Balancing Privacy and Public Good in Wastewater-Based Epidemiological Surveillance

Abstract

Wastewater-based epidemiological surveillance has become a mainstream public health tool, tracking infectious disease, drug use, and other health indicators across entire communities without requiring individual cooperation or consent. This review surveys the rapidly growing ethics literature that has followed this expansion, focusing on the central tension between the technique's public health value and the privacy, stigma, and equity costs it can impose on the specific, often small and already-marginalized populations whose wastewater is sampled most closely. We examine how finer spatial resolution -- from citywide treatment plants down to single buildings -- shifts surveillance from a genuinely population-level signal toward something that functions as group-level, and
sometimes near-individual, monitoring. We then review proposed governance responses, including proportionality-based frameworks for deciding when finer-grained sampling and public data display are justified, technical privacy-preserving approaches such as encrypted data-sharing, and calls for more durable institutional and legal infrastructure than the emergency-response arrangements most current programs were built on. We conclude that the ethical stakes of wastewater surveillance should be matched to its spatial resolution and the sensitivity of what it tracks, with community engagement and governance built into program design rather than added afterward.