Wastewater Surveillance Can Have a Second Act in COVID-19 Vaccine Distribution

The success of the coronavirus disease 2019 (COVID-19) vaccination effort may be limited by the ability to equitably and expediently reach the general public in the final deployment phase. Prior experience has shown that significant cultural, economic, racial, and communication barriers prevent widespread participation in public health initiatives, such as COVID-19 testing and, now, vaccination. Public health agencies would benefit from tools that identify recalcitrant refugia of infection in discrete geographic hot spots and enable targeted vaccine messaging and deployment to expand coverage. Measuring the concentration of virus in municipal sewers could help. After initial waves of mass vaccination, public health officials, along with health care delivery partners, could deploy this approach to identify locations where viral fecal and urinary shedding into wastewater is not declining-thus revealing pockets of concentrated community infection and opportunities for increased vaccination focus. These areas could be described as vaccination deserts.