Waste to Wisdom: Wastewater Molecular and Genomic Surveillance in African Megacities

African countries face escalating public health challenges-including infectious diseases, non-communicable diseases (NCDs), antimicrobial resistance (AMR), drug abuse, and malnutrition-exacerbated by rapid urbanization, poor sanitation, and climate-related risks. Traditional surveillance systems are often inadequate, costly, and inequitable, frequently missing marginalized populations. The "Waste to Wisdom" initiative introduces wastewater-based surveillance (WBS) as a transformative, cost-effective approach to monitor health trends in real time. This pilot project, led by Africa CDC and ASLM, in collaboration with EPHI (Ethiopia), INRB (DRC), and ILRI (Kenya), will be implemented in Addis Ababa, Kinshasa, and Nairobi, covering over 40 million people across diverse urban settings. The pilot will primarily focus on Mpox and other priority pathogens, using it as a key use case to demonstrate the feasibility and public health added value of WBS in complex urban environments for disease early warning. The system will also be adaptable to detect other priority pathogens, supporting broader public health surveillance under a One Health framework. The project will establish a continental coordination mechanism for WBS and generate actionable data to inform early detection, risk assessment, and response strategies-laying the foundation for scalable, multi-pathogen surveillance across Africa.