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Why the world is failing to prepare for the next global health crisis

Coronavirus has highlighted just how crucial good hygiene is. So, why are we still not prioritising access to sanitation, handwashing and drinking water?

Experts are warning that humanity risks further debilitating pandemics because of a lack of access to water, hygiene and sanitation. “If you don’t have water and sanitation facilities, you will increase the spread of infections,” says Dr Maria Neira, Director of Public Health and Environmental and Social Determinants of Health at the World Health Organization (WHO). “In the middle of this pandemic, the most important recommendation we are giving to people, still, is: wash your hands. And over three in 10 people around the world cannot wash their hands.”

A recent WHO report revealed that a third of healthcare centres worldwide do not have handwashing provisions at the point of care; one in four sites have no clean water on the premises; and one in 10 have no toilets. “This means that 1.8bn people use [health] facilities that lack basic water services, and 800m use facilities with no toilets,” said the WHO.

Helen Hamilton, Senior Policy Analyst at the international NGO WaterAid, says the 1.8bn lacking access to water for healthcare could be at greater risk from Covid-19 and future pandemics because they cannot block the spread of infectious diseases. “Investing in hygiene saves lives,” Hamilton says. “There are no resilient health systems that can withstand a pandemic without proper hygiene services. Poor water, sanitation and hygiene services are responsible for 10 per cent of the global disease burden. Without these basic services, public health is undermined, millions of lives are lost, and inequalities are exacerbated.”

Investment in water, hygiene and sanitation is essential for pandemic response and preparedness, Hamilton says. “Without this, communities, businesses and even whole country economies simply can’t be resilient to shocks or health crises,” she says.

Dr Neira cautions that hospitals and clinics that do not have access to water and sanitation should not even be classified as healthcare centres. “If you don’t have water and sanitation facilities, you are compromising the quality of care you need to provide,” she says.

A particular concern for healthcare experts is not only that inadequate water and sanitation hastens the spread of diseases, but also that many of these diseases may then need to be treated with antibiotics. This can drive up the use of antibiotics and the potential for resistant strains of disease, which may be difficult or impossible to treat. According to Dr Tina Joshi, a lecturer in molecular microbiology at the University of Plymouth in the UK, recent figures suggest antimicrobial resistance could cause more than 10m deaths per year by 2050, more than all current annual deaths from cancer and diabetes combined, and more than twice the total global death toll from Covid-19.

Bringing water, sanitation and hygiene to healthcare facilities in the world’s 46 least developed countries would cost up to $9.6bn over 10 years

“Antibiotic resistance remains one of the biggest threats to global health,” says Jeremy Knox, Head of Policy for Infectious Disease at the Wellcome Trust. “Improving access to clean water and sanitation, particularly in healthcare settings, will undoubtedly help stem its development and spread.”

Bringing water, sanitation and hygiene to healthcare facilities in the world’s 46 least developed countries would cost just $0.65 a year per capita. That’s $9.6bn over a decade.

“To provide every person in the world with access to potable water and safe sanitation wouldn't break the bank,” says Helen Clark, former Prime Minister of New Zealand and co-chair of the Independent Panel for Pandemic Preparedness and Response. “It has to be prioritised. It's a question of priorities, and water and sanitation are right up there as among the basics for a decent life. We have to insist that access is universal, in line with the Sustainable Development Goals targets.”

Water and sanitation are particularly important in healthcare centres, which can act as focal points for infection if hygiene measures are not in place

Experts including Joshi have called for water, sanitation and hygiene to be included in global Covid-19 relief schemes, particularly since the pandemic has provided a vivid demonstration of the value of disease prevention. In the early stages of the Covid-19 pandemic, before vaccines were available, countries such as South Korea and Taiwan avoided mass infections by tracking and isolating infected individuals.

They prevented infections using high-tech tools such as mobile phone tracking apps, alongside mask-wearing, temperature checks and use of hand sanitiser. In emerging economies where track and trace programmes are not widespread, social distancing, wearing masks and essential public health measures, such as washing hands, are critical barrier measures. Water and sanitation are particularly important in healthcare centres, which can act as focal points for infection if hygiene measures are not in place.

In July, alongside Clark, Her Excellency Ellen Johnson Sirleaf, former President of Liberia, called on world leaders to learn from Covid-19, and put in place measures to avoid the spread of further pandemics. “It fell on me to lead our population through the devastating experience of the Ebola epidemic and the hard-won recovery from it,” she said. “I speak with conviction when I say that this current pandemic must be the last to cause devastation to human life, societies and economies. As a world, we must do better.”

The Wellcome Trust’s Knox echoes this sentiment. “The Covid-19 pandemic has highlighted the importance of preventing infections in the first place, as well as having strong infrastructure in place to identify, control and treat them when they do occur,” he says. “It’s imperative that we learn these lessons as we consider how to better prepare for and respond to future health emergencies, whether that’s the sudden appearance of a dangerous new virus or the rising tide of antibiotic resistance.”

One key lesson is that stakeholders will need to work together on improving water, sanitation and hygiene. “At the current rate of progress, it will be decades beyond the global deadline of 2030 before everyone, everywhere has access to safe water, clean toilets and handwashing facilities with soap," says Peter ter Kulve, Unilever’s President of Home Care.

“This delay will cost lives and leave us all vulnerable to the devastating impacts of future health and climate emergencies. To tackle any global challenge, we need to take a multi-stakeholder approach,” he says. “The rapid development of Covid-19 vaccines showed us what impressive results collective action can achieve when business, government agencies and academics work together. We need the same level of collaboration to achieve hygiene, clean water and sanitation for all.”

Preventing infection is far more cost effective than treating it, as a way of halting diseases. And for prevention, few measures are likely to be more cost effective than providing access to water and sanitation. Research has found that ensuring everyone everywhere has access to even basic water, hygiene and toilets – which could mean a well within a 15-minute walk, a household toilet, and soap and water to wash hands with – would bring returns of up to 21 times their cost. The question is whether policymakers will wake up to this fact in time to help halt the world’s next pandemic.


Photo by WaterAid/Ronny Sen.

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