Table 1. Summary of barriers, best practices, and future needs for public health agencies using wastewater surveillance data for public health action.

Barrier	Recommended best practices	Future needs (key strategy areas)
Many public health agencies are not yet comfortable interpreting wastewater data	• Communicate results interpretation alongside data limitations and known variability sources • Collaborate with laboratories, wastewater utilities, environmental health departments, and communications experts	Evaluation of wastewater data variability and uncertainty sources in a variety of systems (research)
Public health agencies want to see wastewater data in their own communities to gain confidence in utility	• Provide case studies from community applications and perspectives • Perform retrospective analyses on existing datasets	Documentation of wastewater surveillance use cases for adoption in different communities and infrastructure systems (research and communication)
New knowledge and investment needed to sustain wastewater surveillance systems	• Co-develop programs and methods with scientific experts and government agencies • Share methods and experiences across research, wastewater, and public health	Investment in physical laboratory capacity, personnel, and interagency collaboration frameworks (organizational structures and policy)
Ethics of wastewater surveillance data sharing and use not yet established	• Evaluate sample anonymity • Engage the public in collection and data use	Development of ethical wastewater data use standards for surveillance and research (policy and research)