WasteWatch

WasteWatch leverages wastewater surveillance as an innovative, cost-effective approach to gain comprehensive insights into antibiotic resistance patterns within communities in Tanzania. By developing new biosensors and data analysis tools, our solution aims to enhance understanding, safeguard public health, and help curb the spread of drug-resistant infections in resource-constrained areas.

Edina Mwakipesile, CEO and Principal Investigator of WasteWatch Tanzania, is a public health expert with 15+ years of experience in community-based screening and surveillance programs in Tanzania.

The emergence and spread of antimicrobial resistance (AMR) poses serious challenges in Tanzania and globally. In Tanzania, access to clean water and sanitation is limited, with only 61% having basic water and 32% basic sanitation. This lack of infrastructure contributes to widespread waterborne illnesses. While nationwide statistics are lacking, a 1997 cholera outbreak in Tanzania caused over 40,000 cases and 2,000 deaths. Climate change is also exacerbating disease outbreaks through impacts on weather patterns. 

A major knowledge gap exists around how antibiotic resistance genes (ARGs) disseminate through Tanzania's environment and water systems. With limited individual-level testing, understanding environmental resistance transmission pathways is critical for guiding public health interventions. Our communities in Dar es Salaam and Mwanza rely on surface water sources with unknown AMR contamination risks. However, wastewater surveillance (WS), which monitors sewage for ARGs, has not been utilized due to the lack of optimized protocols and data analytics capacity.  

WasteWatch directly addresses these challenges by establishing a WS program and analyzing data in partnership with local health authorities and universities. We will develop low-cost biosensors to expedite WS sample processing. 

Our solution primarily serves the over 55 million people in Tanzania who are at risk from drug-resistant infections. More directly, we support the Tanzanian Ministry of Health, Community Development, Gender, Elderly and Children which oversees healthcare for the entire population. Their Antimicrobial Resistance National Strategic Plan aims to curb AMR but is limited by inadequate local surveillance data. 

We also directly serve healthcare facilities that treat over 12 million outpatient and 1 million inpatient cases annually where antibiotic prescribing is common. By optimizing therapy, our solution can improve patient outcomes at these over 6,000 dispensaries and 600 hospitals nationwide. 

The 1.7 million residents of Dar es Salaam and Mwanza, our target regions, will particularly benefit from our environmental monitoring efforts. Over 70% of their populations lack access to safely managed sanitation and rely on surface waters that may spread drug resistance. 

By quantitatively engaging over 500 stakeholders through focus groups and surveys, we aim to understand site-specific needs. Our consultations with key decision-making partners like the Dar es Salaam Water and Sewerage Corporation, which serves piped water to 87% of Dar residents, will ensure the relevance and uptake of WasteWatch's antimicrobial stewardship tools.

Our solution provides several key public goods:

1) Open-source biosensor technology: By open-sourcing the hardware designs, software protocols and operating procedures for our portable ARG detection devices, we make the core technology globally accessible for replication, adaptation and improvements by other researchers. 

2) Cloud-based data analytics platform: All wastewater surveillance data, results of analyses showing associations between variables, and interactive visualization dashboards will be hosted on a publicly-available cloud platform with no usage fees. This provides a freely accessible big data resource for policymakers and scientists worldwide.

3) Peer-reviewed publications: Findings from our pilot implementation and initial insights generated on AMR dynamics from integrating diverse data streams will be published in open-access journals and reports. This contributes to the growing body of scientific knowledge in this field. 

4) Policy frameworks: By engaging Tanzanian stakeholders and directly applying integrated results, we aim to produce evidence-based policy templates and recommendations that can guide decision-making internationally. 

In this way, the WasteWatch solution uniquely delivers multiple public goods that advance global understanding and response to antimicrobial resistance through openly-accessible innovation, data, knowledge and guidance.

Our solution aims to have significant impact in Tanzania in the following ways:

Surveillance Impact:
- By monitoring 100,000 wastewater samples over 3 years from 12 cities across Tanzania, we expect to gather data on emerging ARGs affecting over 15 million people in those urban communities.

Healthcare Impact:  
- Insights from 15,000 patient surveys per year could help optimize antibiotic use at 150 healthcare facilities serving over 1.8 million patients annually, improving outcomes for resistant infections.

Environmental Impact:  
- Identifying sources of resistance from 10 major wastewater treatment plants could reduce contamination of surface water relied on by over 3 million people for daily needs like cooking and washing.

Policy Impact:
- Engaging over 600 local stakeholders through annual workshops will support national plans to curb inappropriate antibiotic sales of over $120 million annually, slowing the growth of resistant infections across Tanzania. 

By expanding to a nationwide surveillance network over 3 years while continuing to integrate findings with stakeholders, our solution aims to more directly support public health monitoring and decisions benefiting the well-being of over 15 million Tanzanians. 

Over the next year, we aim to complete our proof-of-concept pilot study and finalize the design of our scalable technology and data integration platform. Specifically:

- Pilot test biosensors and wastewater/survey data collection in 2 cities, engaging 100 respondents total. 

- Analyze initial pilot results to refine devices, sampling procedures and integration approach.

- Publish findings and present to national health stakeholders to gain partnerships.

In the next 3 years, we will scale our efforts nationwide as follows:

- Roll-out biosensors to surveillance sites in 12 major cities, expanding to 100,000 wastewater samples analyzed. 

- Administer 15,000 patient surveys integrated into the platform annually. 

- Onboard health and environmental data from our 12 pilot regions, totaling over 1.8 million patients.

- Expand stakeholder engagement to over 600 participants per year through conferences, workshops. 

- Continuously refine our models and analytics dashboards to optimize insights.

- Publish 2-3 studies per year demonstrating impact of our integrated approach on public health policy and practices.

By the end of the 3rd year, we aim to establish WasteWatch as the leading source of AMR epidemiological evidence for Tanzania, directly informing national strategies through scalable and sustained deployment of our innovative technologies.

Some key metrics we will use to measure our success and impact:

1) Number of wastewater samples analyzed annually - Target Y1: 360, Y3: 100,000. 

Pilot progress: 60 samples analyzed to date with 90% success rate.

2) Number of surveys administered - Target Y1: 300, Y3: 15,000.  

Pilot progress: 120 surveys collected from 2 cities with 80% completion rate.

3) Stakeholder engagement - Target Y1: 50 participants in 2 workshops, Y3: 600 in 12 workshops annually.

Pilot progress: 20 local leaders engaged in initial sensitization meetings.

4) Policy recommendations adopted - Target Y1: 2 accepted by municipal governments, Y3: 8 adopted nationally. 

5) Health outcomes impacted - % decrease in resistant infection incidence correlated to WasteWatch results in pilot communities. 

We will measure these metrics each 6 months and annually to track progress towards targets. Qualitative feedback will also assess effectiveness, challenges to address, and emerging impact pathways for refinement. Regular reviews against goals will guide optimization of our solution over time.

Some key barriers we anticipate and our plans to overcome them:

Financial: Limited funding constrains scale up. We will apply to global science funders and impact investment funds targeting AMR by highlighting integrated approach and potential returns. 

Technical: Harsh field conditions risk device durability. Additional pilot testing under extreme heat/humidity alongside local technicians will improve design robustness.

Infrastructure: Reliance on central labs slows response time. Deploying modular, locally-assembled sensors at multiple small lab hubs near sampling sites overcomes this.

Policy: Resistance data alone may not drive local decisions. Our community engagement strategy educating on One Health model building surveillance into existing routine monitoring will address. 

Partnership: Coordination across sectors/regions challenging. By incentivizing data sharing through our open access platform and establishing formal MOUs, we mitigate siloed working.

To start, seed funding from our University and philanthropic partners covers 1 year operating costs. Thereafter, piloting under extreme conditions with local experts and engaging stakeholders on interdependent solutions using our multi-partner platform design will help maximize feasibility and acceptance, ultimately positioning us to scale successfully within 3 years through competitive external funding.

We are applying to The Trinity Challenge because it directly aligns with our goals and is well-positioned to help us overcome key barriers.

Our integrated data and community-driven approach directly responds to the Challenge's aim of developing solutions addressing antimicrobial resistance through collaborative One Health partnerships. 

However, a core barrier we face is the lack of funding required to deploy our technology at scale and rigorously evaluate impact. The Trinity Challenge's focus on catalyzing ideas through substantial seed funding is perfectly aligned to help us overcome this financial barrier over the next 3 years of implementation.

An additional barrier is moving ideas from pilot to practice. The Challenge's focus on supporting solution maturity will help surge capacity for our small team as we expand nationwide. Its framework of mentorship and active support through the implementation phase will be invaluable. 

Lastly, sustainability is challenging without demonstrating clear impact and cost-effectiveness. The Trinity Challenge's focus on high-quality evaluation will generate robust, publishable evidence to attract additional long-term funding and ensure our work continues having impact for years beyond the initial seed funding period.

We would like to work with organizations that could help initiate, accelerate, or scale solutions to global health challenges through collaboration, including:

- Bill & Melinda Gates Foundation: As one of the world's largest private foundations focused on global health and development, their expertise, networks, resources and funding could help significantly scale impactful solutions.

- Global Virome Project: Their goal of identifying dangerous pathogens before they emerge could align well with solutions addressing future pandemic preparedness and response. Collaboration could strengthen surveillance and identification capabilities. 

- GSK: As a major global pharmaceutical company, their R&D, clinical trial expertise and capabilities in areas like vaccines could help accelerate translation of new solutions into scalable products or programs.

- Imperial College London: Their Global Health Innovation Centre brings together experts across disciplines to tackle global health challenges. Collaboration could leverage their multi-sector knowledge and networks.

- Tencent: As one of the world's largest technology companies, they have capabilities in areas like AI, cloud services and digital platforms that may assist with scaling data-driven solutions or creating new digital public health tools.