As of the time of this writing , wastewater surveillance for SARS - CoV-2 has primarily been reported in high - income settings that are well - served by modern wastewater infrastructure ( Naughton et al . , 2021 ) . But wastewater surveillance has a long history of use in lower - income settings as well , most visibly in the context of polio eradication efforts where environmental surveillance has been widely deployed and in long - term surveillance for S. typhi and paratyphi ( Pogka et al . , 2017;Sikorski and Levine , 2020 ) . Such systems , where extant , can be used in response to the ongoing COVID-19 pandemic as exemplified in Pakistan ( Sharif et al . , 2021 ) . Wastewater surveillance systems for COVID-19 have been developed in at least 55 countries with demonstrated success across a range of climatic , economic , development , and logistical contexts ( Tlhagale et al . , 2022 ) . While wastewater surveillance is not without limitations , it is increasingly clear that it can provide useful data concerning the epidemiology of an infectious disease , such as COVID-19 , especially diseases that are characterized by asymptomatic infections or are inefficiently monitored through clinical surveillance ( Safford et al . , 2022;Hrudey and Conant , 2021 ) . The wealth of experience gained during the COVID-19 pandemic can be leveraged to develop robust wastewater surveillance systems to monitor a wide - range of emerging and re - emerging pathogens , especially in settings where clinical surveillance is insufficient to capture spatial and temporal infection dynamics and inform public health response .