Risk-based cost-benefit analysis for evaluating microbial risk mitigation in a drinking water system

Research gaps and priorities for quantitative microbial risk assessment (QMRA)

The coronavirus disease 2019 pandemic highlighted the need for more rapid and routine application of modeling approaches such as quantitative microbial risk assessment (QMRA) for protecting public health. QMRA is a transdisciplinary science dedicated to understanding, predicting, and mitigating infectious disease risks. To better equip QMRA researchers to inform policy and public health management, an Advances in Research for QMRA workshop was held to synthesize a path forward for QMRA research. We summarize insights from 41 QMRA researchers and experts to clarify the role of QMRA in risk analysis by (1) identifying key research needs, (2) highlighting emerging applications of QMRA; and (3) describing data needs and key scientific efforts to improve the science of QMRA. Key identified research priorities included using molecular tools in QMRA, advancing dose-response methodology, addressing needed exposure assessments, harmonizing environmental monitoring for QMRA, unifying a divide between disease transmission and QMRA models, calibrating and/or validating QMRA models, modeling co-exposures and mixtures, and standardizing practices for incorporating variability and uncertainty throughout the source-to-outcome continuum. Cross-cutting needs identified were to: develop a community of research and practice, integrate QMRA with other scientific approaches, increase QMRA translation and impacts, build communication strategies, and encourage sustainable funding mechanisms. Ultimately, a vision for advancing the science of QMRA is outlined for informing national to global health assessments, controls, and policies.

Multi-criteria decision analysis framework for engaging stakeholders in river pollution risk management

Water pollution presents a substantial environmental challenge with extensive implications for water resources, ecosystem sustainability, and human health. Using a South African catchment, this study aimed to provide watershed managers with a framework for selecting best management practices (BMPs) to reduce pollution and the related risk to river users, while also including the perspectives of key catchment stakeholders. The framework encompassed the identification of and consultation with key stakeholders within the catchment. A Multi-Criteria Decision Analysis (MCDA) methodology using the Simple Multi-Attribute Rating Technique for Enhanced Stakeholder Take-up (SMARTEST) was used to identify and prioritise suitable BMPs in a case study. Decision alternatives and assessment criteria as well as their weights were derived based on stakeholder responses to a two-stage survey. Stakeholders included those utilising the river for domestic and recreational purposes, municipal representatives, scientists, NGOs, and engineers. The assessment of decision alternatives considered environmental, economic, and social criteria. The aggregated scores for decision alternatives highlighted the significance of involving stakeholders throughout the decision process. This study recommends the pairing of structural and non-structural BMPs. The findings provide valuable insights for catchment managers, policymakers, and environmental stakeholders seeking inclusive and effective pollution mitigation strategies in a catchment.

Risk-based cost-benefit analysis of alternative vaccines against COVID-19 in Brazil: Coronavac vs. Astrazeneca vs. Pfizer

We propose a probabilistic model to quantify the cost-benefit of mass Vaccination Scenarios (VSs) against COVID-19. Through this approach, we conduct a six-month simulation, from August 31st, 2021 to March 3rd, 2022, of nine VSs, i.e., the three primary vaccine brands in Brazil (CoronaVac, AstraZeneca and Pfizer), each with three different vaccination rates (2nd doses per week). Since each vaccine has different individual-level effectiveness, we measure the population-level benefit as the probability of reaching herd immunity (HI). We quantify and categorize the cost-benefit of VSs through risk graphs that show: (i) monetary cost vs. probability of reaching HI; and (ii) number of new deaths vs. probability of reaching HI. Results show that AstraZeneca has the best cost-benefit when prioritizing acquisition costs, while Pfizer is the most cost-beneficial when prioritizing the number of deaths. This work provides helpful information that can aid public health authorities in Brazil to better plan VSs. Furthermore, our approach is not restricted to Brazil, the COVID-19 pandemic, or the mentioned vaccine brands. Indeed, the method is flexible so that this study can be a valuable reference for future cost-benefit analyses in other countries and pandemics, especially in the early stages of vaccination, when data is scarce and uncertainty is high.

Integrating Ecosystem Services into Risk Assessments for Drinking Water Protection

Water protection is a widely supported goal in society, but competing interests often complicate the implementation of water protection measures. Moreover, the benefits of protection efforts are typically underestimated as risk assessments focus on the provision of drinking water and neglect the additional services provided by a clean drinking water source. We developed a list of water system services (WSS) that allows assessment of all biotic and abiotic services provided by a drinking water source. The WSS were derived from the Common International Classification of Ecosystem Services (CICES). The objectives of this paper are to (i) introduce the concept of WSS, (ii) describe a procedure on how to develop a region-specific list of WSS and present a list of WSS specifically tailored to Sweden, (iii) present how to integrate WSS into a risk assessment for drinking water, and (iv) illustrate a practical application on a Swedish case study. The results, presented as an assessment matrix, show the provided services and contrast the hazard sources with their impact on all services. The WSS assessment can be used to communicate and negotiate the extent of water protection measures with relevant stakeholders and illustrate synergies and trade-offs of protective measures beyond drinking water protection.

Risk-Based Evaluation of Improvements in Drinking Water Treatment Using Cost-Benefit Analysis

Reliable and safe drinking water supply requires adequate risk management. Decision support models can aid decisionmakers to effectively evaluate risk mitigation measures and allocate societal resources. Here, a Swedish case study illustrates how the installation of ultrafiltration membranes can be evaluated by combining risk assessment and cost-benefit analysis. Quantitative microbial risk assessment was used to assess several contamination sources and estimate the achieved risk reduction from waterborne pathogens using Campylobacter, Norovirus, and Cryptosporidium as reference pathogens. The societal value of the improved water quality was estimated in the cost-benefit analysis by monetising the gained quality adjusted life years and aesthetic water quality improvements. The calculated net present value (mean of 7 MEUR) indicated that the installation of the ultrafiltration membranes was a sound investment from a societal economic perspective. The ultrafiltration membranes reduced the annual probability of infection from 3 × 10−2 to 10−7, well below the U.S. EPA’s acceptable level, as well as improving the aesthetic quality of the drinking water. The results provide a novel example of the importance for water distributors to consider not only health-related metrics when evaluating treatment options or monitoring the drinking water quality, but to also consider the aesthetic quality of the drinking water.