Wastewater-based Epidemiology

One of the biggest challenges to improving the health of a city is defining rapid and accurate metrics, which provide personal anonymity, but allow for data-driven decision-making by stakeholders. Wastewater-based epidemiology provides this solution by leveraging wastewater, and the human biomarkers it contains, as a metric for anonymized public health information. Through this technology, this waste stream can instead be used as a resource to transform the quality and speed at which citizens and policy-makers obtain community health information. For example, the general public can receive early warning of potentially harmful diseases in their community (e.g., influenza outbreaks) and can modify their behaviors to limit exposure, and public health officials can assess in near-real time whether interventions and resources provided to a given problem (e.g., opioid epidemic) are actually working.

Public health decisions are only as good as the data on which they are based. In order to build and maintain healthy cities there is an urgent need for near real-time health data at high spatial and temporal resolutions. Existing methods of assessing population health can be exceedingly expensive, delayed by months or even years before data are accessible, or even suffer from inaccuracies due to reporting bias or a small sample size. For example, the 2010 consumer expenditure survey, which covers approximately 30,000 people for the data dense dairy portion of the study, costs approximately $127 per person for two weeks of data. By comparison, a population of 30,000 can be monitored for 70 days by WBE at approximately $0.58 per person. Additionally, large government studies, such as the National Survey on Drug Use and Health administered by the Substance Abuse and Mental Health Services Administration, suffers an almost year delay for data release. This lack of data cripples organizations’ ability to make informed decisions regarding health metrics such as opioid and alcohol consumption, smoking prevalence, and diet.

AquaVitas works with variable-sized urban communities in the United States. These “target communities” are not limited by demographics, but are a function of the municipal wastewater collection systems. Our communities are often defined as those being served by a particular wastewater treatment plant. Large urban cities are often serviced by several (sometimes dozens) wastewater treatment plants, which equates to many communities within a given metropolitan city. However, our technology is not limited to only collection at the wastewater treatment plant. AquaVitas has patented technology that allows for wastewater collection directly from sewer pipes. Currently in the US, approximately 70% of the population is connected to the municipal wastewater collection infrastructure.  

AquaVitas follows the sociotechnical model that Prof. Halden’s university research laboratory has practiced in their collaboration with the City of Tempe – regular meetings with stakeholders from the target community, and webinars, town halls, and roundtables to translate data to the public, address any concerns they may have, and tailor our data outputs to the needs of the community (written report, PowerPoint, web dashboard, phone app).

Wastewater-Based Epidemiology has been implemented at various scales across the globe, but in most cases it is done largely for research purposes, either to analyze the merit of health biomarkers or to demonstrate feasibility. AquaVitas’ solution is to take the lessons learned and best practices from the past 15 years of WBE research and implement them via sustainable, affordable, and community-focused projects in urban areas. The general process consists of the following steps:

1. Meet in person with city stakeholders (public health workers, wastewater treatment operators, and citizens) to discuss health issues that can potentially be addressed by WBE. Examples include smoking cessation, alcohol consumption, licit and illicit drug consumption, diet and nutrition, and exposure to environmental toxins.

2. Develop a customized sampling campaign (with at least once-per-month frequency) at designated locations throughout the community.

3. Develop an individualized data-reporting format, whether via reports, webinars, presentations, online dashboards, or phone apps.

4. Begin sampling campaign, wherein wastewater samples are collected by local wastewater treatment plant operators and shipped to our lab for analysis. Our lab then analyzes the wastewater samples for health biomarkers, performs WBE modeling, and provides data back in report format to client, with discussion about baseline levels of health markers as well as deviations and trends in the data.

5. Work with the community to interpret these reports to help both implement policy (which policies are needed based on WBE data) and inform on useful policies (which policies are effective based on WBE data).

Prior applications of WBE have been primarily research-based and could be described as feasibility studies, mostly with the end goal of determining if the data was valid.  This project is a large-scale implementation of existing technology.

Our solution utilizes the state-of-the-art WBE methodology, including sample campaign design (e.g., human biomarker selection, sampling frequency, sample type and location of deployment), data analysis, modeling, presentation and dissemination strategies. Many of these techniques were originally developed by researchers in Europe 10 years ago and have since been refined by our research team.

AquaVitas’ method of implementing the WBE process is bolstered by years of prior feasibility studies by Prof. Halden and other experts in the field. In 2015, Prof. Halden collaborated with Dr. Lauren Keeler in creating a two-day workshop (https://repository.asu.edu/items/49794) in which stakeholders from industry, academia, government, non-governmental organizations, as well as the general public, were brought together to discuss best practices for implementing WBE into local communities. We have also held two ethics panels to discuss possible outcomes (positive and negative) from providing WBE data to the public. Prof. Halden’s lab has run a year-long pilot study for the City of Tempe, to monitor the opioids crisis in five district regions of the city. Multiple community engagement tools (town halls, webinars, web applications, brownbag lunches) have been developed and implemented with the City of Tempe, and have all resulted in high community engagement, interest, and utilization. All of this past knowledge has molded the way AquaVitas works with communities as it progresses forward.

Since wastewater collection can aggregate wastewater from thousands to millions of people into one system, the area that we serve is amorphous. We currently work with communities across the U.S. with population sizes ranging from as small as 30,000 to more than 1 million. This is an immense benefit of the technology because we can assess the health of a population at a fraction of the cost of traditional methods. Within the next five years, we will scale-up this effort to include more municipalities, large and small.

With the inception of the startup in June 2019, within one year we are aiming to achieve financial stability. To do this, we need to acquire about 10 to 15 medium-sized (Population 100K-1M) clients, depending on sampling frequency and chemical analyses requested. Additionally, we will complete our online dashboard where each client has the ability to individualize and customize the city’s data presentation and dissemination. In five years, we would like to have clients in all 10 major regions of the United States (as defined by the US EPA), as well as have expanded internationally.

The biggest barrier to the expansion of WBE, is the hesitance of stakeholders and policy-makers in a community to publicize public health data in fear that it may negatively impact the community (e.g., tourism, livability score).

We do not push partners to make data publically available, however we emphasizing the importance of these data and how the sharing of these data both with residents and other communities can education, improve well-being, foster collaboration and spur innovation. All communities have the same goal, improve the health and well-being of their constituents. As more municipalities join in the sharing of data, stigma will decrease and we believe more municipalities will share provide information.

AquaVitas currently has four part-time founders.

Our team is a leading expert in WBE in the United States. Cofounder Prof. Rolf Halden has been informing on public health issues using wastewater and wastewater-derived substances for over 15 years. His work with the antimicrobials triclosan and triclocarban led to the US Food and Drug Administration’s ban of these endocrine disrupting compounds in hand soaps in 2017. Prof. Halden’s lab oversees the Human Health Observatory, the largest repository of wastewater-derived substances in the US, used to understand human consumption and exposure patterns throughout the entire United States. The remaining members of AquaVitas are former doctoral students of this research facility, with experience in the cutting-edge research of this field.

AquaVitas partners with the Biodesign Center for Environmental Health Engineering at Arizona State University with Director Rolf Halden. As an ASU startup, AquaVitas is currently subcontracting with ASU for analytical work. Any lab work AquaVitas performs for clients will be done under the supervision of Dr. Erin Driver, our Chief Scientific Officer.

Our key service is to provide stakeholders with WBE expertise, including biomarker selection, sampling location selection, data generation frequency, modeling and presentation, which better allows for data-informed public health decisions. Our primary customers are local government officials, and associated non-profit entities working with the government to improve public health outcomes. Our day-to-day operations will include wastewater sample collection, processing and analysis, data modeling, report preparation, and online platform development. These wastewater data offer near real-time, accurate, inexpensive, unbiased, anonymous, community-level public health data to our customers. Our revenue is contingent on a subscription service (wherein AquaVitas performs all data-handling), or consulting services (wherein AquaVitas assists the client in implementing their own WBE efforts). Current major expected costs are for field/laboratory staff, sample analysis, and developing and maintaining the online platform. Surplus revenue will be reinvested into the company via development of new health biomarkers, new intellectual property to protect and elevate WBE process, and platform development.

The bulk revenue stream is sourced from annual subscription fees and WBE consulting fees from AquaVitas clients. Additionally, we are currently exploring fast-track and phase I SBIR grants from various branches of the federal government. These would either provide base funds for the company as a whole, or provide funds to further develop our intellectual property.

AquaVitas is applying to Solve for assistance in refining our services to make sure they provide value to our clients. Our employees are also transitioning from the grant-funded world of academia, wherein clients often pay at-cost or don’t pay for services, into private industry, wherein clients are paying higher fees. While we are confident the technology is sound, we would appreciate assistance ensuring that the transition is still sustainable and that our services are holistically addressing the issue we are intending to address.