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Public Health

New Research Traces the Evolution of Wastewater and Environmental Surveillance in Carceral Settings and Analyzes the Ethical, Medical, Legal Challenges

“A public health system that operates with rigor and accountability in all settings, including those most removed from public view, is the only kind of system that can be trusted to protect everyone.”

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.

In a brief analytic essay in the American Journal of Public Health, a team comprised of Boston University and University of Louisville researchers found that carceral WES is neither fully covered by human subjects protections nor fully accountable to traditional public health guidelines, producing a fragmented regulatory landscape in which some safeguards impede informed and effective research while others fail to prevent misuse or harm to incarcerated individuals and surrounding communities.

“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.

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.

Alysse G. Wurcel, MD, MS

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.