A new perspective and review paper argues that wastewater based surveillance (WBS), the technique widely deployed to track SARS-CoV-2 during the COVID-19 pandemic, could become a valuable instrument in the fight against antimicrobial resistance (AMR), one of the leading threats to global public health.
Published in mBio, the paper examines how monitoring antibiotic resistance genes (ARGs) in sewage could support the EU’s One Health approach, the framework that links human, animal and environmental health. AMR is projected to cause 1.91 million deaths worldwide every year by 2050, making early detection tools increasingly urgent.
The review draws on two large scale studies to make its case. A global survey of 79 sewage sites in 60 countries found strong links between the abundance and diversity of ARGs and local conditions such as sanitation infrastructure, access to clean water, and socioeconomic status. A separate analysis of 757 sewage samples from 243 cities in 101 countries identified 49 ARGs common to diverse environments, suggesting a risk of both localised circulation and wider global spread.
The paper is authored by José L. Balcázar, a researcher at the Catalan Institute for Water Research (ICRA), in Girona, Spain. According to his analysis, WBS can be scaled from a single building to an entire city and applied to sewage from hospitals, farms, pharmaceutical plants or municipal systems, though it becomes far harder to implement where sanitation systems are not centralised.
Among the challenges flagged are the technical difficulty of linking specific genes to their hosts, privacy risks tied to raw data from small catchments, infrastructure gaps in low and middle income countries, and the disproportionate exposure faced by communities without adequate sanitation, particularly as climate driven events such as floods and heatwaves may accelerate gene transfer.
The author calls for coordinated action: dedicated funding, pilot projects in low resource settings, international standards for sampling and data interpretation, and clear governance rules on consent and data sharing. Integrated within a One Health strategy spanning public health, veterinary medicine, agriculture and environmental protection, WBS could help detect emerging resistance patterns before they escalate into a broader crisis, the review concludes.
