Considerations for conducting wastewater-based public health assessments in migrant populations

Wastewater-based epidemiology (WBE) provides the ability to generate inclusive and comprehensive population-level health assessments of communities. Recent work suggests these inherent benefits of WBE can serve to support vulnerable communities worldwide, such as migrant populations. The topic of forced migration has gained significant attention in recent decades as conflict and climate change events have increasingly become major drivers of migration around the world. However, information on the health of displaced populations during times of active mobility is lacking due to several logistical and ethical challenges using conventional methods. As environmental, political, and humanitarian conditions continue to evolve, it appears necessary to pursue alternative and adaptable approaches to acquire the health status of such dynamic and vulnerable populations. Here, we propose a call to action to apply WBE in migrant populations to offer inclusive and minimally invasive health assessments in order to: (1) close data gaps in the health information of displaced populations actively traveling along migratory pathways; and (2) promote greater efficacy in deployed interventions. Suggestions to pursue urgent migrant-specific health priorities are proposed, including antimicrobial resistance (AMR), infectious diseases, and malnutrition, along with considerations to promote ethically sound investigation. Overall, these recommendations may serve as a foundation to support subsequent investigation, with the purpose of encouraging global collaboration to offer new insights into the health of migrant and/or forcibly displaced populations.