When Falk College Department of Public Health Chair and Professor David Larsen was notified that he had received a Fulbright U.S. Scholar Award to teach and continue his wastewater surveillance research at the Medical University of Innsbruck in Austria this spring, the academic in him was rightfully excited and proud to receive this prestigious honor.
But Larsen is also a father of four children, and that side of him had a slightly different reaction.
“I didn’t expect to get it because the European posts are quite competitive. When I received the email notification, it was kind of an ‘oh, crap’ moment. What have I done?” Larsen says, smiling.
What Larsen and his wife, Natalia, did was pack up their four children–Isabel, 13; Sophia, 11; Madeline, 8; and Teddy, 5–and travel roughly 6,500 miles to a house they’re renting in Birgitz, a village outside of Innsbruck, from January through July. Their daughters are attending English-speaking schools, while their son is attending a German-speaking preschool (German is the primary language in Austria).
“Their schooling is going to be a bit disrupted, but they’re good students who read a lot and we’ll keep on top of it and fill in the gaps they might miss,” Larsen says. “It is a ski town, so we’ll spend some time skiing, and the schools for the older girls had London excursions last year so perhaps they can do trips like that.”
Fulbright Scholar Awards are competitive fellowships that provide students, scholars, teachers, artists, and professionals of all backgrounds and fields the opportunity to study, teach and conduct research abroad, exchange ideas, and play critical roles in U.S. public diplomacy as they seek to find solutions to shared international concerns.
Since its establishment in 1946 under legislation introduced by the late U.S. Senator J. William Fulbright of Arkansas, the Fulbright Program has provided more than 390,000 scholarships and its alumni include 62 Nobel Laureates, 89 Pulitzer Prize winners, 78 MacArthur Fellows, and thousands of leaders and world-renowned experts in academia and many other fields across the private, public, and non-profit sectors.
At the outset of COVID in 2020, Larsen, an epidemiologist, led an interdisciplinary team of experts in coordination with the New York Department of Health to create a wastewater surveillance system throughout New York State. Today, the New York State Wastewater Surveillance Network is testing for COVID in at least one wastewater treatment plant in all 62 of the state’s counties, covering a population of 15.3 million. The New York State Wastewater Surveillance Network dashboard provides the most recent statistics regarding the network.
Before Larsen and his family traveled to Austria, we asked him about the Fulbright Award, what he’ll be doing in and outside of Austria, and why a wastewater surveillance system to test COVID and other infectious diseases is crucial to worldwide health. Here’s that conversation:
Why did you want this fellowship?
You submit for a specific award, and I submitted for a position at the Medical University of Innsbruck. I had reviewed their papers and there was good science coming out of there, so I reached out to their scientists who are working on wastewater surveillance in Austria and created their own network in the Tyrol region where Innsbruck is located.
I told them about my work in New York State and the wastewater surveillance network here, and they were supportive of my application.
What will you be doing at the Medical University of Innsbruck?
I’m a visiting professor and they’ve asked me to teach two courses that meet once a week and are equivalent to a 3-credit course here. I’m teaching a condensed version of my “Spatial Statistics for Public Health” course, and I developed an overview course for public health surveillance. Those were selected in brainstorming with my colleagues at Innsbruck who thought those would be of most value to their students.
In addition, I’m working with the wastewater-based epidemiologists there, and the research project attached to the Fulbright is the comparison of the networks in New York State and Tyrol.
Will you be working outside of Austria?
There’s a national wastewater network in Austria, and initiatives to establish a global network being led by Europeans. Europeans have been doing wastewater surveillance for drugs since 2010, and they’ve got a great model of collaboration across the different nation states. So, I hope to connect with that team and learn more about it, in addition to working with the Austrians.
I’m working here in New York State, primarily, and others are working across the globe on the same issue and building a global system. So, we’ll take the lessons we’ve learned and the challenges we’ve overcome here in New York and go to Austria, share those, and I hope to learn lessons they’ve learned and the challenges they’ve overcome in Austria, and then Europe, and more broadly. Hopefully, we’ll have a greater understanding and improved wastewater surveillance systems as a result.
Why is this collaboration so important?
We built this (network) with COVID, but we also built it for the future. Right now in New York State, local health departments are using the data we produce–particularly the sequencing data to track variants–but also the hospitalization forecasting that we provide them. Our aim is to provide the local health departments and the public with robust understanding of COVID-19 risk.
At the same time, COVID is not the only infectious disease, and there’s always potential for what we call ‘Disease X,’ which is the next emerging infection. It could be another coronavirus, it could be an avian influenza, it could be something we’re not thinking about right now. The goal is to make this system ready and prepared to empower the public health response to whatever comes in the future.
In New York State, we supported the polio response in 2022 and made a huge impact on understanding how many people were at risk of polio. We are piloting influenza, RSV, Hepatitis A, Norovirus, and Antimicrobial Resistance (which occurs when a virus doesn’t respond to medicine). Antimicrobial Resistance is a looming public health threat and could be very impactful. We do support the COVID response, but that’s the tip of the iceberg of where we hope the wastewater surveillance network goes.
The idea here is that perhaps most, if not all, infectious diseases can be surveilled or found in wastewater. Beyond that, drugs and environmental toxicants and pollutions and other measures of non-communicable diseases can be measured. How do we build this system to make the world a better place?
What motivates you to do this?
This came about because I wanted to safely open my kids’ schools. I wanted to get back to normal. When COVID hit, we shut down and I supported the response–I still support the response we had–but it was a response made without local understanding of risk.
Infectious diseases are local. You have travelers that take them from community to community, but you can have little enclaves of safe places. We had one at Syracuse University in the fall of 2020. It was safe from COVID because of the aggressive public health measures and the aggressive infectious disease surveillance we were doing with wastewater and testing.
Could we have a situation where infectious disease is threatening, but we have these little pockets of freedom? And that’s informed a lot of my work: How do we live a free life in a world affected by infectious disease? The way to do that, in my view, is to fight these diseases so they’re no longer a threat and then you have to be able to confirm that they’re not affecting people. That’s where infectious disease surveillance comes in.
Vaccinations are down, and a new COVID variant is on the rise. What’s your message to people as we approach the four-year anniversary of COVID?
People associate COVID with public health restrictions: masks, closed restaurants, closed schools, quarantine, isolation. But at its best, public health is empowering. Freedom from polio, the ability to drink tap water, the trust we have in our food system, the long-term health care as we get older. That is public health. And if we are on the front foot–if we prevent the disease–then we can avoid the restrictions that happen. The shutdowns are a last resort when we have overflowing morgues and overflowing hospitals and it’s a panic button. It was the last resort and that’s the situation we found ourselves in.
Real public health is, how do we build a system so we don’t get into that position again? Vaccines are part of that toolkit; clean air, air filtration, environmental adjustments are also part of that toolkit and infectious disease surveillance is definitely part of that toolkit.