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Ethical Considerations for Wastewater and Environmental Surveillance in Carceral Settings: Building a Framework to
Ameera S Abu-Khalil1, Alysse G Wurcel1, Ted R Smith1
1Ameera S. Abu-Khalil, Carly Ching, Johnathan Muhvich, Yanina Nahum, and Muhammad H. Zaman are with the Department of Biomedical Engineering, Boston University, Boston, MA. Alysse G. Wurcel is with the Section of General Internal Medicine, Boston Medical Center, Boston, MA. Meera J. Kariyil is with the Chobanian & Avedisian School of Medicine, Boston University, Boston, MA. Ted R. Smith and Rochelle H. Holm are with the Center for Healthy Air, Water and Soil, Christina Lee Brown Envirome Institute, School of Medicine, University of Louisville, Louisville, KY.
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. (Am J Public Health. Published online ahead of print August 13, 2026:e1-e7. https://doi.org/10.2105/AJPH.2026.308542).
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