In the nineteenth century it was believed that cholera, a major global problem, was transmitted and spread by a ‘bad air’ or ‘bad smells’ from rotting organic matter. But in 1854 the physician Dr John Snow (1813-1858) conducted pioneering investigations on cholera epidemics in England and particularly in London where he demonstrated that contaminated water was the key source of the epidemics. His thorough investigation of an epidemic in the Soho district of London led to his conclusion that contaminated water from the Broad Street pump was the source of the disease and, consequently, the removal of the handle led to cessation of the epidemic.

The modern use of wastewater-based epidemiology (WBE) for disease outbreak surveillance was first demonstrated in the 1940s by John Paul and James Trask at Yale University for the detection of poliovirus in sewage. The use of WBE for poliovirus detection and therefore the identification of poliomyelitis outbreaks has since become a core strategy for poliovirus eradication. In 1988 the Global Polio Eradication Initiative was established and WBE has played a crucial role in the eradication of wild poliovirus. Indeed, pre-COVID, poliovirus detection represented the most comprehensive global wastewater surveillance program for infectious disease surveillance.

PCR was invented by Kary Mullis, an American biochemist working for Cetus Corporation, and published the method in 1985. It was first used in WBE in the 1990s and allowed for rapid and accurate detection of pathogen genetic material, replacing slower, older techniques such as culturing.

The concept of wastewater-based epidemiology, also known as ‘sewage epidemiology’, was first proposed by Dr Christian Daughton, US Environmental Protection Agency, in 2001. Daughton, largely recognised as a pioneer, proposed analysing wastewater to bridge the gap between biomarkers and human health, allowing for the assessment of community consumption habits without directly testing individuals.

Researchers in Italy first used liquid chromatography-mass spectrometry (LC-MS) to measure illicit drug metabolites in the River Po. Ettore Zuccato demonstrated for the first time that an illicit drug, cocaine, was present in the aquatic environment, and was able to show that trace amounts of human metabolites in water could be traced back to population-wide drug consumption.

The group analysed samples of wastewater from whole communities for 100+ chemicals that were either markers for health and disease, indicators of human exposure to hazardous chemicals or those that could adversely affect human health or the environment. This work at Bath became a global hub for advancing mass spectrometry-based WBE and made major contributions to developing the technology, eventually leading to its use as an evidence based early warning tool. As a result of working with Professor Kasprzyk-Hordern and her colleagues for more than a decade, local water utility company, Wessex Water, has supported the development of WBE technologies to monitor public and environmental health risks including COVID-19 surveillance.

Instead of only targeting known drugs, instruments like Time-of-Flight (TOF) mass spectrometers allowed scientists to screen for thousands of different substances simultaneously, including pharmaceuticals, pesticides, and lifestyle products.

In 2010, a Europe-wide network was established with the aim of standardising the approaches used for wastewater analysis and coordinating international studies through the establishment of a common protocol of action. The network, Sewage Analysis CORe group Europe (SCORE) involved 6 countries initially, including the UK working in collaboration with Norway, the Netherlands, Italy, Spain and Switzerland. The network now has more than 34 organisations across the world. Since 2011, SCORE has provided the European Union Drugs Agency (EUDA, formerly EMCDDA) with critical, near real-time data on illicit drug use across Europe.

From 2015–2017, the SEWPROF programme brought together leaders in the field across Europe in academia, research institutes and the private sector and utilised their expertise and commitment in training a highly employable cohort of researchers.

The UKRI Global Challenges Research Fund project developed an early warning system for infectious disease spread by tracking SARS-CoV-2 in urban water in South Africa and Nigeria. This low-resource approach enabled real-time, community-wide surveillance, identified infection hotspots, guided public health responses, and improved estimates of virus spread and immunity.

The ReNEW project (Developing Resilient Nations) aimed to develop real-time community-wide diagnostics and a tuneable multi-hazard public health early warning system with the ultimate goal of strengthening community resilience. The £1.35M project was funded by the EPSRC Global Challenges Research Fund and led by the University of Bath and Stellenbosch University.

Researchers in Professor Kasprzyk-Hordern’s group, together with Wessex Water, used WBE from early 2020 to track SARS-CoV-2 in the Bristol / Bath region. By analysing wastewater samples with sensitive RT-qPCR methods, they could detect viral RNA even before people showed symptoms or sought testing, offering real-time insight into community transmission. Additionally, the group was able to detect COVID-19 spike proteins in wastewater using mass spectrometry, giving proof of concept for wastewater-based proteomics. Alongside viral markers, the team also tracked chemical indicators, revealing changes in medication use, lifestyle behaviours, and disinfectant chemicals during the pandemic. The work demonstrated WBE’s potential for routine monitoring and early warning of infectious diseases, evaluating public health measures, and detecting new pathogens.

The Centre, funded by Research England’s Expanding Excellence in England (E3) scheme, was set up to transform public and environmental health management, by establishing the first Urban Living Lab facility - a state-of-the-art digital water sensing platform, training base and ideas hub. CWBE will establish the first One Health Platform encompassing WBE systems, sensing technologies and efficient modelling workflows to gather data and monitor environmental and public health.

CWBE works with regional and national stakeholders, including UKHSA, Ministry of Justice, Environment Agency, Bath & North East Somerset Council, and Wessex Water, to provide a practical roadmap for a UK early-warning system platform. The NERC Centre of Doctoral Training in Real-Time Digital Water-Based Systems for Environmental Health (Red-ALERT CDT) also began, led by the University of Bath in partnership with Cardiff University, University of Exeter, Bangor University and the UK Centre for Ecology and Hydrology.