Ethical considerations of wastewater-based disease surveillance—a qualitative interview study

Introduction: Public health implementation of wastewater-based disease surveillance (WBDS) increased dramatically during the COVID-19 pandemic. WBDS raises unique ethical considerations because of its community-scale method of disease surveillance. However, the perspectives of community members regarding the ethics of WBDS are absent from the literature. Methods: We explored ethical considerations of WBDS by interviewing community members and professionals across the United States using vignettes and a semi-structured interview process. Vignettes highlighted ethical opportunities and concerns noted in the literature, and interview questions solicited information relevant to Kass's Public Health Ethics Framework. Professional interviewees were identified from their contributions to the field of WBDS, and community interviewees were recruited through a national survey panel firm. We recorded, transcribed, and qualitatively analyzed interview data using a blended inductive and deductive approach. Results: We interviewed 8 community members and 13 professionals from February to November of 2023. Interviewees broadly supported WBDS and collectively identified a variety of conditions needed for the ethically acceptable conduct of WBDS, such as transparency, effective communication, data privacy, legitimate purpose, responsible data use, public oversight, equity, and community engagement. Ethical concerns and suggested protective measures were similar between the two interviewee groups with few notable differences. Discussion: This exploratory study found interviewees were receptive to WBDS when accompanied by transparency, safeguards against data misuse, and clear public health purpose.