Environmental Surveillance in One Health: Early Signs for Early Actions

Why Environmental Surveillance Matters in One Health

In a world where human, animal, and environmental health are so deeply intertwined, an ability to detect early disease signals and act collaboratively has never been more critical. To that end, environmental surveillance (ES) comprises a valuable tool that can detect pathogen signals before they surface as clinical/veterinary cases, unlike traditional surveillance methods, and is crucial for capturing community-level disease emergence and spread proactively. ES in India has been widely used for monitoring poliovirus and SARS‑CoV‑2 and is fast emerging as an early warning system for a host of other pathogens, Antimicrobial Resistance (AMR), and more, within a holistic One Health framework, cutting across the domains of human, animal and environment health.

One Health provides the conceptual and operational framework within which environmental surveillance, including wastewater surveillance, serves as a core tool to track shared risks across humans, animals, and ecosystems. By enabling triangulation of data across human, animal, and environmental domains, ES within a One Health paradigm supports coordinated and timely public health action at the human–animal–environment interface.

Benefits of ES as an Early Warning System

Environmental surveillance uses samples such as wastewater, surface water, soil, air, food-chain matrices and vectors to infer exposure and circulation of pathogens, chemicals, and AMR markers in populations and ecosystems. It captures signals that clinical or veterinary surveillance may miss (for instance, asymptomatic infections, under-diagnosed pathogens and subclinical AMR), thus complementing “classical” case-based systems. Environmental surveillance can:

• Detect early pathogen circulation in the community

• Identify trends before clinical/veterinary case numbers rise

• Support timely public health decision-making

ES in Antimicrobial Resistance: A Key Use Case

AMR is one of the top 10 global health threats, placing millions at the risk of untreatable infections.¹ A recent Indian study found that 83% of patients who come to hospitals already carry drug-resistant pathogens,² highlighting the alarming scale of an AMR crisis. It’s a significant One Health challenge as AMR pathogens and Antimicrobial Resistance Genes (ARGs) can be transmitted to and from humans either directly, or indirectly via animals and environmental pathways.¹

Environmental surveillance is especially useful in settings where clinical AMR data is incomplete or skewed toward larger hospitals, providing a broader picture of resistance patterns at the community level. Conducting ES at high-risk animal–human interfaces (e.g., livestock farms, wet markets, slaughterhouses, hospital effluents) as part of a One Health strategy comprises a powerful tool to check disease spillovers and detect AMR in time.

Sustainable Integration of ES within the One Health Ecosystem: Turning Challenges into Solutions

Sustainably integrating environmental surveillance into the One Health ecosystem requires moving beyond research pilots to address the operational, institutional, and coordination challenges. Following are some key aspects/areas where concerted action can help address the inherent challenges of ES implementation leading to sustained and scaled benefits on the ground:

Hospital Linkages: Stepping up wastewater surveillance (WWS) in hospital facilities to track AMR and test for pathogens can help triangulate WWS data with clinical surveillance data. The frequency of monitoring should be increased and a regular cadence maintained to detect infections early, thus “nipping them in the bud”.

Central Initiatives and Public-Private Partnerships: Government initiatives, such as the ICMR’s plan to expand WWS across 50 cities (from the current 5) to test for 10 pathogens offer programmatic support. Besides, public-private partnerships can leverage private sector capabilities to efficiently scale ES/WWS activities across cities.

Technology and Data Integration: Time matters for pathogen detection, making the development of faster and more sophisticated testing methods critical to strengthening the early warning systems. Across the ES workflow, from sample collection and transportation to processing, detection, reporting, and analysis, technological solutions can play an important role.

In India’s non-sewered settings, identifying suitable sampling sites at open drains or nullahs and estimating catchment populations comprise a challenge. Advanced tools to map informal sewage networks and associated populations can offer a viable solution, where private sector can substantively contribute.

In India’s non-sewered settings, identifying suitable sampling sites at open drains or nullahs and estimating catchment populations comprise a challenge. Advanced tools to map informal sewage networks and associated populations can offer a viable solution, where private sector can substantively contribute.

Once ES data is generated, publicly accessible dashboards showing real-time pathogen trends are essential for awareness and action. However, effective interpretation and use of this data require strengthened capacity and training among decision-makers to enable timely, effective and targeted public health interventions. Development and efficient use of coordinated dashboards and data systems can help ensure that warning signals from across animal populations, wastewater, or environmental samples do not remain in silos, are picked up on time and acted upon effectively.

Costing: For scaling up ES/WWS within the One Health strategy, research data on costing and cost-effectiveness of ES/WES is essential to equip policymakers with evidence on the relative costs and benefits of this surveillance method. In this context, ISB’s Max Institute of Healthcare Management is undertaking a study to map the current landscape of wastewater and environmental surveillance (WES) initiatives in India, and examining WES operational models, financing mechanisms, and emerging best practices. The institute is also developing a multi-city and multi-pathogen costing tool to estimate the costs and resources required for programmatic WES implementation across different pathogens and geographies and alongside preparing a plan for engaging in a cost-effectiveness analysis of WES under various sampling strategies and outbreak scenarios.

Conclusion

A One Health approach is essential for strengthening early warning systems for infectious diseases and antimicrobial resistance, with environmental surveillance comprising a shared monitoring system across sectors. Its impact will ultimately depend on how well it is integrated into routine public health decision-making, strengthening links between human, animal, and environmental health systems.

*The blog draws insights from the discussion on ‘Strengthening Early Warning Systems and Response through One Health and Environmental Surveillance’ during ISB’s Healthcare Catalyst 2026 led by Dr. Deepshikha Batheja, Principal Research Scientist, MIHM, ISB & co-led by Dr. Shreejata Samajpati, Senior Researcher, MIHM, ISB

References

1. Wastewater and Environmental Surveillance Summary for Antimicrobial Resistance (2025). World Health Organization. https://www.who.int/publications/m/item/wastewater-and-environmental-surveillance–summary-for-antimicrobial-resistance

2. Van Der Ploeg, K., Vos, M. C., Rughwani, H., Severin, J. A., Post, R. A., Reddy, D. N., … & Bruno, M. J. (2025). Preprocedural screening for multidrug-resistant organisms in endoscopic retrograde cholangiopancreatography: an international, multicentre, cross-sectional observational study. Eclinicalmedicine, 90.