This is what we need to prioritise to prevent another pandemic

As the COVID-19 pandemic continues to ravage the globe, a frequent prevention message heard everywhere is “wash your hands with soap”. Proper handwashing is the standard advice to prevent the transmission of pathogens, including the novel coronavirus. However, what happens when there is no access to a reliable water supply or soap?

A staggering 3 billion people across the world face this question, according to the Joint Monitoring Programme run by UNICEF and the World Health Organization (WHO). Equally concerning is that 750 million people and 2 billion people lack access to basic drinking water and sanitation respectively.

Despite the UN recognising water and sanitation as human rights a decade ago, progress towards universal access to water, sanitation and hygiene (WASH) has been slow. The COVID-19 pandemic has only served to illustrate that far too many people have little or no access to WASH services.

It has further amplified existing inequalities, putting vulnerable communities at even greater health risk due to constraints that arise with lack of access to WASH. People living in least developed countries, remote rural areas, refugee camps and overcrowded slums face magnified risks in this pandemic. For example, informal settlements and slums, which house over a billion people, often have unreliable and intermittent water supply, impermanent hygiene infrastructure, shared toilets and inadequate space for social distancing, which makes standard prevention advice impractical.

The situation is especially dire in schools and health care facilities across the Global South. A 2019 study found that one in five schools had no sanitation facilities, and almost one in two lacked basic handwashing facilities. This puts over 800 million children, many of whom rely on schools for basic nutrition, at risk of a health crisis that is not just due to COVID-19. At the peak of this pandemic, it is shocking to find that 84% of healthcare facilities in Sub-Saharan Africa do not have even basic hygiene service at points of care.

These numbers reaffirm that WASH is critical now more than ever, and needs urgent global action to respond to the serious threat this pandemic poses to lives and health systems. A World Leaders’ Call to Action on COVID-19, signed by heads of state, leaders of international agencies and private companies, among others, states: “Our response plans – at national, regional and global levels – must therefore prioritize water, sanitation and hygiene services.”

The World Bank estimates that $114 billion is the required global investment every year, until 2030, to reach Sustainable Development Goal 6: water, sanitation and hygiene. But that's not all it would achieve; every dollar invested in water and sanitation would return over $4, and improve global GDP by 1.5% due to reduced healthcare costs and increased productivity, according to the WHO.

Despite the economic and public health benefits, especially in light of COVID-19, only 9% of countries surveyed by UN Water have enough financial resources to implement WASH plans. These are crucial to prevent the transmission of the coronavirus, and further offer global health benefits – such as reducing the spread of antimicrobial resistance – which go beyond this pandemic.

All this calls for a rapid increase in investments in strengthening and extending WASH access. A variety of financing instruments already exist, including blended finance, microfinance, development aid, private finance, public finance, domestic capital and even commercial investments. Improving the efficiency of existing financial flows through the three Ts – taxes, tariffs and transfers – with better regulation and policies is also essential to fill this funding gap.

Early detection of the novel coronavirus in wastewater has been documented through multiple research studies. Although there are no reported cases of transmission via wastewater, a monitoring mechanism could be put into place for tracking community level infections of COVID-19 using municipal wastewater, as has been done in Switzerland. This opens yet another possibility of leveraging urban water systems to build resilience.

The WASH sector has long been advocating most of what is required for the response to this pandemic; universal access to safe water, sanitation and hygiene services. COVID-19 is a wakeup call to prioritize universal and equitable access to WASH services not just in households, but also in schools and healthcare facilities.

The pandemic has trained a spotlight on water, sanitation and hygiene, and responses to the pandemic have often included investments in WASH infrastructure, services and behaviour campaigns. These gains must persist in a post-COVID world, to prevent further shocks caused by future epidemics, a changing climate and conflicts. This 19 November marks yet another World Toilet Day, but one that must remind us that every crisis is an opportunity. We must use this one to strengthen efforts in WASH to realise the multiple co-benefits of economy, environment and public health – not just to combat this pandemic, but to prevent one in the future.