BY RICHARD SKOLNIK
White Rock

Los Alamos County has ended its wastewater-based disease surveillance system (WBS) for COVID, RSV, Influenza A, and Influenza B. The purpose of this article is to inform the community about the manner in which I believe Los Alamos County has mis-managed this program and to encourage the community to demand that the County continue WBS and manage it in a transparent, ethical, and technically competent manner.

The Importance of Wastewater-Based Disease Surveillance
Despite significant declines in the number of COVID cases and deaths, COVID in 2023 was still the 8th leading cause of death of those over 65 years of age and the 10th leading cause of death overall. Many workdays and many schooldays are also being lost to COVID, as our school superintendent, for example, informed us recently. The costs of long-COVID are also very high. Yet, most surveillance for COVID has been dropped in the US. This makes WBS all the more important for providing the community with data that can inform the personal choices and public health efforts needed to keep people healthy. The data has similar value for RSV and Influenza.

Despite the above, and the fact that WBS has shown itself in the US and globally to be a valuable and cost-effective tool, Los Alamos County has ended its WBS program. This decision is consistent with the approach to wastewater surveillance that the County has shown since the inception of the pandemic: the County has managed the program in ways that appear to reflect
major gaps in transparency, ethics, and technical competence, as noted below.
The Lack of Transparency
For quite some time, the County got wastewater data from its contractor, but did not make that
data public.

The County recently informed the community in a press release that its contractor would no longer be providing it with wastewater data – which it was doing for free. However, the County did not inform the community that this means that, at least for now, the WBS program has ended.

Ethical Failures
The County withheld from the public data which community members could have used to protect the health of their families. This violates the basic principles of public health ethics.

Technical Failures
When CDC changed its contractor for the national WBS program, Los Alamos opted to stay with the original contractor. It appears that no one with technical competence in public health was involved in this decision, which should have been based on a consideration of the longer run benefits and costs of the CDC vs. Biobot programs. Such an analysis would have favored CDC’s much broader program. The other New Mexico communities doing WBS are in that program, as are the overwhelming majority of other American communities engaged in WBS, as well.

The County appears to have withheld the WBS data from us primarily because it did not know what to say about the data. It is good that the County knew it had no competence in this domain.

However, any number of people in New Mexico or elsewhere could have helped the County to do this quickly and inexpensively, if the County had sought such help.

The Community’s Next Steps
The above account and the County’s dropping wastewater surveillance suggest important gaps in the quality of government services that we should not accept. Do we really want to have a County government which is willing to spend millions of dollars on other services but is unwilling to spend any money on one of the few tools left for disease surveillance at the local level?

With the above in mind, I am asking the County to urgently join the CDC wastewater surveillance effort. The County must make public the data it collects through such a program.
The County must also provide the public with regular analyses of the data and its meaning for personal behaviors and public health practice. The County should enlist technical help as necessary for this work.

Richard Skolnik is the former Director for Health, Nutrition, and Population for South Asia at
the World Bank. He was a Lecturer in Global Health at The George Washington University and
Yale, and the Executive Director of a Harvard AIDS treatment program for three countries in
Africa. Skolnik is also the Instructor for the Yale/Coursera course Essentials of Global Health,
the author of Global Health 101, fourth edition. He presently holds a Lecturer’s appointment at
the Yale School of Public Health.