Anticipating future epidemics with OBEPINE+.

How did the OBEPINE+ project come about?

Vincent Maréchal: The OBEPINE network (site in French) was established in March 2020, at the start of the Covid-19 crisis. We were among the first to demonstrate a correlation between the quantities of SARS-CoV-2 genomes found in wastewater and epidemiological data in the general population. From July 2020, we received support from the French Ministry of Higher Education and Research (MESR) to develop a pilot project on 200 wastewater treatment plants to validate this approach on a larger scale. The stations selected were able to monitor around 40% of the French population, taking into account the diversity of the different regions. This work, funded to the tune of 3 million euros, demonstrated the relevance of wastewater-based epidemiology and prompted the European Commission to recommend its adoption by member states.

In July 2022, as part of France 2030 and the national acceleration strategy for emerging infectious diseases (EIDs) and CBRN threats, the General Secretariat for Investment and the MESR (French Ministry of Higher Education and Research) asked GIS OBEPINE to design a platform to be integrated into the national system for preventing and combating future epidemics. We submitted the OBEPINE+ project in December 2022, and received a very favorable initial assessment from the international jury set up by the French National Research Agency.

Who are the players involved in OBEPINE+ and how will they work together?

V. M.:

OBEPINE+ brings together 22 partners from the public and private sectors, including research institutes such as CNRS and Inserm, and companies such as SUEZ, VEOLIA and IAGE. We work closely with institutions such as Sum'EAU, Santé publique France, and Emergen, which deals with the genomic surveillance of viruses in human populations. We would also like to involve PREZODE, a structure specialized in infectious diseases originating in the animal world. By integrating these different players, we cover all the dimensions of the "One Health" approach, which takes into account the interactions between human, animal and environmental health.

To coordinate and optimize these efforts, we will be setting up a steering committee responsible for defining strategic orientations and ensuring communication between these different entities.

What are the concrete actions planned by OBEPINE+?

V. M.: We'll be developing tools to detect priority pathogens such as different forms of influenza, respiratory syncytial virus, avian influenza, monkeypox virus, and mosquito-borne viruses such as dengue fever. We will also be setting up projects focusing on rodent-borne pathogens, such as hantaviruses and leptospires, and developing a livestock effluent monitoring activity to detect new pathogens at source. This approach is particularly relevant in view of the threat posed by avian flu viruses and their risk of transmission to humans.

Another focus of OBEPINE+ is to develop a sequencing structure to identify pathogens in wastewater. We will also be building an aquatheque. This permanent bank will store wastewater samples over the long term. Access to these samples will enable us to carry out retrospective studies to better understand the emergence of pathogens and their spread across the territory.

We also have very innovative projects in the field of monitoring sexually transmitted infections (STIs) through wastewater. We plan to monitor pathogens such as papillomaviruses, chlamydiae, gonococci or the agent responsible for syphilis, either on a very local scale such as a university campus, or on a national or even international scale. For this project, we will be collaborating with the national reference centers (CNR) to create a national observatory for monitoring STIs via wastewater. In the long term, this global monitoring will enable us to assess the impact of vaccination campaigns against oncogenic papillomaviruses, which are the main cause of cervical cancer.

What are the ethical challenges associated with wastewater epidemiology?

V. M.: Wastewater analysis raises ethical and legal issues in that it involves a form of population surveillance without explicit consent. We have set up an ethics committee, including sociologists and philosophers, to address these issues. The aim is to ensure that our research respects the rights and expectations of citizens, while providing effective tools for public health.

How do you see OBEPINE +'s international development?

V. M.: In a skills transfer approach, we are developing collaborations in South America, a major emerging territory, and more specifically with the Oswaldo Cruz Foundation (Fiocruz), one of the leading science and technology institutions in the health field in Latin America. In French Guiana, we are trying to develop a project to monitor the health of Amazonian populations using wastewater in addition to population-based epidemiological data. This work will be carried out in parallel with monitoring the circulation of pathogens in wild fauna (mosquitoes, wild mammals, etc.).

We are also working in Africa, notably in Tunisia, Morocco and Guinea, as part of the ATLANTES project (site in French), for which OBEPINE is the scientific coordinator. The idea is to share our expertise and tools to help these countries set up wastewater-based epidemiological surveillance systems capable of supporting public health players. In countries where sanitation systems are not as sophisticated as ours, we are already able to identify virus circulations, such as measles in Guinea. In this respect, wastewater epidemiology remains an excellent tool for anticipating the emergence of infectious diseases, with an extremely cost-benefit ratio compared with population-based monitoring.

In Europe, we are working on a project with Poland and the Czech Republic as part of the 4EU+ alliance. Its aim is to strengthen the use of wastewater in research projects, by integrating a variety of skills from different disciplines such as sociology, medical sciences and basic sciences.

As part of the 4EU+ alliance, we are also organizing an international conference to be held on November 12 at Sorbonne Université, with the participation of the World Health Organization, to work on the link between wastewater epidemiology approaches and their sustainable integration into national and trans-national surveillance systems.