Ethical Considerations for Wastewater and Environmental Surveillance in Carceral Settings: Building a Framework to Guide Public Health Interventions.

Abu-Khalil, Ameera S; Wurcel, Alysse G; Smith, Ted R; Ching, Carly; Kariyil, Meera J; Muhvich, Johnathan; Nahum, Yanina; Holm, Rochelle H et al. · Am J Public Health · 2026

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Abstract

US jails and prisons are characterized by constrained autonomy, heightened surveillance, and disproportionate disease burden. Here we trace the evolution of wastewater and environmental surveillance (WES) in carceral settings and analyze the ethical, medical, and legal challenges. Key considerations include elevated risks of reidentification, limited consent and participatory governance, asymmetric data stewardship, medical ethics, and potential misuse or stigmatization of health data. Carceral WES is neither fully covered by human participant protections nor fully accountable to traditional public health law, which is particularly applicable when unvalidated health monitoring tools lead to liberty-restricting or punitive consequences. WES in carceral settings requires participatory governance, strong data protections, and clear limits on downstream data use to ensure that benefits do not reinforce structural inequities. (<i>Am J Public Health</i>. Published online ahead of print August 13, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308542).