Qualitative assessment of a novel results-based partnership between national wastewater surveillance centers of excellence and utility companies, Houston (Texas), Colorado, Wisconsin, and California, 2023

The U.S. Centers for Disease Control and Prevention (CDC) initiated the National Wastewater Surveillance System (NWSS) in September 2020. Four initial Centers of Excellence (COEs) were established between 2021 and 2023 in Houston (Texas), Colorado, Wisconsin, and California to guide wastewater surveillance efforts for public health. Our objective was to increase understanding of factors that facilitated implementation of wastewater surveillance from the perspectives and experiences shared by health department COEs and wastewater utility partners. We used purposive sampling to select one key respondents from each of the four COEs and four respective wastewater utility partners. We conducted eight in-depth interviews related to the implementation of wastewater surveillance and identified common experiences and key points from interview transcription files. Insights on WWS implementation from COEs and wastewater utility partners were distilled from the responses into lessons learned. Three primary themes emerged after we analyzed the interview responses: perceived community benefits from wastewater surveillance, collaboration and trust building among partners that helped program advancement, and sustainability strategies and considerations. This analysis provides insights into novel collaborations between utility companies and the public health sector. It highlights the need to have leadership support for program continuation and to help showcase the public health importance of WWS.