Ireland's State of the Environment Report 2024

379 Chapter 14: Environment, Health and Wellbeing Topic Box 14.4  Our waste water as a powerful public health monitoring tool – establishment of Ireland’s National Wastewater Surveillance Programme The pandemic saw the implementation of waste water monitoring across Europe as a tool to track COVID-19 and its variants in the community. People infected with the SARS-CoV-2 virus can shed virus in their faeces and urine, which can then be detected in untreated waste water. Analysis of the waste water can be used to inform public health teams providing estimates of the frequency of infection and of variants of the virus that are circulating. The analysis acts as an additional, complementary tool providing community-level information to other public health surveillance systems monitoring the number of people testing positive or seen in healthcare facilities. Ireland’s National SARS-CoV-2 (COVID-19) Wastewater Surveillance Programme was established in 2020 by the Health Service Executive (HSE), Uisce Éireann, the National Virus Reference Laboratory and University College Dublin, and involved the sampling of 68 waste water catchment areas across Ireland on a weekly basis (Ringsend sampled twice per week). The catchment area analysed covered 80% of the population connected to the public waste water treatment facilities across a broad geographical area. The results of analysis of samples continue to be reported on a weekly basis by the HPSC. 8 Since January 2023, the number of catchment areas covered by the COVID-19 surveillance programme has been reduced to 30; however, the programme still covers approximately 70% of the population connected to the public waste water system. Beyond COVID-19, the establishment and operation of the surveillance programme now represents a national surveillance infrastructure that could be readily applied to micropollutants (biological and chemical contaminants in water in trace quantities). Waste water surveillance could be a powerful public health tool acting as an early warning system for environmental or human health threats, or allowing longitudinal surveillance for contaminants or pathogens of concern. For example, indirect environmental surveillance for antimicrobial resistance (AMR) consistently lags behind direct surveillance for AMR in human or animal populations; however, systematic waste water surveillance now offers a timely and powerful opportunity to gain insights and to provide a more integrated view of AMR dynamics in our populations and ecosystems. There is also opportunity to combine the waste water monitoring systems in operation across various countries into an integrated global network for disease surveillance (Keshaviah et al ., 2023). Ireland is currently collaborating with other countries across Europe to develop the use of waste water surveillance and to integrate this with other public health surveillance tools. 8 www.hpsc.ie/a-z/nationalwastewatersurveillanceprogramme/ (accessed 16 July 2024). Antimicrobial resistance. Antibiotics revolutionised the treatment of bacterial infections and made many modern medical procedures possible. However, the overuse and misuse of antimicrobials such as antibiotics, for human or animal health, has resulted in a rapid increase in AMR, which jeopardises the effectiveness of these medicines and modern healthcare systems. AMR is considered responsible for more than 35,000 deaths each year in the EU and European Economic Area countries (ECDC, 2020). An analysis of the economic burden of AMR in Ireland in 2019 found that over 4700 resistant infections occurred across 50 public hospitals, resulting in 215 deaths and approximately 5000 years of healthy life lost. In addition, these patients’ lengthier hospital stays were estimated to cost at least an additional €12 million in that year (HIQA, 2021). AMR has been identified as one of the top three health threats for priority action by the European Commission and EU Member States (HERA, 2022), and it is consistently listed as one of the strategic risks facing Ireland under the government’s annual national risk assessment (Department of the Taoiseach, 2023b).