(Boston)—Wastewater and environmental surveillance (WES) – the analysis of water and environmental samples like sewage to enable early, non-invasive tracking of biological and chemical markers across a population – is a powerful and increasingly common public health tool. When paired with clinical data, it offers a real-time window into community health that can inform faster, more targeted responses to infectious disease. However, its use in carceral settings like jails and prisons remains ethically underexamined.
"Incarcerated populations already experience pervasive surveillance, constrained autonomy, and disproportionate disease burden, and a long history of exploitation in research. Carceral settings are therefore exceptional spaces where WES can enable heightened forms of monitoring and punitive restriction without the protections normally expected in either research ethics or public health practice," the authors explain.
The researchers examined public health guidelines, human-subjects research regulations, medical ethics codes, and constitutional law, and found that none were designed with this scenario in mind. They also conducted a stakeholder analysis of all parties affected by carceral WES and traced the practice from its origins in drug detection to its expansion during COVID-19 and emerging applications such as hepatitis A surveillance. Their analysis documents how rapidly and quietly the practice has grown with almost no regulatory oversight.
According to the researchers, incarcerated individuals across many institutions and several states have already had movement restricted and activities canceled based on WES data without the safeguards required for sound clinical decision-making. "If surveillance without consent or recourse becomes normalized in carceral settings, it becomes easier to justify elsewhere, like in immigration detention, psychiatric facilities, and rural communities with isolated water systems," notes co-author Alysse G. Wurcel, MD, MS, associate professor of general internal medicine at Boston University Chobanian & Avedisian School of Medicine and infectious disease physician at Boston Medical Center.
The researchers hope this work contributes to the development of clear ethical standards for wastewater surveillance in carceral settings - standards that center the rights, dignity and voices of incarcerated people rather than treating them as passive subjects of misguided public health surveillance.
Researchers from Boston University's College of Engineering contributed to this research.
