In a commentary, OHT’s Dr. Ramanan Laxminarayan and collaborators discuss the European Union’s proposal to amplify sewage surveillance efforts to monitor AMR in highly populated areas. The authors praise the new emphasis on sewage surveillance, a disease prevention method used for decades against polio, but caution that the data should be collected intentionally to fill knowledge gaps. Furthermore, they suggest using a combination of phenotypic and gene-based approaches, given the pros and cons of each strategy.