Their paper, led by Pooja Padmakumar, a postgraduate student at Bangor University, highlights that invasive fungal infections are estimated to cause approximately 2.5 million deaths globally each year - more than tuberculosis and malaria combined.
The study, published in PLOS Pathogens, also states that fungal pathogens receive “disproportionately limited” research investment and public health attention compared with bacterial infections. A fungal pathogen is a fungus that causes disease in humans, animals, or plants by invading tissues and overcoming host defences.
The paper calls for greater investment in fungal pathogen surveillance and research, including the development and evaluation of wastewater-based surveillance systems that could complement existing approaches used for diseases such as COVID-19 and polio.
Pooja Padmakumar from Bangor University said, “The development of a coordinated surveillance strategy to detect fungal outbreaks lags behind this evolving threat. At the moment, there’s a broad lack of awareness of the threat this poses. Hospital outbreaks caused by drug-resistant Candida species are increasingly common, and despite the World Health Organization’s (WHO) designation of priority fungal pathogens requiring urgent surveillance innovation, this has not yet translated into widespread public health action. In our study, we examine why existing clinical surveillance frameworks fail for fungi, and identify the key research priorities to address this gap. Clinical surveillance alone is inadequate for tracking fungal pathogens. Our paper offers wastewater-based surveillance as a solution, that needs to run alongside routine clinical surveillance."
The paper also warns that climate change, expanding immunocompromised populations and limited availability of effective antifungal treatments are combining to create ecological and clinical conditions favourable to the emergence and spread of fungal pathogens.
It attributes the lack of adequate surveillance for fungal pathogens to their historical prioritisation below other infectious diseases, the distinct challenges involved in detecting and monitoring fungal infections, and technical and economic constraints on diagnosis.
It advises that future surveillance should adopt a One Health framework, integrating wastewater-based epidemiology with clinical, veterinary, and agricultural monitoring to better capture the emergence, transmission and ecological drivers of fungal pathogens and antifungal resistance.