Coronavirus is a hygiene crisis

Date: 18th March 2020

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National governments are responding to the Coronavirus on an unprecedented scale. In addition to school closures and bans on large gatherings, borders are closing, flights are cancelled and whole populations are in lockdown as we collectively try to contain the virus. Each of us is touched by this very public health emergency. We are asked to protect ourselves, our families and our neighbours. For millions of people, there are strict restrictions in place, curbing our movement and social contact. Most contracting the virus will have mild symptoms but vulnerable people, including the elderly or those with existing health conditions, could be very sick and some will die.

Yet there is no vaccine for COVID-19. To break transmission chains, individuals are advised to look closer to home for how they can be empowered to self-protect. Quite simply, for individuals and households, this starts with good hygiene.

Breaking human transmissibility of viruses like COVID-19 is about practising what we preach. Handwashing with soap, for at least 20 seconds, after going to the bathroom; before eating; and after nose-blowing, coughing, or sneezing is the ultimate “do it yourself” vaccine.

But what happens when the urgency to contain and stop the impact of COVID-19 or for that matter cholera, polio, measles and Ebola, reaches populations unable to respond? Experts worry that “social distancing” will be difficult to do in overcrowded cities and slums, where people are disproportionately affected by HIV, tuberculosis and other infectious diseases.

According to the WHO/UNICEF Joint Monitoring Report, the appalling fact is that in 2017, some 3 billion people still lacked a basic handwashing facility in their home, nearly three-quarters of the population of Least Developed Countries lacked handwashing facilities with soap and water, and in 2016, nearly 900 million children worldwide lacked a basic hygiene service at their school. Similarly, one out of six health care facilities globally had no hygiene service, meaning they lacked hand hygiene facilities at points of care.

Many of those 3 billion people live in South Asia and Sub-Saharan Africa, whose populations account for 85% of the world’s poor and where health systems are more fragile, lacking funding (and often enough trained personnel) to provide proper care. Last month, WHO Director-General Tedros Adhanom Ghebreyesus said his “biggest concern” was COVID-19 spreading in countries with weak health systems.

Worse still: many of those 3 billion people are in the most vulnerable situations: those with disabilities, the elderly, women and girls, displaced people, indigenous populations and those living in the hardest-to-reach rural areas. In the wake of the current outbreak, Bill Gates has also suggested supporting these regions to be able to respond as an essential preventative measure for this and future health crises.

Since 1995, the London School of Hygiene and Tropical Medicine has been developing evidence of the effectiveness of handwashing with soap against diarrhoeal diseases, and private sector companies, have launched successful campaigns to inculcate personal and lasting hygiene habits.

Yet, governments and the international community have failed to prioritise adequate financing at the scale needed for Sustainable Development Goal 6, target 2 – access to adequate and equitable sanitation and hygiene for all. This is a failure that when coupled with the threat of a global hygiene pandemic is an outrage.

According to the latest UN-WATER/WHO Global Analysis and Assessment of Sanitation and Drinking-Water (GLAAS) report, many countries, including those in Africa and Asia, have estimated the costs needed to implement their national plans for water, sanitation and hygiene, less than 15% of these countries reported having sufficient financial resources to implement these plans.

At the current trajectory, it will take until 2043 to achieve universal access to basic sanitation. The SDG target of safely managed sanitation will only be realised in the 22nd century. Targets linked to hygiene – and to getting the behaviour to be the norm – may take even longer to be achieved.

So, what will this take? National prioritisation and leadership, budgets and sustained commitment to set and achieve inclusive targets, not just for current outbreaks, but for sustained progress. At the international level, there is an urgent need to secure a dedicated mechanism – a Fund – that will provide governments with catalytic funding to tackle and reduce sanitation and hygiene-related disease inequality.

In recognising that action in one SDG area will affect outcomes in others, alongside a dedicated sanitation and hygiene fund, there must be a true effort to complement global health and global education investments. Given the breadth and complexity of the SDGs, this also requires attention on governance to allow for alignment of policies and implementation.

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