You’ve probably seen the news that last weekend, President Joe Biden and Congressional leaders reached a deal to raise the U.S. government’s debt ceiling. The deal passed both houses and Biden signed it yesterday.
In order to reach this bipartisan deal, Biden had to make a lot of compromises—including limiting funding for COVID-19 and other public health needs. The deal could make it harder for state and local governments to distribute COVID-19 vaccines, track disease through programs like wastewater surveillance, and prepare for future health threats.
The federal government is essentially taking back $27 billion of COVID-19 funds that it provided to various federal agencies, according to reporting by Ximena Bustillo and Tamara Keith at NPR. The move focuses on funds for programs that concluded or have “no immediate demands,” per a White House document shared by NPR.
But programs with “no immediate demands” could easily have demands in the coming months. One of NPR’s examples is funding for the federal Department of Health and Human Services (HHS) to research and distribute vaccines, which can be distributed to other agencies (the CDC, NIH, FDA, state and local health departments, etc.). Vaccine distribution might not be a big need right now, but it likely will be in the fall, when new COVID-19 boosters become available.
Another potential need could be wastewater surveillance for COVID-19 and other health threats. The CDC’s National Wastewater Surveillance System (NWSS) was funded through 2025 by the American Rescue Plan, but it’s possible some of those funds could be in the HHS money pulled back by the debt ceiling deal. This would obviously be a huge loss for the U.S.’s ability to get early warning about future COVID-19 surges, as well as warnings about other pathogens. (Shout-out to Sean Kennedy for pointing this one out.)
In addition, the debt ceiling deal may lead to a smaller budget for the NIH, as Sarah Owermohle reports in STAT News. This could have implications for the agency’s ability to fund research into many pressing diseases, including Long COVID. The NIH has already wasted a lot of its Long COVID funding so far, according to my reporting, so it would be pretty bad news if more support for this research is not available.
The White House has claimed that Biden’s deal preserves funds for some key COVID-19 issues, according to NPR, including next-generation vaccines and Long COVID research. It’s hard to verify this, though, because of how convoluted federal COVID-19 funding has been. From a recent brief by the Association of State and Territorial Health Officials:
“Given the way Congress appropriated COVID-19 funding, and the way funding was later transferred between federal accounts and agencies, it is extremely difficult to discern which federal public health programs are affected by the rescissions.”
Public health funding often follows a cycle of “panic and neglect.” When a crisis occurs, governments panic and put tons of money into the immediate response. But after that crisis fades, it falls into neglect, with less money devoted to preparedness—even though preparedness efforts could help avert the next crisis. We’re clearly in that neglect part of the cycle for COVID-19 now; the debt ceiling deal is just the latest example.
My attempt to explain the wastewater surveillance funding ecosystem in one diagram. (Credit: Betsy Ladyzhets)
This week, I have a new story out in Scientific American about why the wastewater surveillance infrastructure built during the pandemic may not last in the long term. While current monitoring projects aren’t likely to go anywhere right now, issues with funding, uneven commitments at state and local levels, and the overall novelty of this field may lead those programs to shut down in the coming years.
Here’s the story’s opening paragraphs:
During the past three years of the pandemic, testing sewage water for the virus that causes COVID has become a valuable tool: it has spotted surging infections and new variants weeks before they showed up in medical clinics, for instance. The technology has also warned of other health threats such as seasonal viruses and increased opioid use.
But now its long-term ability to protect public health is in jeopardy. Funding uncertainty from the federal government and uneven commitments from state health departments have raised the specter that wastewater monitoring programs may shut down in the future.
The U.S. Centers for Disease Control and Prevention’s National Wastewater Surveillance System (NWSS), which includes the majority of wastewater testing sites in the U.S., is “fully funded through 2025,” says Amy Kirby, director of the program. But after that, “new sources of sustainable funding” are needed, Kirby says, ideally through the CDC’s regular budget rather than resources tied to COVID. Uncertainty about money—along with logistical challenges and questions about how to interpret data from this relatively novel source—has made some state governments hesitant to invest in the technology, leading to an uneven national system.
My reporting for this piece involved interviews with the CDC, state and local public health agencies, and other major wastewater organizations (Biobot, WastewaterSCAN). I learned a lot about the overall ecosystem for funding wastewater surveillance, including a lot of somewhat-technical details that didn’t make it into the SciAm story. So, I’m sharing some of those details here.
Where wastewater surveillance funding comes from:
The primary funder for wastewater monitoring programs across the U.S. is CDC NWSS. The CDC itself received funding through the American Rescue Plan in 2021, sufficient to fully fund NWSS through 2025.
That CDC funding has gone in two main directions. First, the CDC has funded state and local public health agencies to set up (and maintain) their own wastewater testing projects. This is how most of the states with robust programs (places like New York, Utah, Virginia, Ohio) have funded their efforts. State and local health agencies may also receive funding from their own local governments, though most of the agencies I talked to for my story said they were primarily relying on the CDC. New York State is one major example of a state government funding wastewater surveillance right now.
And second, the CDC has set up national contracts with wastewater testing companies to supplement NWSS in places where monitoring otherwise might not be happening. The agency first contracted with LuminUltra in early 2022, then switched to Biobot Analytics last spring. Earlier this year, Biobot’s contract with the CDC was extended for six months, through July. After that, the agency plans to enter a new, five-year contract with a wastewater testing company that will cover COVID-19 as well as other emerging diseases, like mpox. This contract could go to Biobot or another company; the CDC is currently going through an application process.
Biobot and other private companies like it are also receiving funding from private sources, such as venture capital firms. In addition, individual water treatment facilities, local governments, and even businesses might set up contracts with private companies to help them test the wastewater in their jurisdiction. For example, Toronto’s Pearson Airport has contracted with LuminUltra to test wastewater from the airport terminals. In these cases, funding is coming from the specific organization that wants testing, rather than a larger program. Biobot also tests at hundreds of sites for free through its Biobot Network, in exchange for sharing the data publicly.
Finally, there’s a whole separate ecosystem of academic wastewater surveillance efforts, mostly run by university labs or research centers. WastewaterSCAN is the biggest example of this right now; the project was founded at Stanford and Emory Universities, but has since expanded through grants and philanthropic funding to cover about 150 sites across the country. Most academic projects either partner with specific treatment facilities in their areas or test the sewage on their campuses—SCAN is an exception with its broader scale.
Concerns for wastewater surveillance’s long-term future:
As you can probably tell by this description of the funding landscape, wastewater surveillance in the U.S. is pretty complicated. When scientists started testing wastewater for SARS-CoV-2 in spring 2020, this was basically a grassroots effort with different research projects across the country trying out different things. CDC NWSS has worked hard to compile data into one national system and develop standards, but the system is still far from unified.
For the CDC program to continue its efforts, the agency needs more long-term funding—and this funding shouldn’t be tied to COVID-19. The potential for wastewater surveillance to inform public health decisions goes far beyond this pandemic, and funding should reflect that potential; also, no COVID-specific funding packages have passed Congress since the American Rescue Plan, in 2021.
One way Congress could do this would be by expanding a funding system called “Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases,” or ELC. Most wastewater grants to state and local health agencies over the last couple of years have gone through ELC, though the funding came from the American Rescue Plan. Many of the health officials I talked to for my story like ELC, know how to fill out the annual applications, and would want to keep using it to receive wastewater funding.
Before the pandemic, the ELC program was drastically underfunded, I learned from experts at the Association of Public Health Laboratories (APHL). States’ applications historically “vastly exceed the money that CDC is given to put out for them,” APHL policy officer Peter Kyriacopoulos told me. APHL recommends that Congress should expand the program’s funding from $300 million per year (its pre-pandemic benchmark) to $800 million per year, or more. The ELC program is up for renewal this year, which could be an opportunity for Congress to add more permanent funding for wastewater surveillance and other epidemiological efforts.
More permanent funding could go a long way in convincing more state health agencies to invest in wastewater surveillance programs, rather than relying on outside assistance from companies like Biobot or academic partners. More data and guidance on how to actually use wastewater data to inform public health decisions would help, too, since many agencies are still figuring this out. Such investment at the state level would help make the country’s wastewater infrastructure more comprehensive, and more capable of responding to new health threats.
Instead, right now, we have an uneven system. Some places are regularly monitoring for COVID-19 and easily able to expand to new testing targets, while others might lose this valuable data source in the next year or two. For any local reporters reading this, I highly recommend digging into your community’s wastewater surveillance system, and figuring out whether it’s set up for the long term.
Public health departments, underfunded and under threat: This week, Kaiser Health News (KHN) data reporter Hannah Recht released the dataset behind KHN and The Associated Press’s recent feature on how local public health departments in the U.S. have been left unprepared to face COVID-19. The dataset includes six files examining spending and staffing at public health departments across the country.
COVID-19 testing sites: The healthcare company Castlight has built a comprehensive database of COVID-19 testing sites in the U.S., down to the ZIP Code level. Castlight’s Tableau dashboard allows users to explore this database by county and compare the number of available test sites with current case counts. This dataset was cited in a recent 538 article on testing disparities.
The CoronaVirusFacts Alliance Database: Since the start of the pandemic, Poynter’s International Fact-Checking Network has connected fact-checkers in over 70 countries working to correct COVID-19 misinformation. The results of these fact-checkers’ work are compiled in a database, which you can search by country, fact rating, and topic.
COVID-19 Data Dispatch 