Waste Not, Want Not

Precision Health Platform Improves Public Health Through Wastewater and Environmental Surveillance


Public health surveillance is underfunded and underemphasized across the globe—especially as it relates to early warning for disease outbreaks through non-clinical surveillance methods.

Non-clinical individuals can under or over-report symptoms of illness for a variety of reasons or may be asymptomatic. The disconnect between private, state, and national data collection systems makes aggregation and analysis challenging. Often, once data is available, it’s too outdated to be actionable or presented such that an average person cannot comprehend it. Another challenge is that very few systems are working with an equity lens to focus on the needs of people down the socioeconomic and cultural hierarchy. How does a daily wage worker who cannot afford to miss work make decisions to protect their health during COVID-19?  That’s the question Precision Health Platform set out to answer, informed and accelerated by a global pandemic.

The Challenge 

In India, the World Health Organization has reported more than 45 million cases of COVID-19 since January 2020, resulting in 533,000 deaths. It became clear that the disease could take a toll on the country’s health and wellbeing. Like many countries worldwide, the government at the state and national levels had to deal with several challenges related to monitoring the outbreak and providing services to a vast and diverse population. 

In a resource-constrained environment, how do we ensure equitable access to information and resources? We are trying to ensure that the larger population in a city, especially the marginalized and vulnerable, is being served.

Prerak Shah, technology system and visualization lead

“No one organization can solve this challenge single-handedly,” said Project and Communication Lead Sabhimanvi Dua. 

When COVID surged, the government was quick to focus on isolating and treating patients who were already symptomatic. However, wastewater can detect even asymptomatic cases. The organization began to monitor wastewater pathogens, developing the country’s first public health early warning platform for pandemic preparedness. 

Hungry for greater insights and better preparedness, other laboratories and academic institutes in India welcomed this approach and began to partner up for this initiative.

“Any information relevant to COVID-19 was essential for them because they were working in an emergency. The whole sense of urgency at that point in time made them very receptive,” said Shirish Harshe, senior technical lead at Precision Health Platform. “They took some of our early warning signals very seriously and developed action items based on that.”

The Solution 

Precision Health Platform first found a seat at the table in Bengaluru’s COVID war room, where their public health surveillance helped inform the city’s COVID response strategy.

“We can nudge the government in understanding the value of environmental surveillance and how it can be leveraged for public health,” said Prerak Shah, technology system and visualization lead. “Many of these things are becoming internalized within the public system.”

We’re getting the data from the communities, and we have to enable them to use it as well. We were able to take complicated epidemiological data and translate it into lucid insights and communication products.

Sabhimanvi Dua, project and communication lead

Shah helped create a public dashboard that synthesizes Precision Health’s findings and makes it easy for journalists, doctors, government leaders, and regular citizens to understand COVID-19 trends better while they’re happening. The dashboard uses Geographic Information System (GIS) technology to synchronize and display trends on a map. Insights are regularly shared through the platform’s social media as well.

“We’re getting the data from the communities, and we must give it back to them. We were able to take complicated epidemiological data and translate it into lucid insights and communication products,” said Dua, pointing in particular to the platform’s public data dashboard and Environmental Surveillance for COVID-19 – The Playbook. The playbook is an open-source, step-by-step guide on conducting citywide wastewater surveillance so that communities and organizations worldwide can learn from the platform’s experience. “Even five years from now, I know that the playbook will top the list of things I’m proud of.”

The team is cognizant, however, of not overstepping or sidestepping their public partners. They present the information as simply and objectively as possible and allow government leaders to serve as the public health spokespeople given their mandate. For Precision Health, it’s about data, science, communication, and equity.

“It is very easy to create panic and be portrayed as a fear-mongering organization, and we don’t want that,” Harshe said.

The team warned that it would also be easy to focus just on communities where data is accessible. 

“In a resource-constrained environment, how do we ensure equitable access to information and resources? We are trying to ensure that the larger population in a city, including the marginalized and vulnerable, is being served, not just the well-off or affluent ones ,” said Shah.

In part, that has meant collecting wastewater samples from open sewer drains and relying on a growing network of more than 26 partners to monitor health symptoms being reported on the ground.

The Takeaway 

Growing that network will be essential as Precision Health moves beyond Bengaluru and the four other cities in which their team of 14 is currently operating: Lucknow, Jodhpur, Tiruchirappalli, and Thiruvananthapuram. When identifying new partners, they look for organizations that have partnerships with a lab and established relationships and credibility with the government and the community.

“We started in Bengaluru amidst the wave with all hands on deck, but when we scaled, we knew we couldn’t be everywhere. We believe that through orchestration, knowledge sharing, and technical support, our partners—civil society and community organizations—can help this work go further,” Dua said.

Precision Health wants to explore ways to localize public health surveillance information further and is already beginning to monitor and track other pathogens, including influenza and hepatitis. The system they built applies to other diseases with the potential to be expanded and tailored to the needs of different regions and countries depending on their unique public health patterns.  This expansion involves integrating climate change impacts on human health into their systems within the next few years.

“​​There is a very strong health implication from climatic events,” said Policy Catalyst, Asha Jyothi, who leads the intersectional work between climate and health. “Drought leads to greater heat strokes and malnutrition, for example. Climate change can even exacerbate diabetes or anemia and affects new and expecting mothers in physiological, emotional, and sociocultural ways. It’s all connected.” 

Ultimately, by tracking more pathogens, integrating more data, and serving more cities, Precision Health aims to help people become more resilient and proactive and live longer, healthier lives.

“For us, it will be a very long-term impact factor because we want to see communities gain resilience for health and how that translates into healthy days,” Harshe said. “We want to reduce unhealthy days over time.”