Sewage Surveillance Wins Broad UK Public Support, With Privacy Caveats

A nationally representative survey of 1,157 UK adults has found that 92 percent support wastewater-based epidemiology, the practice of monitoring human pathogens and biomarkers in sewage to track public health. The study, published in BMC Public Health, also revealed a significant awareness gap: fewer than half of participants, just 37 percent, knew that SARS-CoV-2, the virus responsible for COVID-19, could be detected in faeces. The research, led by Margaret E. Knight and colleagues including Davey L. Jones, was conducted in June 2022 through the ESOMAR-accredited panel provider YouGov, with participants quota-sampled by age, gender and Government Office Region, and responses post-stratification weighted to match UK population demographics.

Wastewater-based epidemiology has grown rapidly worldwide in both uptake and scope, yet it remains largely unregulated, leaving researchers to develop their own frameworks for its ethical application. Ensuring that the technique is used in line with societal values and public consent is a key consideration for the field. To gauge where the UK public stands, the survey measured support and comfort on 5-point Likert scales, and awareness on a 3-point scale, across a range of wastewater monitoring applications, sampling locations and potential data users. The results show that public endorsement is strong but not unconditional.

Support for public health monitoring by government agencies was highest for health risks such as toxins and infectious diseases, each at 92 percent, and noticeably lower for lifestyle factors such as mental wellbeing, at 83 percent, and smoking habits, at 82 percent. The pattern suggests that the UK public draws a distinction between monitoring for direct health hazards and monitoring that touches on personal behaviour, even when both occur at the population level through the same sewage sampling infrastructure.

Spatial resolution emerged as another key factor shaping attitudes. Participants reported greater comfort with the surveillance of larger populations and with sampling at near-source locations such as hospitals, care homes, prisons, schools and airports. By contrast, only around half of respondents, between 47 and 56 percent, were comfortable with household-level surveillance. The finding indicates that acceptance of wastewater monitoring declines sharply as the scale narrows toward identifiable individuals and households, a pattern with direct implications for how wastewater programmes are designed and where samples are collected.

Trust also varied significantly depending on who would ultimately use the data. Confidence in data handling was highest for public health institutions and research organisations, and lower for private businesses and the police. The authors conclude that the findings demonstrate broad public support for wastewater-based epidemiology, with important caveats around privacy, spatial resolution and data use. They argue that transparent communication and citizen engagement will be central to maintaining trust and ensuring ethical implementation as wastewater monitoring programmes expand.

Subject of Research: Public awareness and perceptions of wastewater-based epidemiological health monitoring in the United Kingdom

Article Title: Public awareness and perceptions of wastewater-based epidemiological health monitoring in the United Kingdom

Article References: Knight, M. E., Grimsley, J. M. S., J. Wade, M., Cross, G., Lewis-Borell, L., Rimmer, C., Weightman, A. J., Feilzer, M., & Jones, D. L. (2026). Public awareness and perceptions of wastewater-based epidemiological health monitoring in the United Kingdom. BMC Public Health. https://doi.org/10.1186/s12889-026-29783-y

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29783-y

Keywords: wastewater-based epidemiology, public health surveillance, SARS-CoV-2, sewage monitoring, public opinion survey, United Kingdom, privacy, data governance, health monitoring, survey research, ethics, BMC Public Health