Pathogen surveillance has changed rapidly in the era of COVID-19. As COVID testing became more widely available, especially with the advent of inexpensive home-based tests, tracking exactly where pathogen hotspots were forming became more challenging.

In the nation of Georgia, ICAP at Columbia University is launching a national surveillance program that will address such a gap, by tracking the presence of SARS-CoV-2 and other pathogens through wastewater-based surveillance. The project builds on ICAP’s efforts to strengthen health systems and build global health capacity in the Eastern Europe and Central Asia region.

Supported by the Centers for Disease Control and Prevention (CDC), ICAP, in collaboration with the Columbia University School of Engineering and Applied Science (SEAS), will provide technical assistance to the Georgia Ministry of Health to develop, plan, and implement a national wastewater surveillance system and help build local capacity for interpreting wastewater surveillance data. ICAP will also help develop a dashboard to display wastewater surveillance data, which will be made available to key stakeholders in-country.

Wastewater surveillance data can be an important tool for informing public health actions, for example, providing early warnings anywhere from 4-7 days or even longer in advance of clinical detection of rising COVID-19 cases. It also requires far fewer resources, equipment, and personnel than systematic testing of individuals. Monitoring the scale of COVID-19 and its variants, as well as other pathogens that can be detected in wastewater, can help predict a pandemic’s pathway.

“Wastewater surveillance is such a vital tool because a virus like SARS-CoV-2 can be detected even if people do not have symptoms,” said Suzue Saito, lead director of Strategic Information at ICAP and principal investigator of the project. “It’s this kind of knowledge that is going to help us get ahead of major outbreaks”

This will be the first time ICAP leads a wastewater surveillance system internationally. In 2020, as COVID-19 spread rapidly throughout New York City, ICAP and SEAS spearheaded wastewater sampling for SARS-CoV-2 at several dormitories on the Columbia University campus.

“Wastewater streams bear an imprint of the health of the community from which they are derived,” said Kartik Chandran, professor of Earth and Environmental Engineering at Columbia University and lead collaborator on the project. “Beyond COVID-19, there is much more that can be done to broaden efforts to track and control other pathogens and human health threats (such as antimicrobial resistance) through wastewater surveillance. Such efforts could benefit immensely from the integration of disciplines such as public health, epidemiology, and engineering – exactly as it is happening as part of this ICAP program.”

Despite major improvements in innovation and education in the Eastern Europe and South Caucasus (EESC) region in recent years, disruptive events such as COVID-19 have stalled important growth within the health sector. There is a critical need, for example, to train individuals to effectively track, contain, and eliminate outbreaks using innovative approaches like environmental surveillance. In April 2022, ICAP convened a workshop in Georgia on communicable disease risks with participants from eight countries in Eastern Europe, the South Caucasus, and Central Asia. Workshop participants highlighted the need to create regional communities of practice that can facilitate the sharing of experiences, documents, tools, and lessons learned across the region.

In Georgia, ICAP will support a regional community of practice on respiratory disease surveillance, where participants from Georgia, Kyrgyzstan, and Uzbekistan will receive training in-person, and participants from other countries in the EESC region will be invited to participate in monthly online discussion sessions. Additionally, in collaboration with Training Programs in Epidemiology and Public Health Interventions Network (TEPHINET), ICAP will also support a regional Field Epidemiology Training Program (FETP) based in Georgia, which will aim to build epidemiologic and public health capacity in the region and ensure there are experts who can address major health threats when they arise. In between these workshops, FETP participants will conduct field activities in their home country, including rapid needs assessments, evaluations, field investigations, and surveillance monitoring. In addition to supporting activities related to strategic planning, network strengthening, sustainability, and institutionalization of the training program, ICAP will support virtual professional development activities for the FETP alumni network.

As a part of this collective work in the EESC region, ICAP will be establishing a new office in Georgia by the end of 2022.

“ICAP’s continued support in this region underscores our commitment to Global Health Security,” said Anna Deryabina, regional director of ICAP in Eurasia. “Disease surveillance is a benchmark of public health preparedness. Through this project, it’s exciting to be able to expand our depth in this area by collaborating with Columbia University wastewater surveillance experts, building on our track record of improving health outcomes in the region through innovation and sustained relationships.”

Photo: “ToT on Communication and IWRM” by AIO SIDS IWRM Project is licensed under CC BY-NC-SA 2.0.

About ICAP

A major global health organization that has been improving public health in countries around the world for nearly two decades, ICAP works to transform the health of populations through innovation, science, and global collaboration. Based at Columbia Mailman School of Public Health, ICAP has projects in nearly 40 countries, working side-by-side with ministries of health and local governmental, non-governmental, academic, and community partners to confront some of the world’s greatest health challenges. Through evidence-informed programs, meaningful research, tailored technical assistance, effective training and education programs, and rigorous surveillance to measure and evaluate the impact of public health interventions, ICAP aims to realize a global vision of healthy people, empowered communities, and thriving societies.

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