Towards the institutionalization of wastewater surveillance for public health: results from the EU-WISH mapping survey.

Wastewater-based surveillance (WBS) is increasingly recognized as a valuable tool for monitoring public health at the population level. However, its integration into national public health frameworks across Europe remains uneven. In mid-2024, the EU-WISH Joint Action conducted a system mapping survey across 27 European countries to assess the governance, development, and integration of WBS systems. The survey combined quantitative and qualitative data to evaluate national strategies, legal and financial frameworks, and system capacities. By May 2024, most participating countries had operational WBS systems, primarily targeting SARS-CoV-2. Other monitored targets included influenza and other respiratory viruses, poliovirus, antimicrobial resistance (AMR), emerging pathogens, illicit drugs, and health-related biomarkers. Prioritization in system design was largely based on operational feasibility and perceived public health value. Challenges identified included fragmented governance, lack of sustainable financing, and limited workforce capacity. Integration into public health decision-making varied, and dissemination practices differed significantly across countries and surveillance targets. The EU-WISH survey provides a baseline assessment of WBS implementation across Europe and highlights key enablers and barriers to its institutionalization. The findings support ongoing efforts at national and EU levels to enhance coordination, sustainability, and integration of WBS into routine public health frameworks.