Risk-Based Decision Model for Microbial Risk Mitigation in Drinking Water Systems

Doctoral thesis, 2019

Microbial risks in drinking water systems can cause sporadic pathogenic infections and waterborne outbreaks resulting in large costs for society. In 2010 for example, around 27,000 persons were infected with Cryptosporidium in Östersund, Sweden. It is so far the largest waterborne outbreak in Europe, and societal costs were estimated at SEK 220 million (approx. 20 million €). To achieve a safe drinking water supply, assessment of microbial risks and, when needed, implementation of risk mitigation measures is necessary. However, drinking water systems are complex, and risk mitigation measures are expensive. A thorough evaluation of possible mitigation measures is thus essential for identification of the most suitable alternative and efficient use of societal resources. In this thesis, a risk-based decision model for evaluating and comparing microbial risk mitigation measures in drinking water systems is presented and illustrated using two Swedish case studies. The decision model combines quantitative microbial risk assessment and cost-benefit analysis in order to evaluate decision alternatives from the perspective of social profitability. The quantitative microbial risk assessment is complemented with water quality modelling and consideration of unexpected risk events, such as extreme weather events and combined sewer overflows, in order to reflex the complexity of drinking water systems. To facilitate transparent cost-benefit analyses, the effect of different health valuation methods on the output from the decision model is presented. In the decision model, health benefits and other benefits are monetised for each mitigation measure and compared to the costs for implementing the measure. It is possible to combine decision criteria such as tolerable risk levels and maximising the net present value when applying the decision model. The decision model integrates several scientific disciplines, thus constituting a novel approach to evaluate microbial risk mitigation measures in drinking water systems and provides a structured analysis that includes often neglected aspects. The model provides transparent and holistic decision support and facilitates well-founded decisions balancing risks, costs and societal benefits.