European wastewater surveillance remains unevenly integrated, but it has been strengthened by new frameworks and obligations since the pandemic. According to the Abbott Pandemic Defense Coalition, many epidemiologists anticipate a major health crisis in the coming years. A growing number of European public systems are subject to epidemiological wastewater surveillance, while decentralized diagnostics still require progress in integration at the continental level. The technological tools exist; their joint deployment remains incomplete despite European political and regulatory commitments.
The Essentials
- Three-quarters of global epidemiologists forecast a major health crisis by 2050, according to the Abbott Pandemic Defense Coalition (2024).
- Wastewater surveillance, which allows detection of a virus before the first hospitalizations, is gradually being deployed in European public systems.
- Decentralized diagnostics—rapid tests outside a central laboratory—still require better integration with early warning systems.
- Europe has the necessary technologies; the problem lies in interoperability, completeness, and implementation of existing frameworks, rather than a complete absence of common framework.
- The Pandemic Agreement was adopted in May 2025; subsequent negotiations have focused notably on its Pathogen Access and Benefit Sharing annex and its implementation.
Early Detection Remains Fragmented, Five Years After the Covid Lesson
Covid-19 revealed a structural weakness: states had common European alert and surveillance mechanisms, though their national capacities were heterogeneous. The architecture has undergone substantial changes, even if its integration and coverage remain incomplete.
The central problem is fragmentation. Member states operate their national networks within a coordinated European surveillance and reporting framework. When a new pathogen emerges in a border region, the delays in reporting information to European authorities vary depending on national capacities. Notification delays can worsen the risk of spread, among many other factors.
Wastewater surveillance illustrates this situation well. This method, which consists of detecting viral traces in urban effluents before patients consult a doctor, can anticipate a wave by seven to fourteen days over clinical indicators. A few European countries have deployed it at scale, notably the Netherlands, Austria, and Malta, while other regions are gradually expanding their surveillance coverage, according to the study published in September 2026 in Frontiers in Public Health. The sensors exist and analysis protocols are validated.
The barrier is organizational and financial.
Decentralized diagnostics pose the same problem in another form. A decentralized diagnostic is a test that can be interpreted on site, in a pharmacy, a doctor’s office, a school, without waiting for results from a central laboratory. Such tests exist for many pathogens. But their deployment requires logistical chains, training, validation standards, and above all information systems capable of feeding results in real time to health authorities. The 2025 IPPS report identifies persistent global vulnerabilities in pandemic preparedness and development of medical countermeasures.
A detection delay can be worsened by incomplete integration of local diagnostic results and other surveillance, testing, and reporting factors.
The Persistence of National Silos After the 2020 Trauma
Health is largely within the purview of member states, but the Union has significant support and coordination powers in the face of cross-border health threats. Member states accepted substantial coordination via the ECDC; they did not resist all mandatory shared surveillance, even if the extent of data and practical implementation vary. The treaty limits general harmonization in health, but it authorizes European measures for monitoring and alert in the face of cross-border threats.
Sharing real-time health data raises questions of sovereignty, privacy, and sometimes economic competition. Several member states fear that early data on a nascent epidemic may affect their tourism or commercial reputation before the risk is even confirmed. Governance reforms exist, but their deployment and integration can still be strengthened.
The ECDC saw its mandate reinforced in 2022. Beyond advisory functions, it exercises coordination, surveillance, risk analysis, and technical support. Structured data reporting obligations exist, but real-time transmission of all diagnostic results remains incomplete. This gap is the major institutional brake.
This blockage is not unique to Europe. At the global level, the WHO faces the same problem. Its International Health Regulations, which theoretically require member states to notify public health emergencies within 24 hours, were followed very unevenly during the Covid pandemic. Revision of these regulations, finalized in 2024, brings improvements, but states retain significant powers over health data, even if this does not prevent European obligations on surveillance data sharing.
Current Technological Capacities, Independent of Political Agreement
The state of available tools contrasts with the slowness of governance. Several technological innovations could, if deployed at scale, substantially reduce detection delays.
Genomic surveillance of wastewater is the most documented example. By sequencing DNA and RNA present in urban effluents, it is possible to detect not only known viruses, but new variants, even pathogens not yet identified. The Netherlands developed this capacity during the Covid pandemic; the sampling network is national, but since July 7, 2025, a growing share of stations has been measured only weekly, while the network continues to receive at least one weekly sample from each station; variant PCR was used as a rapid circulation indicator, supplemented by sequencing to identify variants. This model is reproducible. Its deployment at European scale could reduce the economic impacts of a delayed pandemic response, as Covid demonstrated.
Point-of-care diagnostics represent a second available breakthrough. Rapid molecular tests, sometimes multiplex, can be deployed at certain peripheral or proximate care sites, depending on the test, pathogen, and local capacities. Their current limitation is European data integration, which requires strengthening and better standardization, despite existing platforms. A positive test performed in a Warsaw pharmacy does not automatically report to the ECDC. Agreements and standards already exist, but their extension to proximity diagnostic results and their interoperability remain to be strengthened.
Artificial intelligence for epidemic forecasting constitutes a third tool. Models trained on mobility data, internet search data, hospital data, and genomic surveillance could potentially detect warning signals before the first hospitalizations. Several academic teams, notably at the Swiss Federal Institute of Technology Zurich and the Pasteur Institute, demonstrated the feasibility of these approaches during Covid. But European surveillance governance already exists, though it must still be extended and adapted to certain data and AI applications. One may refer, on this subject, to what China has undertaken in early detection and digital monitoring of chronic diseases: the demonstration that data infrastructure always precedes the algorithm.
Three Trajectories for Europe by 2030
Three paths seem open for the next decade, with very different implications depending on the political will mobilized.
The first is the status quo. National silos would persist, wastewater surveillance coverage would remain heterogeneous and fragmented, and decentralized diagnostics would largely remain disconnected from alert systems. In this scenario, a next emerging outbreak would spread before current detection mechanisms signal it to authorities. Detection delays significantly influence the spread and magnitude of an epidemic. This scenario is not a prediction: it is the baseline if nothing changes.
The second path runs through a cross-border financing agreement, carried by the G20 and WHO. The idea, discussed since 2022 in WHO Pandemic Agreement negotiations, consists of creating a dedicated financing mechanism for decentralized regional diagnostics in low-capacity countries, and parallel extending wastewater surveillance coverage in Europe. This scenario would also require strengthening the network of field epidemiologists trained under the FELTP (Field Epidemiology Training Program), currently active in sub-Saharan Africa but underfunded.
This path relies on voluntary commitments and existing financing mechanisms, without revision of European treaties. Its limit lies in the need to improve coordination and data integration between member states.
The third path is the integration of artificial intelligence forecast tools into public surveillance systems. It is technically the most ambitious and politically the most delicate, as it would require strengthened health data sharing between states. This scenario could improve detection timelines compared to current capacities. But it requires data governance to strengthen and extend at European scale. The adoption of AI in European public health systems remains uneven anyway, concentrated in better-resourced countries, a phenomenon that JdP has documented for other sectors, notably AI adoption in large companies.
These three scenarios are not mutually exclusive. Wastewater coverage can progress without waiting for a WHO agreement. Decentralized diagnostics can be connected to national surveillance platforms before being linked to a continental platform. Deployment depends on mobilization of budget commitments and coordination between member states.
The Actors Who Are Moving Forward, and What They’re Doing Concretely
A few initiatives deserve to be named because they show what is possible.
The Commission and its Joint Research Centre have overseen the European system since 2021; the ECDC engaged its structured integration subsequently. By 2022, all 27 member states had taken surveillance measures, with variable intensity and coverage. It made it possible to detect several early signals during the Omicron wave and track the progression of XBB and JN.1 variants before hospital data confirmed their circulation. This is a partial success: the network lacks standardization between countries, and several member states in the South and East do not yet participate. The ECDC is working to harmonize analysis protocols; results of this harmonization should be published by end of 2026.
The Abbott Pandemic Defense Coalition brings together public and private actors, diagnostic manufacturers, governments, philanthropic foundations, to fund decentralized diagnostics in low-income countries and model how to extend this coverage to peripheral areas of wealthy nations. Its 2024 report estimated that many epidemiologists anticipate a major health crisis and formulated concrete recommendations on funding a global network of decentralized diagnostic points. These recommendations are currently feeding Pandemic Agreement negotiations in Geneva.
The WHO has been negotiating since 2022 this international agreement on pandemic prevention, preparedness, and response. Talks have stalled several times over data sharing and equitable access to vaccines. The WHO continued work on a draft in May 2024; the Pandemic Agreement was adopted on May 20, 2025. In 2025, negotiations focused on the PABS (Pathogen Access and Benefit Sharing) annex of the WHO Pandemic Agreement, concerning access to pathogenic materials and sequencing information as well as benefit sharing. The 2027 horizon for an operational agreement is the signal to watch.
Global health does not progress uniformly, and epidemic surveillance capacities are not independent of health systems as a whole. Tensions on health personnel, nurse shortages, for example, which also affect local surveillance capacities, complicate the deployment of any early detection network that requires trained field staff.
The Next Eighteen Months as an Indicator
Three signals will allow judgment, by end of 2027, on whether Europe has changed trajectory.
The first is the rate of wastewater surveillance coverage. If this rate progresses significantly by 2027, it will mean that commitments made since 2022 translate into real infrastructure. If stagnation is confirmed, the first scenario, status quo, will gain traction.
The second signal is progress of the Pandemic Agreement at the WHO. In 2025, negotiations focused on the PABS annex of the WHO Pandemic Agreement, concerning access to pathogenic materials and sequencing information as well as benefit sharing. A PABS agreement would limit certain effects of fragmentation in pathogen and sequence sharing, without abolishing state sovereignty.
The third signal is budgetary. Several member states have announced investments in their epidemic surveillance capacities since 2022; actual commitments, line by line in national budgets, are harder to verify. The ECDC publishes each year an assessment of member states’ public health capacities under the International Health Regulations: the 2026 edition will be a truth test.
Many global epidemiologists believe a major new health crisis is probable in coming years. The challenge for Europe is to have, when it arrives, an architecture capable of detecting an outbreak in days rather than weeks. Detection delays significantly influence the impacts of an epidemic. The tools to achieve this are available.
Funding is mobilizable. What is lacking concerns rather completeness, interoperability, and broadening of shared data than a complete absence of agreement between states.
Sources
- Frontiers in Public Health, September 2026, Pandemic preparedness and early detection in European public health systems
- Abbott Pandemic Defense Coalition, 2024 Report (Pandemic Defense Coalition, no guaranteed URL)
- IPPS, Global Diagnostics Gap Assessment 2025 (Global Initiative on Pandemic Preparedness and Health, no guaranteed URL)
- GAVI, Report on Epidemic Surveillance Systems 2026 (no guaranteed URL)
- ECDC, European Wastewater Surveillance Network, reports 2021-2025 (European Centre for Disease Prevention and Control)
- WHO, Pandemic Agreement, partial text adopted May 2024 (World Health Organization)
