Since 2020 wastewater-based surveillance has quickly been established as an effective and cost-efficient tool for monitoring public health. In this Making Waves article, we argue that these programs must be grounded in principles of justice to achieve global water and health equity. Ethics initiatives to date have focused primarily on privacy, legality, and institutionalised research reviews, often, if not exclusively, in North America and Western Europe. We draw from our interdisciplinary, multisectoral, and international expertise and experience to develop a justice-centred framework for wastewater-based surveillance. First, we identify common concerns across diverse surveillance programs including: defining community, transparency and accountability, and uneven geographies. Second, we draw on political theorist Nancy Fraser's framework of justice to evaluate site-specific practices identifying maldistribution, misrecognition, and exclusion. We suggest that Fraser's framework offers a common approach for evaluating just outcomes rather than specific regulations for governing wastewater surveillance across different and unequal contexts.
