Most U.S. Adults Support Wastewater Monitoring, and Nearly All Would Act on It

CDC set up the National Wastewater Surveillance System in 2020, during the COVID-19 pandemic, and later added data dashboards for mpox and influenza A. Wastewater utilities that take part have named community health as a reason for doing so, and a lack of public backing could lead them to stop. Yet little was known about whether the public supports wastewater monitoring, or whether its data change what people do. As new surveillance methods develop, understanding how communities see them — and the risks they may pose — is an ethical necessity.

The survey

• When: July 24–26, 2024
• Who ran it: Porter Novelli Public Services, with input from CDC, to guide public messaging about wastewater surveillance
• What: a nationwide, nine-question online survey in English
• Sample: 1,016 adults chosen by nonprobability quota sampling, weighted by gender, age, region, race and ethnicity, and education to match the U.S. population (Current Population Survey)
• CDC reviewed it and judged it not to be research.

Four questions about support for monitoring different kinds of pathogens gave such similar answers (Cronbach's α = 0.91) that they were averaged into one measure of overall support.

Findings

The protective steps people most often chose were:

1. washing hands more often — 76.1%
2. avoiding large gatherings — 61.1%
3. avoiding visits to people at higher risk of complications from infection — 59.1%

Differences between groups

Support for monitoring differed by age (p<0.001): it was lowest among 18- to 29-year-olds, at 62.0%, and highest among those 65 and older, at 82.8%.

It also differed by marital status (p=0.03): 78.1% among people married or in a union, 71.7% among the divorced, widowed or separated and 70.7% among the never married.

Wanting rapid data regardless of interpretation varied by race and ethnicity (overall p<0.01):

The people most in favor of rapid access also included men (62.3% vs. 53.5% of women), the employed (65.1% vs. 49.2% of those not employed) and residents of urban (62.6%) and suburban (58.0%) areas, compared with rural residents (51.0%).

Limitations

1. It was an internet panel, so people with limited internet access or tech skills may have been left out.
2. Awareness of wastewater surveillance may vary by place, and people who knew more about it may have been likelier to take part.
3. Answers may reflect social desirability bias — saying what seems desirable rather than true opinions or behavior.
4. It asked only about monitoring for infectious diseases; support for other uses may differ.
5. Because it was in English only, people with limited English proficiency aren't represented.

What it means

Support for monitoring wastewater for infectious diseases is strong across many groups of U.S. adults, and people say they would use the data to guide their health behavior. Most even want quick access before experts can say what the data mean for risk or action. Publishing wastewater data can keep the public informed and encourage early protective behavior — but the data should come with clear public health interpretation.

Sources

Based on Soelaeman RH, Kleven D, Losch J, et al., "Notes from the Field: Support for Wastewater Monitoring and Influence on Protective Behavioral Intentions Among Adults — United States, July 2024," Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention; a work of the United States government in the public domain.