Equities and Inequities Inherent in Wastewater Surveillance Systems for Public Health: New York State, 2020-2024.

Publication date: May 21, 2026

Objectives. To evaluate equity in wastewater-based infectious disease surveillance, including equity of inclusion, outbreak detection, and disease forecasting. Methods. We assessed New York State’s wastewater surveillance network using census tract-level data to compare social vulnerability and environmental burden across included, sewered but excluded, and unsewered communities during the scale-up of the network (2020-2024) and under changing coverage scenarios. We modeled outbreak detection equity by estimating outbreak sizes required for 95% confidence in the detection of hypothetical pathogens and assessed forecasting equity using county-level COVID-19 hospitalization predictions in relation to population size, coverage, and vulnerability. Results. We found similar vulnerability distributions between included and sewered but excluded communities. The 25% most vulnerable communities required median outbreak sizes 3. 45 times larger for detection than did the 25% least vulnerable. At medium sensitivity, more than 80% of individuals living in poverty and minoritized populations lived in areas where outbreaks exceeded 10 infections before detection. Forecasting accuracy was lower in smaller ( 60%) counties and increased with population size and network coverage (P 

Semantics

Original Article