Community-led wastewater testing in northern, remote and isolated communities

During the COVID-19 pandemic, nearly every major city in Canada established a wastewater testing surveillance program. However, bringing this technology to northern, remote and isolated communities, which have some of the most at-risk populations for COVID-19 complications, has been more challenging. The Public Health Agency of Canada’s National Microbiology Laboratory (NML) has been instrumental helping to deliver community-led wastewater surveillance programs to these communities by providing testing supplies, training and ongoing quality assurance oversight. This is in addition to the NML’s work to bring COVID-19 diagnostics to these northern and remote communities.

“Equity in terms of health outcomes is important,” says Dr. Chand Mangat, NML Research Scientist with the National Wastewater Surveillance Program. “We need to deploy creative solutions to understand emerging public health issues.”

The benefits of testing wastewater in remote communities

Severe outbreaks can happen very quickly in these communities due to a higher number of multi-generational homes, overcrowded housing, highly interconnected populations and significant barriers to timely access to healthcare. One of the main benefits of wastewater testing is that it can give the community an early warning of a potential outbreak. If there is a spike in cases, it can alert leadership and public health in the area to take steps to curb the outbreak such as distributing rapid testing supplies or initiating public health measures. Testing wastewater in the community means samples don’t have to be sent to the NML or another central laboratory, saving valuable time. The information communities get from testing sewage can also be important to coordinate vaccination efforts or guide the distribution of antiviral treatments.

“Wastewater testing does not require major infrastructure. It has a low footprint and a single sample provides a window into the health of the community,” says Dr. Mangat.

Six communities in the Northwest Territories have been using wastewater testing for the last 18 months. The testing has detected multiple outbreaks and given the communities an early warning so they were able to take preventative action quickly and reduce the further spread of COVID-19.

Community-based wastewater testing programs

In 2022, the Champagne and Aishihik First Nations and the Village of Haines Junction in the Yukon worked closely with the NML to create a program that addresses the specific needs of the community. Together, they developed a tailored solution that aligned with the wishes of community leadership and put the community in control of all the data gathered from the wastewater testing program.

“Our wastewater surveillance program grew from the interest we have in understanding the prevalence of COVID-19 in Dakwäkäda/Haines Junction so residents and our local governments can make the best, most well-informed decisions on risk management and how to go about our daily lives,” said Dän nätthe äda Kh’úkhįá (Champagne and Aishihik First Nations Chief Barb Joe). “We are building our community’s resilience to understand and respond to COVID-19 while also building community capacity through a Champagne and Aishihik First Nations Citizen-owned business, Dawnix Water Services, to run our local lab.”

Dr. Michael Becker, a research scientist with the NML northern, remote and isolated initiative highlights the importance of these programs.

“These are community-led initiatives that respect the right to self-determination of health for our partners,” says Dr. Becker. “We are the players in the background providing support but the programs really come to life in the hands of the community.”

Earlier in the pandemic the NML scientists faced the challenge of finding a wastewater test that people can do in communities that did not have laboratories and without compromising on data quality. They were actually able to implement a rapid test for point of care diagnostic testing devices that performs as well as laboratory tests. Another hurdle that had to be overcome was getting good quality samples from the existing wastewater infrastructure. This required coordination between wastewater engineers, local public health leadership and the communities to find solutions.

Going forward, the scientists hope that the success of the wastewater testing program in Dakwäkäda/Haines Junction might encourage more communities to establish their own programs.

Improving health equity

Beyond COVID-19, the NML is exploring how their work with the Champagne and Aishihik First Nations and the Village of Haines Junction, as well as other communities, can help develop into a larger community-based collaboration. The NML is often in discussion with communities to explore other ways that wastewater may be able to support surveillance of other high impact diseases. In the laboratory, scientists are looking at how they can use wastewater testing to detect other pathogens such as those that cause sexually transmitted and bloodborne infections, influenza, tuberculosis, monkeypox, polio and antimicrobial resistance.

“There’s been a revolution in healthcare throughout the pandemic, especially in northern, remote and isolated communities, where they are getting better access to tools to take care of their own health and are thus able to make their own health decisions,” says Dr. Becker.

Dr. Becker says their team is passionate about helping to provide equitable access to healthcare for all people in Canada.

“Seeing the impact that this wastewater testing program has been making in these communities, during the pandemic, has been an incredibly rewarding experience. I’m excited to see how this work continues to grow beyond COVID-19,” he says.