well-utilized during the COVID-19 pandemic, and there has since been significant research into and discourse on the practice. In 2023, the National Academies of Sciences, Engineering, and Medicine convened a committee on the efficacy of wastewater surveillance. The committee was comprised of experts in infectious disease, epidemiological surveillance, and wastewater management. These experts determined that wastewater surveillance was critical for rapid response procedures during the COVID-19 pandemic, and that it should be expanded to appropriately respond to future outbreaks in the United States.
Multiple scientific studies have also been conducted to review the effectiveness and necessity of wastewater surveillance. One study, published in Nature Medicine, emphasizes the benefits of wastewater surveillance and how it helps inform public health initiatives during disease outbreaks. This study also discusses the use of wastewater surveillance to identify and track new variants of emerging infectious diseases, critical for public health response in the midst of an outbreak. An article published by the American Society for Microbiology reaffirms the benefits of wastewater surveillance, especially its timeliness in determining outbreak zones. Wastewater surveillance has proven successful in various outbreak situations, and these sources emphasize how its expansion could further improve public health initiatives across the United States.
Argument in Opposition to the SEWER Act
There are worrisome ethical implications of wastewater surveillance. An article published by Distillations Magazine—the official magazine of the Science History Institute—claims that one of the main downsides to wastewater surveillance is a lack of health information privacy. It also discusses how the information gleaned from wastewater surveillance can be taken and used by non-public health government entities, such as the police, to track diseases and people. This has the potential to be unlawful. This article also argues that the lack of regulation on wastewater surveillance, due to its rapid expansion during the COVID-19 pandemic, has led to ethically-ambiguous uses of health data and other private information.
Another review of wastewater surveillance asserted that the lack of guidelines and regulations for wastewater treatment has made the useful practice ethically risky. The key perspective from this review is that the data gathered from wastewater surveillance needs strict supervision to reduce the risk of violating individuals’ rights to privacy. Alongside these ethical concerns, a research article published in the American Journal of Preventative Medicine Focus considered issues related to wastewater surveillance equity. This article found that surveillance methods could exacerbate existing inequitable public health practices that disproportionately affect marginalized communities.
It highlights that the communities surveyed by the NWSS are predominantly white, and states that unless this issue is addressed in the future, proper expansion of the activities of the NWSS will not be possible. These articles examine the key ethics-related issues up for debate, upon which arguments in opposition to the SEWER Act have expanded.
Conclusion
As the CDC continues to face challenges in its leadership, bills seeking to expand its activities, like H.R. 766, face barriers in their movement through Congress. The apparent death of the SEWER Act may correlate with the conflicts between HHS Secretary Kennedy and the CDC, or may be related to the lack of regulation and equity in current wastewater surveillance programs. Regardless, wastewater surveillance is critical to rapid public health response during infectious disease outbreaks. It remains to be seen whether changes are made to wastewater surveillance programs to increase equity and ethical precautions. These changes may be necessary for programs like the NWSS to be expanded, keeping the U.S. population’s interests and health in mind.
FAQ
Q: Has wastewater been tested in the U.S. before?
A: Wastewater testing, and epidemiology based on the water is not new in the U.S., and effluent wastewater surveillance is part of this.
Q: What does it mean to be stuck in congressional committee?
A: This means that a bill has been referred to a congressional committee, but it has stalled, which means that it cannot move forward to the floor to be voted on.
Q: Why was Susan Monarez dismissed as CDC Director?A: Monarez says that she was dismissed for not agreeing to change vaccine policy. Kennedy denies this. BBC has published an article on the issue, which has been debated from multiple perspectives.