Future Prospects for Water, Waterborne Pathogens and Public Health

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This work is being shared with NCBI under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License . Governors, American Academy of Microbiology GOVERNORS, AMERICAN ACADEMY OF MICROBIOLOGY Vanessa Sperandio, Ph.D., Chair University of Wisconsin–Madison Karen C. Carroll, M.D. Johns Hopkins University School of Medicine Sean Crosson, Ph.D. Michigan State University Suzanne Fleiszig, O.D., Ph.D. University of California Berkeley Susan Golden, Ph.D. University of California San Diego Jay T. Lennon, Ph.D. Indiana University Melissa B. Miller, Ph.D. University of North Carolina at Chapel Hill School of Medicine Susan E. Sharp, Ph.D. Copan Diagnostics Alfredo Torres, Ph.D. University of Texas Medical Branch Paul E. Turner, Ph.D. Yale University Susan Weiss, Ph.D. University of Pennsylvania Henry Neal Williams, Ph.D. Florida A&M University COLLOQUIUM STEERING COMMITTEE Rita Colwell, Ph.D., D.Sc. (Co-Chair) University of Maryland at College Park and Johns Hopkins Bloomberg School of Public Health Antarpreet Singh Jutla, Ph.D. (Co-Chair) University of Florida Nur A. Hasan, Ph.D., MBA Arius Bioscience and EzBiome Inc. Jonathan Patz, M.D., MPH University of Wisconsin–Madison Guru Madhavan, Ph.D., MBA National Academy of Engineering Andrea Ottesen, Ph.D. U.S. Food and Drug Administration PARTICIPANTS Kristen L. Beck, Ph.D. IBM Research–Almaden Jesse E. Bell, Ph.D. University of Nebraska Medical Center and University of Nebraska–Lincoln Kyle D. Brumfield, Ph.D., M.Sc. University of Maryland at College Park Cynthia Collins, Ph.D. Ginkgo Bioworks Mary “Molly” Finster, Ph.D. Argonne National Laboratory Jay Garland, Ph.D. U.S. Environmental Protection Agency Jack A. Gilbert, Ph.D. Scripps Institution of Oceanography, University of California San Diego Charles N. Haas, Ph.D. Drexel University Vincent Hill, Ph.D., MS U.S. Centers for Disease Control and Prevention Scott A. Jackson, Ph.D. National Institute of Standards and Technology C. Sunny Jiang, Ph.D. University of California Irvine Samantha Joye, Ph.D. University of Georgia Venkataraman (Venkat) Lakshmi, Ph.D. University of Virginia Upmanu Lall, Ph.D. Arizona State University Jay T. Lennon, Ph.D. Indiana University Karen Levy, Ph.D., MPH University of Washington School of Public Health Erin Lipp, Ph.D. University of Georgia Elena Litchman, Ph.D. Michigan State University Victoria McGovern, Ph.D. Burroughs Wellcome Fund Sandra McLellan, Ph.D. University of Wisconsin–Milwaukee Katherine (Trina) McMahon, Ph.D. University of Wisconsin–Madison Patrick Monfort, Ph.D. Centre National de la Recherche Scientifique (CNRS), University of Montpellier Thanh (Helen) Nguyen, Ph.D. University of Illinois Barbara Ransom, Ph.D. National Science Foundation Kellogg Schwab, Ph.D., MHS Johns Hopkins University Bloomberg School of Public Health Jeffrey Shaman, Ph.D. Columbia University Mailman School of Public Health The American Academy of Microbiology is grateful for the Association for the Sciences of Limnology and Oceanography's and Burroughs Wellcome Fund's support of this project. Executive Summary Humans were once nomadic, constantly moving in search of resources. However, the Industrial Revolution marked a significant turning point. We chose to abandon our wandering ways and establish permanent settlements, creating communities designed to meet our diverse needs. Water, an elemental necessity for life, continued to be a crucial resource. Yet we failed to foresee how fluctuations in water availability would profoundly affect the ecology of environmentally sensitive pathogens, thereby impacting human health in unforeseen ways. This oversight has led to complex challenges in managing water resources and safeguarding public health functions. With more than 3.5 million deaths each year attributable to waterborne pathogens, it is a critical time to question our ability to understand the relationships between water and public health, particularly to the etiological pathways in which environmentally sensitive pathogens interact with human populations and have resulted in major pandemics of our times. We also need to provide introspection on the very basic tenet of life: is safe water a right or a privilege? This report seeks scientific scholarship and evidence to answer this question, with particular emphasis on waterborne pathogens as the key indicators of safe water available for humans. This report is based on the deliberations of experts who participated in a colloquium on December 5 and 6, 2024, organized by the American Academy of Microbiology, the honorific leadership group and think tank within the American Society for Microbiology (ASM), and the American Geophysical Union (AGU). These experts, from various fields and sectors, focused on how changes in water and the environment affect the spread of infectious diseases. They reviewed current knowledge and identified key gaps in understanding the relationship between water and disease-causing microorganisms in today's world. They identified several key issues to enhance public health. Expand collaboration and engagement. Experts in earth sciences, microbiology, hydrology and public health along with community leaders need to collaborate. Strengthen water systems. Modern and resilient water infrastructure allows for improved water safety, reduced disease risk and sustainable economic benefits. Improve knowledge sharing. Integrate data systems that link Earth observations and weather parameters with public health information for proactive public health support. Introduction All living organisms, from the tiniest microbes to the largest mammals, rely on water for survival. However, availability and quality of this crucial resource are increasingly unpredictable due to various factors. Microbes, including those that cause disease, play a vital role in water systems and are essential for maintaining life on Earth. Several factors contribute to the variability of water resources. Variable weather patterns. Enhanced variability in weather and climate processes is altering precipitation and temperature, affecting water availability. Pollution. Industrial, agricultural and urban pollution are contaminating water sources, making them unsafe. Population growth. Increasing human populations are putting more pressure on water resources, leading to shortages and conflicts. These changes not only limit the availability of clean water but also create new pathways for humans to interact with pathogens. As water becomes scarcer and more polluted, the risk of waterborne diseases increases. To build a resilient response to these health challenges, it is crucial to understand how environmental changes impact waterborne pathogens. This involves studying the interactions between weather, water and climate processes. The goal is to generate knowledge for a deeper understanding of these dynamics, so that we can develop strategies to protect public health and ensure sustainable water management for future generations. More than 3.5 million deaths are attributed to waterborne pathogens annually (Wellcome 2024). Globally, 1 in 3 people do not have access to safe consumable water, putting a vast number of people at risk of waterborne pathogens ( UNICEF 2019 ). Microorganisms, such as viruses, bacteria and protists, are found in all water systems. A subset of microbes can cause disease when humans drink or interact with water contaminated by those microbes, known as waterborne pathogens. Waterborne diseases include a range of illnesses caused by pathogens such as Vibrio cholerae (cholera), Salmonella (typhoid fever), Hepatitis A, Norovirus, Giardia lamblia and Cryptosporidium . These diseases can lead to severe health outcomes, including diarrhea, which is a leading cause of death among children under 5 years old. In the United States, waterborne diseases affect over 7 million people annually, resulting in approximately 601,000 emergency department visits, 118,000 hospitalizations and 6,630 deaths. The direct healthcare costs associated with these illnesses are estimated to be around 3.33 billion USD per year. Globally, the World Health Organization (WHO) estimates that 1.4 million deaths and 74 million disability-adjusted life years (DALYs) could have been prevented with safe water, sanitation and hygiene (WASH) services in 2019. Unsafe WASH services are linked to 69% of all diarrheal deaths and 356,000 deaths from acute respiratory infections. Innovations in public sanitation systems in the 19th century, such as the development of sewage systems and water treatment facilities, greatly reduced the burden of waterborne diseases and death. However, aging infrastructure and increasingly extreme weather events pose severe risks to safe drinking water for a growing global population. Water-related weather events are expected to increase in frequency, intensity and duration, via excessive rainfall, floods and droughts. These events can lead to contamination of water supplies, exacerbating spread of waterborne diseases. Addressing the global burden of waterborne diseases requires significant investment in modernizing water infrastructure and improving access to safe water and sanitation. This is crucial to reduce the health and economic impacts of these preventable illnesses. More recently, in 2024 alone, water-related natural disasters, such as flooding, cyclones and hurricanes, caused more than 8,700 deaths and over 550 billion USD in damage globally (Global Water Monitor 2025). These storms heighten microbial pathogen exposure, thereby increasing the risk of infection. Skin, gastrointestinal and respiratory infections have increased after severe storms ( Liang and Messenger 2018 ; Lynch and Shaman 2023 ). In addition, warming temperatures are associated with increased incidence of vector-borne and waterborne infections ( Levy et al. 2016 ; Paz 2024 ). Globally, the number of waterborne infections is rising and expected to increase because of aging sanitation systems and more extreme weather events ( Levy et al. 2018 ; Kunz et al. 2024). More than 4 billion people globally, the majority of whom live in low- and middle-income countries, access water from unmonitored and unsafe sources ( Greenwood et al. 2024 ). Building more robust water surveillance systems can increase pathogen monitoring and reduce outbreaks. In addition, environmental data linked with public health information can be used to develop predictive models to anticipate waterborne disease outbreaks and thereby offer proactive warnings of local health risks from contaminated water. This report is based on deliberations of experts in microbial sciences, infectious disease, hydrology and climate science who participated in a colloquium on December 5 and 6, 2024. The event was organized by the American Academy of Microbiology, which is the honorific leadership group and think tank within the American Society for Microbiology, and the American Geophysical Union. The colloquium was also supported by the Association for the Sciences of Limnology and Oceanography. Participants focused on the critical role of water and environmental variability in the transmission and distribution of infectious pathogens. They reviewed the current understanding of and outlined key knowledge gaps about the interplay of water and pathogenic microorganisms in today's world. Discussions highlighted the impact of extreme weather events and aging infrastructure on water safety and public health. From their discussions, the participants developed a holistic strategy for managing water resources and leveraging global data to improve human health and well-being. They identified several key issues to enhance public health. Modernizing water infrastructure. Investing in advanced water treatment and distribution systems to ensure safe drinking water. Enhancing surveillance and monitoring. Implementing robust systems to track water quality and pathogen presence. Promoting interdisciplinary research. Encouraging collaboration across microbial sciences, hydrology and climate science to address complex challenges. Improving public awareness and engagement. Raising awareness about the importance of safe water and sanitation practices and engaging with local communities to co-develop collaborative solutions. The report underscores the urgency of addressing the global burden of waterborne diseases through coordinated efforts and innovative solutions. Integrating scientific knowledge and technological advancements can mitigate the risks posed by waterborne pathogens and enhance global health outcomes. Brief History of Sanitation, Public Health and Waterborne Diseases Water treatment dates back to ancient civilizations, with early methods like solar radiation, boiling and filtration recorded in India (2000 B.C.E.) and Minoa (3200–1100 B.C.E.) ( Mala-Jetmarova et al. 2015 ). Greek (eight to sixth century B.C.E.) and Roman (100 B.C.E. to 500 A.D.) civilizations had long-distance aqueducts and the ancient Incan city of Macchu Picchu (1450–1540 A.D.) had a sophisticated water conveyance system ( Wright et al. 1997 ; Mala-Jetmarova et al. 2015 ). The first well-documented large pumped water supply system was developed in the late 16th century to pump water from the River Thames to the London population ( Mala-Jetmarova et al. 2015 ). The River Thames in London also played a major role in the history of our understanding of waterborne disease transmission. Previously, diseases such as typhoid and cholera, which are now known to be caused by exposure to polluted water, were believed to be transmitted by sewer gas “miasma” (literally “foul air”) ( Barnes 2002 ). The focus of wastewater management at that time was based on separation of odiferous materials ( Beach 2022 ). John Snow's 1854 cholera investigation in London pioneered modern epidemiology, demonstrating the link between consumption of contaminated water and disease ( Johnson 2006 ). The advent of drinking water distribution and treatment systems occurred concurrently with the “epidemiological transition” observed in the early 20th century, when mortality rates fell precipitously and life expectancy rose. Although collection of waste and conveyance for discharge were recognized as alleviating immediate concerns, it was soon realized that the disposal of waste into bodies of water could result in contamination of the receiving waters. Water contamination led to diseases associated with degraded potable and recreational water. Municipalities pursued strategies of longer offshore pumping of waste and/or relocation of drinking water sources. At the turn of the century, major cities began to incorporate various aspects of modern water treatment and distribution systems into their municipal water supply services. The first large-scale municipal water system in the U.S. was built in Philadelphia at the dawn of the 19th century ( Cutler and Miller 2005 ). Many large cities subsequently followed in Philadelphia's footsteps and by 1940 most major U.S. cities had built filtration plants. Furthermore, the “urban penalty,” i.e., the higher mortality rates in urban populations, disappeared during this period ( Cutler and Miller 2005 ). Before 1900, the leading cause of death was infectious disease. By 1940, chronic conditions such as heart disease and cancer took the lead as causes of death ( Anderson et al. 2018 ). Originally developed to reduce discoloration and turbidity, the advantage for public health by water filtration was increasingly recognized. Chlorination, introduced in the early 20th century, provided a major advance. Jersey City was the first municipality in the U.S. to chlorinate its water supply. This approach quickly gained in popularity because of its cost-effectiveness ( Anderson et al. 2018 ). In conjunction with these water treatment measures, municipalities also began to recognize the importance of source water protection, to ensure clean water delivery to water treatment facilities ( Fig. 1 ). Economic analysis has suggested that provision of clean water was responsible for nearly half the total mortality reduction in major cities, three-quarters of infant mortality reduction and nearly two-thirds of child mortality reduction ( Cutler and Miller 2005 ). These improvements cannot be fully disentangled from other concurrent advances in urban areas, such as improvements in food safety, housing quality and nutrition, but it is widely believed that filtering and chlorinating drinking water was a major factor in the notable decline in typhoid mortality ( Anderson et al. 2018 ). Figure 1 General water treatment process. Source: CDC. At the same time, treatment of wastewater also improved, moving from direct discharge of sewage to rivers to conveyance of wastewater to treatment plants in recognition that water treatment alone was not adequately protective of public health ( Tarr et al. 1984 ). One of the first wastewater treatment plants using chemical precipitation was brought online in the U.S. in Worcester, Massachusetts in the late 1800s. Activated sludge technology was described in the early 1900s and the first of large-scale activated sludge wastewater treatment plants were built shortly thereafter. With increasing population and concern for environmental protection, further innovation in wastewater treatment occurred. These can be broadly characterized as follows. Primary treatment . Larger, coarser solids are physically removed, most frequently by gravity settling. Secondary treatment . Biological processes are used for degradation of organic material. This also results in reduction of pathogens by various mechanisms. The most common processes are trickling filters and activated sludge. Advanced/tertiary treatment . Further treatment by combinations of chemical, physical, and/or biological processes removes nutrients and trace organic compounds and achieves greater reduction of pathogens. With higher levels of tertiary treatment, the effluent can be suitable as a source of water supply. These processes include addition of chemical coagulants or precipitants, sand filtration, membrane filtration, activated carbon treatment and chemical oxidation. Disinfection . This may be done after secondary or tertiary treatment to achieve high levels of pathogen reduction, allowing discharge into recreational waters or in proximity to drinking water intakes. The disinfection processes most commonly used are chlorination, ozonation and ultraviolet light irradiation. Current Impact of Environmental Factors on Water, Waterborne Pathogens and Public Health Impact on Water and Water Microbes Projections estimate that global clean water demand will increase by 55% by 2050 due to rapid urbanization and environmental changes ( Panhwar et al. 2022 ). This surge in demand is driven by factors such as manufacturing, thermal electricity generation and domestic use ( Boretti and Rosa 2019 ). Many factors impact the availability of water resources, such as competition between communities seeking access, environmental pollution, temperature, ocean acidification and precipitation. Heavy precipitation events, which are becoming more frequent, can overwhelm stormwater infrastructure and water reservoirs, leading to flooding. Conversely, decreased precipitation can result in droughts that deplete water resources. Both scenarios pose significant challenges to natural and engineered water systems ( Berg and Hall 2015 ). For instance, floods caused nearly 100,000 deaths and affected 1.6 billion people between 2002 and 2021 (UNESCO 2024). Droughts, on the other hand, impacted over 1.4 billion people and caused 170 billion USD in economic losses during the same period (UNESCO 2024). Water quality degradation exacerbates water stress and demand for water resources suitable for human use ( Fig. 2 ). Wastewater infrastructure is particularly vulnerable to extreme weather, which can reduce treatment efficiency (Infrastructure Report Card 2025). Environmental variables like temperature and drought can increase biological oxygen demand and make waste streams more difficult to treat ( Motesaddi et al. 2025 ). Reduced rainfall can also increase corrosion in conveyance systems due to high concentration of pollutants, anaerobic conditions or higher salinity ( Hughes et al. 2021 ). Rising sea levels and intensified rainfall can disrupt resident microbes in various environments, further complicating water management ( Hamlington et al. 2024 ). Wastewater treatment plants (WWTPs) are also susceptible to extreme weather. Increased rainfall, rising temperatures and earlier snowmelt runoff can lead to untreated sewer overflows and increased flooding, which compromise the efficiency of WWTPs and raise energy consumption and maintenance costs ( Zouboulis and Tolkou 2014 ). Additionally, the scarcity of water resources due to environmental change necessitates increased wastewater reuse, further complicating treatment processes. These statistics highlight the urgent need for improved water management strategies to address the growing demand and the impacts of environmental changes. Figure 2 Impacts of environmental drivers on water resources and society. Source: California Department of Water Resources. Aquatic microorganisms are diverse and include members of all domains of life. They are key players in major biogeochemical cycles and ecosystems, including primary productivity (conversion of energy into organic compounds), nutrient recycling and water quality. The aquatic ecosystem harbors pathogenic microbes, including viruses, bacteria, fungi, cyanobacteria and microeukaryotes. Many are highly sensitive to changing conditions, with environmental drivers that include temperature, pH, salinity, resource availability, physical mixing, etc. Because species and their strains have different environmental responses, some may increase in abundance and others decline under given environmental conditions. Species whose traits enable fitness under given conditions are winners and the others are losers ( Dutkiewicz et al. 2013 ). Different responses of microbes to changing environmental parameters induce changes in microbial community composition and function, including pathogens ( Litchman et al. 2015 ; Cavicchioli et al. 2019 ; Kapetanović et al. 2024 ; Seymour and McLellan 2025 ). For example, toxic, bloom-forming cyanobacteria in fresh water can have higher temperature tolerance, hence are favored by higher water temperatures ( Thomas et al. 2016 ; Huisman et al. 2018 ; Litchman 2023 ). Increasing biomass of toxic cyanobacteria in lakes, rivers and coastal oceans is associated with poor water quality and negative consequences for animal and human health and local economies ( Hamilton et al. 2014 ; Chorus and Welker 2021 ). Cyanobacterial toxins can contaminate drinking water sources, negatively affect recreational activities and change aquatic food webs ( Hamilton et al. 2014 ; Chorus and Welker 2021 ). Thus, an entire ecosystem can deteriorate, with increased prevalence of waterborne pathogens due to stimulation of growth by environmental factors, namely, high temperature and hydrological change ( Levy et al. 2018 ). Pathogenic microbial taxa may be preferentially selected, e.g., some bacterial pathogens increase and viral pathogens decrease in number with increasing temperature ( Chua et al. 2022 ). The dependence on water of several infectious disease agents is well recognized. Bertuzzo and Mari (2017) provide a listing of infectious diseases associated with hydrology, namely, flooding, droughts and intense rainfall, the latter linked to diarrhea, cholera, schistosomiasis, micro- and macro-parasite infection, malaria, yellow fever, dengue and other illnesses. Water-related infectious disease outbreaks are catalogued in the Global Infectious Disease and Epidemiology Network (GIDEON). Beyond hydrology, GIDEON lists diseases correlated with population density and socioeconomic vulnerability ( Yang et al. 2012 ). Precipitation, water availability and temperature are considered most important, with respect to infectious disease outbreaks. Extreme climatic events have been associated with profound changes in composition and dynamics of aquatic microbial communities ( Philippot et al. 2021 ). Effects on microbes that occur after natural disasters comprise a “disaster microbiology,” where infections rise after extreme weather events ( Smith and Casadevall 2022 ). If conditions are close to or beyond tolerance limits of the microbes, richness and diversity of microbial communities decline ( Teittinen et al. 2022 ). Species-poor communities have proven more vulnerable to perturbation, with lower potential for maintaining key functions, such as productivity, nutrient recycling, stability, etc. ( Schmidt et al. 2020 ; Seidel et al. 2022 ; Teittinen et al. 2022 ). Understanding and predicting reorganization of aquatic microbial communities during changing environments are key to maintaining and enhancing global human well-being. Despite the many effects of environmental drivers on microbes, they have a strong capacity in adapting to novel conditions ( Lenski 2017 ). Microbes can evolve to have higher temperature optima when subjected to extremely warm temperatures or a tolerance to low pH and toxic compounds ( O’Donnell et al. 2018 ; Scheuerl et al. 2020 ; Mathivanan et al. 2021 ). The microbial adaptive capacity, with respect to novel environments, depends in large part on abiotic drivers and biotic interactions ( Scheuerl et al. 2020 ; Aranguren-Gassis et al. 2019 ). Also, adaptive capacity differs among microbes, with the challenge being to determine the capacity of aquatic microbes to adapt to many environmental drivers simultaneously and also to understand how their community composition and diversity may change in the future ( Levin and Bergstrom 2000 ). Box Waterborne Infections After Extreme Weather in Florida Case Study. Public Health Impact The environment plays a significant role in disease transmission. Rising temperatures, shifting precipitation patterns and extreme weather events influence spread of pathogens and infectious disease ( Fig. 3 ) ( Bell et al. 2018 ). Extreme weather events drive pathogen transmission by increasing exposure, degrading water quality and reducing sanitation effectiveness ( Patz et al. 2008 ; LaKind et al. 2016 ). Simply stated, floodwaters spread contamination from human and animal waste and droughts reduce the ability of water bodies to dilute pollutants. These extremes result in the spread of infectious diseases, highlighting a critical link between hydrology and infectious disease. Thus, where combined with an aging water infrastructure, the ability of water systems to protect against spread of disease is severely weakened ( Olds et al. 2018 ). Figure 3 Links among environmental drivers, water quality and exposure to waterborne pathogens. Source: U.S. Global Change Research Program. Wastewater systems are increasingly vulnerable to changing weather patterns, which can significantly affect efficiency and reliability. Their failure pose significant risk to public health since untreated or partially treated sewage discharged into local waterways will contaminate the water source and increase risk of waterborne disease. For example, hurricanes and floods have caused widespread power outages and the bypassing of billions of gallons of untreated sewage into water bodies (Kenward et al. 2013). Adaptive strategies, such as infrastructure upgrade, technological innovation and energy-efficient design, are essential to ensure wastewater system resilience and provide safe water. Although there has been progress in understanding how environmental parameters affect public health and influence water-related health issues associated with waterborne pathogens, significant knowledge gaps remain. An effective response to changes in temperature, humidity and other climate parameters is needed because they influence microbial evolution, particularly antimicrobial resistance. Since weather extremes drive sequential weather events like flooding and drought, how they influence pathogen spread and impact treatment systems needs attention. Contamination of coastal aquatic environments also occurs with recreational activities. Crowded beaches contribute to fecal pollution of the water and spread of antibiotic resistance genes ( Toubiana et al. 2021 ). Relatively little is known about direct risk to public health, especially during heat waves. Many case datasets compiled for specific infectious diseases lack sufficient resolution to determine climate-related outbreaks, making it very difficult to link environmental conditions to the emergence of a specific disease. Stronger surveillance and an expanded monitoring system are essential for an effective public health system. Specific public health information needed includes climate-related stressors that influence disease transmission, especially challenges to sanitation. When floods spread contaminants to soil or water and droughts retain and accumulate pathogens in high concentrations, both of which occur in tandem, the complex conditions created make predicting the outcome very difficult. Thus, to respond effectively to both ongoing and emerging threats, public health systems must be dynamic, proactive and adaptable. In summary, both infrastructure and the assessment of current threats require strengthening. Wastewater infrastructure in particular is susceptible to both extreme weather and changes in precipitation resulting in reduced treatment efficiency. For example, warmer temperatures allow increased biofilm formation in water pipes and faster decay rates for chlorine. Because private wells are not subject to the same safety standards as public water systems, landowners are responsible for monitoring. There is a critical need for education, outreach and testing to minimize risk of contaminated water ( Peer et al. 2024 ). Smaller municipal systems require aging infrastructure to be upgraded and monitoring established to identify and mitigate threat. Thus, risk and vulnerability assessment are crucial to identify areas of concern and to forecast geographic locations with higher risk in coming decades ( Ebi et al. 2021 ). Future Prospects for Water, Waterborne Pathogens and Public Health Predictive Models for Outbreaks and Health Risk More than 4 billion people worldwide do not have access to safe drinking water; hence solutions to bolster sanitation infrastructure and predict waterborne health risks will have to adapt to local needs ( Greenwood et al. 2024 ). Environmental and public health data integrated into infectious disease models can inform public health decisions and reduce waterborne disease (see the Vibrio case study). Earth observation and sensing data systems that are easily accessible, integrated with public health information and reflect local conditions are examples of using “environmental intelligence” to inform resilience and mitigation options for public health. Earth Observations and Sensing Studies have highlighted linkages between hydrology, the water cycle and infectious diseases. Hydrological indicators have been used to monitor mosquito-borne West Nile virus transmission ( Shaman and Day 2005 ). Increase in infectious disease is evident after hydrologic disasters such as floods and droughts ( Liang and Messenger 2018 ). However, many studies were either regional in nature, based on models or conducted over short time periods. Since infectious disease outbreaks generally are regional in geography, there is always a potential for spread and therefore continental scale analysis is required. In addition, most regions of the world lack in situ observations of critical environmental parameters, e.g., precipitation, soil moisture and standing water, or the data are not publicly available. Publicly available Earth observations help regional, continental and global analysis ( Fig. 4 ). Data are generally available for the past two to three decades, thereby ensuring temporal continuity in analysis (see the Vibrio case study). Quantification of the water cycle that includes flux (precipitation) and storage (standing water and soil moisture) is essential to informing disease models, specifically for prediction, and are of significant public health value. These Earth observations are easily accessible to users and require little or no background knowledge of remote sensing theory or data structure, which makes it easy to use in public health research and application. Data sets can be used for stand-alone analysis and/or as input to infectious disease models. Figure 4 Examples of hydrological Earth observations. Source: Space4Water Portal. Precipitation. The Global Precipitation Measurement (GPM) mission is an extension of the Tropical Rainfall Measuring Mission (TRMM) that provides global scale rainfall and snow estimates. It was launched in February 2014 and has been providing precipitation retrievals of 0.1 resolution and several timescales, from 30 minutes to daily, on a global scale (60S–60N), for better understanding of rain and snow processes under normal or extreme conditions, as well as for improving accuracy of hydrology and weather models ( Hou et al. 2014 ). The Integrated Multi-satellitE Retrievals for GPM contains data from the early and most recent precipitation estimates from TRMM (2000–2015) and GPM (2014–present) ( Huffman et al. 2015 ). Soil moisture. The Soil Moisture Active Passive mission provides medium spatial resolution and frequently revisits the soil moisture and freeze/thaw state on a global scale. It operates on a near-polar Sun-synchronous orbit with 6 a.m./p.m. overpass times and has a constant incidence angle of 40 degrees, as well as a 1000-km-wide swath that allows a 2–3 day global revisit ( McNairn et al. 2014 ; Chan et al. 2016 ; Chan et al. 2018 ; Colliander et al. 2017 ). Meanwhile, the Soil Moisture and Ocean Salinity satellite carries an L-band radiometer to observe topsoil layer soil moisture and sea surface salinity. Surface water. The ability to observe the location of water bodies and pooling, or surface water extent, especially during flood events, is essential for infectious disease models and studies. Space-borne remote sensing applications from missions such as Sentinel-1, Landsat, the Cyclone Global Navigation Satellite System and the Surface Water and Ocean Topography provide large-scale surface water extent mapping. Through the combination of multiple missions, global surface water extent can be observed nearly daily, providing timely and accurate information on water body dynamics. Accessing real-time data on pathogen dynamics will help improve epidemic predictive models. Yet, research is still needed to understand better the relationship between viral dynamics in wastewater and a disease outbreak and how to refine the sampling strategy according to the level of information sought. Furthermore, wastewater-based epidemiology provides useful information to inform public health decisions at the national, local, city and regional levels. Clearly, it should be a component of public health strategy. Box Vibrio Outbreak Case Study as an Example of Using Satellite Data to Improve Public Health. Public Health Data To enhance water safety, public health organizations and researchers will need to focus on improving surveillance and harmonizing data systems to foster better integration of Earth observations with public health data. This will provide opportunities to improve understanding of these relationships, as well as leverage machine learning and other analytical tools to assess emerging threats. There exists a large amount of publicly available information on waterborne disease outbreaks. For instance, the U.S. Centers for Disease Control and Prevention (CDC) hosts the Waterborne Disease and Outbreak Surveillance Reporting system and the European Centre for Disease Prevention and Control (ECDC) provides surveillance and updates on food- and waterborne diseases. However, these data are not always well integrated with local environmental information. Monitoring systems should be reevaluated to enhance environmental data integration. For example, reporting systems could emphasize individual event tracking and higher-resolution data to capture dynamic changes better (see the malaria case study). This information should be integrated with structured metadata frameworks and descriptive ontologies to support programmatic assessment and predictive models. It will be critical to secure and enhance information resources and harness the burgeoning array of quantitative tools for real-time disease monitoring and public health support. At the same time, it should be recognized that microbial outbreaks and the models used for their identification are dynamic in nature. As digital infrastructure is built for earlier and more sensitive detection, these systems must also be adaptable to emerging pathogens with genetic exchange and changes in the underlying modeling technologies for their prediction. Additionally, clinical records are highly regulated with little public access, making it more difficult and time intensive to connect records of illness to larger outbreaks or environmental factors. Data systems that ensure patient privacy while enabling real-time data sharing on outbreaks need to be developed and integrated into waterborne pathogen monitoring systems. This goal requires investment; however, the health and economic benefits will be enormous. For seamless integration among different systems, data harmonization and reporting standards will be necessary to ensure scientists from many different disciplines, e.g., public health, microbiology, hydrology and climate science, can all utilize the same data sets effectively. The World Health Organization (WHO) outlined consistent standards for monitoring, reporting and managing waterborne infections ( Fig. 5 ) (WHO Regional Office for Europe 2019). Likewise, other initiatives such as the National Microbiome Data Collective have aimed to create a framework for standardizing and structuring metadata data collected for these microbial samples (genomics, microbiome, proteomics or metabolomics) ( Vangay et al. 2021 ). Supporting public health systems to apply these standards worldwide can provide valuable information to track and monitor outbreaks. Figure 5 WHO protocol for developing and establishing a water-related infectious disease surveillance system. Source: WHO Regional Office for Europe 2019. Though waterborne diseases are a global problem, solutions that meet local needs and conditions merit priority. Each region has a unique set of factors, such as average temperature range, precipitation level, geography, established infrastructure and population. In addition, incidence and occurrence of specific waterborne pathogens vary significantly across countries, regions and communities. Monitoring and data systems need to be tailored to specific factors of each region and aligned with their public health system. Given that resources for monitoring are limited, citizen and community science initiatives including sequencing at the edge can play a valuable role in expanding data collection and improving long-term monitoring. These efforts should engage with local stakeholders to co-develop systems that meet the needs of the local community. The rising incidence and geographic expansion of waterborne infections highlight the need for proactive, data-driven public health interventions. By integrating predictive models with localized water safety initiatives, health agencies can mitigate risks associated with waterborne pathogens while promoting sustainability of the aquatic ecosystem. Specifically, water-related infection disease data collected thus far can be used to augment foundation models, which could then be fine-tuned to address specific geographic or pathogen constraints. Continued advancements in high-resolution environmental monitoring, coupled with community engagement and infrastructure investment, will be essential to ensuring water safety and reducing the global burden of waterborne infections. Box Malaria Case Study for Linking Clinical and Environmental Data to Improve Public Health. Sustainable and Updated Infrastructure that Promotes Public Health and Economic Benefits The lack of sufficient water, sanitation and hygiene (WASH) services worldwide results in estimated annual economic losses totaling 260 billion USD, which encompasses healthcare costs and productivity loss as well as premature deaths and wider socioeconomic damage ( Hutton et al. 2012 ; World Bank 2016 ). The reported economic losses from inadequate WASH services significantly underestimate the true burden since they fail to include indirect expenses like reduced agricultural productivity (see the water reuse case study) and environmental-related vulnerabilities along with educational setbacks caused by child diarrheal cases. Box Economic Highlights. In the U.S., extreme weather events have significant financial and public health implications especially regarding waterborne disease transmission. Annually, waterborne diseases in the U.S. result in approximately 7.2 million illnesses and 6,630 deaths, with a direct healthcare cost estimated at 3.3 billion USD per year ( Collier et al. 2021 ). Tropical cyclonic storms in the U.S. between 1996 and 2018 led to a 48% rise in Shiga toxin producing Escherichia coli infections one week post-storm, a 42% increase in Legionnaires’ disease two weeks after storm events, and a 52% surge in cryptosporidiosis cases during storm weeks ( Lynch and Shaman 2023 ). Beyond healthcare expenses, natural disasters impose extensive economic burdens from destruction of transportation, health care, residential and commercial infrastructure. Science-based multisectoral interventions represent investments that deliver substantial benefit-to-cost ratios. According to the WHO, investment in water and sanitation infrastructure generates economic returns of $4.30 for every $1 spent through decreased disease burden and better productivity ( Hutton and Haller 2004 ). In high-risk environments, including areas prone to increasingly occurring extreme weather events, the return can be as high as 7:1, underscoring the importance of implementing data-driven and scalable solutions adapted to local needs. Engineered systems for safe drinking water benefit society by reducing infections, thus lowering public health costs ( Collier et al. 2021 ; WHO 2023 ). However, current water systems are aging and operating beyond their designed lifespan. These systems can be impacted by extreme weather events, such as flooding or heat waves, overwhelming the systems and lowering efficacy of overall treatment. Since 1980, the U.S. has experienced over 400 weather and climate disasters, each with damages exceeding 1 billion USD, culminating in a total cost surpassing 2.1 trillion USD ( Smith 2020 ). Specifically, floods, often linked to waterborne disease outbreaks, caused approximately 135 billion USD in damages between 1990 and 2022 ( Liu et al. 2024 ). The annual average of extreme weather events for 1980–2024 was 9, while the average for the past 5 years (2020–2024) was 23 ( Smith 2020 ). As extreme weather events are by no means lessening in frequency, the future holds critical challenges for public health preparedness and water system infrastructure. Investments in water infrastructure are needed that take changing environmental parameters and extreme weather events into account. This includes building more decentralized solutions that address region-specific geographical and environmental conditions and meet the needs of the local community. Microbes underpin wastewater infrastructure and are potential targets to counter the stressors of environmental variability and the economic and ecosystem costs associated with infrastructure failures. Estimates made by the U.S. Environmental Protection Agency in the 2022 Clean Watersheds Needs Survey found that 630 billion USD is needed to bring wastewater infrastructure up to standard operating levels, even without considering the additional pressure of extreme weather events. Li et al. described city level adaption actions for multiple environmental challenges but emphasized the need for future modeling efforts to pinpoint effective strategies ( Li et al. 2023 ). Improving treatment plants, including the biological processes within the plant, to deal with anticipated challenges, such as high biological oxygen demand of incoming waste streams, would maintain effluent water quality standards. Most of the focus on the role of microbes in wastewater treatment has been at the treatment plant, yet there are tens of thousands of miles of pipes that contain an extremely high biomass ( McLellan and Roguet 2019 ). Further, there may be an opportunity to harness the potential of microbes as the nature-based solution for enhancing pre-treatment of waste or reducing detrimental effects that cause pipe deterioration through the design or reengineering of systems. Current wastewater conveyance systems have selected for a uniform microbial population regardless of geographic location and time of year; however, the functional significance of many of the population is relatively unexplored ( LaMartina et al. 2021 ). Impacts of sewer corrosion are well documented and are expected to increase with drought conditions that reduce flows ( Li et al. 2023 ). Unraveling the role of specific microbes in both beneficial and detrimental effects on these systems can lead to more informed engineering strategies to maintain and improve sanitation. Box Water Reuse Case Study. Scientific and Community Engagement Interdisciplinary thinking creates powerful opportunities for insight, discovery and innovation, yet the research environment dissuades crossing disciplinary boundaries. Managing, evaluating and funding researchers who stay within familiar disciplinary tracks is frequently easier than understanding individual needs, impacts and discovery horizons of those who cross boundaries. Scientists do not always have a deep understanding of other fields, which makes it difficult for scientists to communicate or see connections with disparate fields. In addition, many of the challenges facing researchers who cross disciplines are not scientific but cultural. Going forward, the culture of science will have to focus on cross-disciplinary training, along with training in science communication, so scientists can effectively incorporate scientific, social, economic and physiological factors into their discussions of scientific results ( Kappel and Holmen 2019 ). Better understanding waterborne disease prevalence and spread is critical for the health of humanity, necessitating scientific and medical communities work together to lower barriers to transdisciplinary approaches. Additionally, community members and organizations need to be partners in the planning stages of any research or public health initiatives. Community insight will be pivotal to ensuring programs meet local needs and wants, which will bolster usage of programs by the community. This co-creation allows all impacted stakeholders to address hard, practical problems involving far more insight than from a single discipline. The link between planetary sciences, public health and climate-impacted communities is increasingly important. However, large-agency science funding has limited interdisciplinary research, which enables relatively close disciplines to collaborate while creating gulfs between more distant ones. This kind of research, where the intersection of planetary science and biology can alleviate human suffering and illness, is not easy to fit into the scope of any single agency. However, appreciation of the nexus of climate science, planetary scale processes, microbiology and infection biology is a relevant necessity. Science interaction with cities, states, regions, nations and the world is moving faster and the associated work needs support. Small funding organizations, especially from non-government sectors globally, are often more agile and can effectively support projects focused on health, environment and civil society. In addition, professional societies and global partnerships offer unique opportunities for engagement and innovation for a healthier future. Conclusions Water is an essential resource of life, but this vital resource is under threat. Extreme weather events, pollution and microbial pathogens all jeopardize access to safe water. Fortunately, microbes and microbial data are the foundation on which to improve human health and well-being. Environmental intelligence that integrates environmental and public health data into infectious disease models will reduce waterborne disease and build public health resilience. The participants of the colloquium outlined major opportunities for strengthening waterborne disease prevention systems. Environmentally intelligent integrated data systems. An extraordinary amount of environmental and weather data, Earth observations, public health information and waterborne pathogen monitoring exists. However, the data are not always integrated to provide a holistic view of the role and impact of weather on waterborne outbreaks. Data systems that harmonize diverse types of data to connect environmental data and weather events with infectious disease will be critical for real-time disease monitoring and proactive public health support. Harnessing AI and machine learning to assess emerging threats will prepare local communities better for outbreaks, such as have occurred in the aftermath of extreme weather events, to increase public health, safety and security. Sustainable and economically resilient public health systems. Integration of surveillance systems with modern water infrastructure and community monitoring allows improved water safety standards and sustainable economic benefit while reducing disease risk. Microbes can be harnessed to reengineer water systems to be more resilient to changing weather parameters. Implementation of the interventions will create stronger systems while reducing downstream costs and fostering sustainable development. Global perspective with local solutions. Since more than 4 billion people globally do not have access to safe drinking water, addressing this worldwide issue will require solutions that meet local needs. Scientists must engage with community members and organizations to understand the local issues and work across disciplines and sectors to co-develop collaborative solutions. Expanded science communication and cross-disciplinary training for scientists allows greater efficacy in assessing and communicating risk, key to addressing waterborne disease outbreaks. To protect lives and reduce public health burdens, future efforts should focus on enhancing disease surveillance, strengthening water infrastructure and improving the assessment of current and future risks. Addressing these major challenges will require cross-disciplinary collaboration, community engagement and innovative monitoring and research programs. A global community of scientists, public health advocates, local leaders and philanthropists will constitute the foundation for a safer future by supporting societal health and well-being. References Akanda A, Jutla A, Gute D, Evans T, Islam S. 2012. 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Thank you as well to the partner organization American Geophysical Union (AGU) and supporting organization Association for the Sciences of Limnology and Oceanography (ASLO). The colloquium report is supported by a grant from the Burroughs Wellcome Fund (BWF) to help disseminate the insights developed by the experts. The American Geophysical Union is an international association of more than 60,000 advocates and experts in Earth and space science. Fundamental to our mission since our founding in 1919 is to live our values, which we do through our net zero energy building in Washington, DC, and by making scientific discoveries and research accessible and engaging to all to help protect society and prepare global citizens for the challenges and opportunities ahead. The Association for the Sciences of Limnology and Oceanography (ASLO) is an international aquatic science society that was founded in 1948. For more than 70 years, it has been the leading professional organization for researchers and educators in the field of aquatic science. The purpose of ASLO is to foster a diverse, international scientific community that creates, integrates and communicates knowledge across the full spectrum of aquatic sciences, advances public awareness and education about aquatic resources and research and promotes scientific stewardship of aquatic resources for the public interest. Its products and activities are directed toward these ends. With 3,000 members in more than 70 countries worldwide, the society has earned an outstanding reputation and is best known for its journals and interdisciplinary meetings. The Burroughs Wellcome Fund serves and strengthens society by nurturing a diverse group of leaders in biomedical sciences to improve human health through education and powering discovery in frontiers of greatest need. We greatly appreciated the leadership and support from Stefano Bertuzzi, Ph.D., MPH, ASM Chief Executive Officer, and Kimberly Shankle, Chief People and Change Management Officer, for this colloquium. Many ASM departments and staff were vital to the Colloquium. We would like to give special thanks to Nguyen K. Nguyen, Ph.D, MBA, Director, American Academy of Microbiology, and Rachel M. Burckhardt, Ph.D., Program Officer, Scientific Analysis, for their expertise and efforts to develop the colloquium and this report. We want to thank Emily Johnson of AGU for their help organizing and supporting the Colloquium and Nicole Zimmerman for their participation in the Colloquium. We would like to thank the Public Policy & Advocacy Department for their idea contribution and collaboration and the Communications Department for promoting the report, especially Aleea Khan, Ashley Hagen, M.S., Joanna Urban, Thomas Owens and Ava Walderman. Finally, thank you to Travis Frazier for designing the report. American Academy of Microbiology (Academy) is the honorific branch and scientific think tank of the American Society for Microbiology (ASM), a nonprofit scientific society with more than 30,000 members. Fellows of the Academy have been elected by their peers in recognition of their outstanding contributions to the microbial sciences. Through its colloquium program, the Academy draws on the expertise of these Fellows and other experts to address critical issues in the microbial sciences. This report is based on the deliberations of experts who gathered to discuss a series of questions developed by the steering committee. All participants had the opportunity to provide feedback, and every effort has been made to ensure that the information is accurate and complete. The contents reflect the views of the participants and are not intended to reflect official positions of the Academy or of American Society for Microbiology. Report on an American Academy of Microbiology and American Geophysical Union Colloquium held on December 5 & 6, 2024. © 2025 American Society for Microbiology. All rights reserved. This work is being shared with NCBI under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License . Bookshelf ID: NBK621436 PMID: 41955393 DOI: 10.1128/AAMCol.Jun.6.2025 Share Views PubReader Print View Cite this Page Water, Waterborne Pathogens and Public Health: Environmental Drivers [Internet]. Washington, DC: American Society for Microbiology; 2025. doi: 10.1128/AAMCol.Jun.6.2025 PDF version of this title (1.7M) In this Page Governors, American Academy of Microbiology Executive Summary Introduction Brief History of Sanitation, Public Health and Waterborne Diseases Current Impact of Environmental Factors on Water, Waterborne Pathogens and Public Health Future Prospects for Water, Waterborne Pathogens and Public Health Conclusions References Acknowledgments Other titles in this collection American Academy of Microbiology Colloquia Reports Related information NLM Catalog Related NLM Catalog Entries PMC PubMed Central citations PubMed Links to PubMed Recent Activity Clear Turn Off Turn On Water, Waterborne Pathogens and Public Health: Environmental Drivers Water, Waterborne Pathogens and Public Health: Environmental Drivers Your browsing activity is empty. Activity recording is turned off. Turn recording back on See more... 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