- Influenza A, influenza B, H1N1, monkeypox,
COVID, of course—that was the first sort of pathogen
that we started looking for.
- This is an open drain:
More than a third of all sewage in India flows here,
and testing it through environmental surveillance
could save millions of lives.
- When I told my kids for the first time
that I was testing sewage, they were disgusted;
at the same time, they were fascinated.
It works beautifully
in lower-income sections of urban areas
where people's poop converges.
- It's the first time that we see something
that belongs to everyone,
and now people can actually protect themselves.
- Environmental surveillance has a huge potential
because there are so many people who don't have access
to regular testing.
- Poop is a great equalizer.
Everybody poops—whether they're rich, they're poor.
It's not just important for India, but for everyone.
- To solve the world's most pressing problems,
we need to trust those closest to the challenge.
These are the solutions that make our world
a better place for everyone.
This is "Rethinking Possible."
- For anybody who walks around Bangalore,
the first thing that you do see are the open drains.
I don't think there are too many high-income countries
with open drains—
I would be very surprised, in fact.
I'm Varsha Shridhar.
I am a molecular biologist, and a biotechnologist.
In the '60s, polio wastewater surveillance
was basically the first large-scale public health
wastewater surveillance, but after that,
there hasn't really been any sort of ongoing research
into what can wastewater be used to test for.
- It wasn't until the urgency
of the COVID-19 pandemic that interest
in wastewater surveillance renewed.
And after one study showed
that underground wastewater surveillance could serve
as an early warning system,
it prompted the question:
Could it work in open drains too?
- Chaudhuri, take one, marking.
- My name is Dr. Angela Chaudhuri.
I serve as chief catalyst of Swasti.
It's a global public health organization
that serves some of the most marginalized populations.
In March 2020, already many people were affected by COVID.
We really wanted to know if open drains
held some clues for us,
so we had to prove for ourselves that this experiment
would actually work.
- I would not say we were winging it,
but it was definitely not something
that we had tested before.
- We literally had a fishing rope
with a plastic bottle tied at the end,
and we just kept doing that.
- We were just like, "Put the bucket into the water,
and carry it to the lab."
But when we saw that our first positives,
I think we both freaked out.
There was this kind of shriek,
"Ah! It's positive!"
- With the backing of Swasti
and a host of other
health-interested collaborators,
they created the Precision Health Platform,
a public dashboard were wastewater test results
could be viewed in real-time,
and could inform communities to know an outbreak
was imminent seven days before hospitals
started filling up.
- This meant that government administrators
could warn the hospitals.
They could plan human resources.
They could plan their staff,
and they could plan for hospital beds.
- Initially, I was not able to see the connection
between what I thought would be an isolated research finding
to a public health response that could actually lead
to some kind of an actionable insight.
- Well, when there was a spike,
our data was better than theirs.
- Angela is an extremely experienced
public health professional,
and so she was able to see the next steps forward.
- It all starts here, with the sewage collection.
Through barcodes, they track
where each sample is scooped up.
- All these sites are geo-tagged.
This is the bottle of the sample
which was taken from this particular site.
This represents a population
of around 500 households on average.
- Samples are then taken to Dr. Varsha's lab
where RNA is extracted and tested for various pathogens.
Then that information is transmitted to the dashboard,
corresponding to each
500-household section of the city.
It puts everyone, no matter status or wealth or location,
on a level playing field.
- It's a lot about governance.
Why shouldn't we have access to information like that?
The platform itself is setting a new standard
in what should be a public good.
I would like to know what risks are out there
in a way that I understand so I can take care of myself.
- People who live in slums in India
often don't have access to proper health care.
So with this information available
to community leaders,
health authorities, and journalists,
it can be disseminated throughout communities,
delivering on this massive public health challenge.
- If they don't fall sick because they're protected
by masks and other interventions,
then they're able to lead their livelihoods
without any concerns.
- What I am most excited about the future
is the integration of environmental signals
with community clinical data
for conditions like antimicrobial resistance,
tuberculosis, and new and emerging pathogens.
- In addition to expanding their testing
to other pathogens or
compounds of public health interest,
the Precision Health Platform
is also expanding across India.
Their framework is available for any place with open drains.
- We started with Bangalore.
Now we're in five cities across India,
with interest from Cambodia and Philippines as well.
Our dream is to see this scale up in as many cities
as possible so that the cities are better prepared.
- The years since 2020 have only sort of underscored
that we are a bunch of slightly weird people
who like to test gross things.
I think what sort of drives me in this
is the constant need for tinkering.
We have evolved from a biomedical lab
into a public health action on the ground.
- Scientists, people who hold political posts,
artists, all of these people came together
to deliver health outcomes for some
of the most marginalized people.
Precision Health Platform has shown me
local innovations can help us plan and prepare
for the next pandemic—
perhaps even the next disasters
that are going to hit us.