Research Fellow, Centre for Global Health, University of Oslo, Norway
PHA Next Gen Member
The need for access to safe water, sanitation and hygiene has proven to be of the utmost importance in order to safeguard human health, especially amidst the ongoing COVID-19 pandemic. These three symbiotic terms are collectively known as WASH. Among them, hand-washing is the most commonly recommended measure to prevent the spread of disease. My concern is about the link between WASH and climate change as well as how understanding this planetary issue is essential in order to prepare for future pandemics. I believe that WASH is important to the planetary health agenda, particularly for urban populations.
WASH In The Time of COVID-19
The enormous role of WASH in the global health field has become evident yet again in light of the current COVID-19 crisis. While no definite remedy is approved yet for this deadly virus, frequent hand-washing, proper hygiene practices, and social distancing are currently the most prescribed pieces of public health advice. Previous Ebola and Zika outbreaks have helped prompt this decision. In a recently published NPR article, Dr. Joia Mukherjee, chief medical officer at Partners In Health and associate professor of global health at Harvard Medical School stated,
“When Ebola hit, one of the biggest concerns was the lack of running water and sanitation for hand-washing and proper waste disposal. It almost seemed like an unsolvable problem. And yet relatively rapidly, solutions were put together.”
Although other surrogate coronaviruses are able to persist in water and sewage, the current culprit behind the COVID-19 pandemic, SARS-CoV-2, seems unable to do so thus far. However, ensuring access to WASH remains essential. The importance of access to safe water, proper sanitation and hygiene in the current scenario lie in that if we cannot ensure access to WASH, detrimental effects far beyond contracting the disease will emerge. One of the biggest WASH challenges in light of COVID-19 includes the safe disposal of personal protective equipment (PPE). Grey water, which is water from washing reusable PPE, needs safe disposal facilities. However, many countries have not yet upgraded their waste management facilities to tackle the immense increase in discarded pieces of PPE that are highly contaminated. Even single use masks, gowns and gloves are being reused after being washed with shampoo water and then resold by corrupt syndicates.
Co-benefits of WASH Measures Implemented During COVID-19
I believe that WASH measures during the COVID-19 crisis have demonstrable co-benefits for the global community. The environment is arguably the recipient of the most benefits from lockdowns, such as slowing some of the effects of climate change, which in turn positively affects safe water reserves. However, diseases resulting from lack of access to WASH have been less frequently reported so far. The U.S. CDC has reported fewer foodborne disease outbreaks in 2020 as compared to previous years. Even in the 2020 ECDC Communicable Disease Threat Report, foodborne and waterborne diseases are not listed as threats to the EU, due to a reported lack of recent outbreaks. Besides hygiene and frequent hand-washing, increased emphasis on proper cough etiquette and widespread use of face masks have contributed largely to increased infection control for other diseases as well as COVID-19. While the death toll in many European countries was very high, transmission was slowed due to infection control via WASH interventions. At the same time, many developing countries are taking more time to consider how to combat inadequate health literacy regarding hand hygiene as well as a lack of proper WASH provisions, sustainability and infrastructure. One of the valuable outcomes of this pandemic has been world leaders’ call for action on COVID-19 regarding how we must prioritize ensuring that water, sanitation and hygiene services are accessible to all — given that they are the first line of defense against disease. COVID-19 has only further illuminated the urgent need to ensure access to WASH and emphasize how essential it is to the planetary health agenda.
WASH, Climate Change and Sustainable Development Goals (SDGs)
Global access to WASH has been included in the UN Sustainable Development Goals (SDGs), which have the goal of being reached by 2030. (SDG 6, for example, is wholly focused on ensuring the availability and sustainability of access to clean water and improved sanitation for all). Among WASH components, access to clean water is predicted to experience significant interruptions due to climate change, making it much more difficult to access and practice proper sanitation and hygiene. It is well-known that the impacts of climate change, such as rising temperature, increased frequency and severity of droughts, rainfall, landslides, and floods, make people vulnerable. As such, people are forced to reckon with migrating within as well as out of their own countries. Large shares of climate change victims typically reside in urban slums with poor sanitation and hygiene facilities, which only further perpetuates the vicious cycle of poverty, disease, and malnutrition. Although people of all ages can suffer from enteric infections due to consumption of unsafe water and poor sanitation, children are at greatest risk with many facing growth retardation via environmental enteropathy. In addition, lack of access to WASH provisions in urban slums makes slum dwellers more susceptible to communicable diseases, such as COVID-19, dengue, and more. Including the impacts of climate change in WASH education when communicating with individuals in urban households is an important way to combat the dual burdens of climate change and lack of access to WASH via health literacy. Unfortunately, developing countries that experience rapid urbanization are often challenged with lack of infrastructure and stakeholders’ knowledge of these issues.
The Planetary Impact of COVID-19
Though the emergence of SARS-CoV-2 is still under investigation, a strong link to zoonotic transmission from bats is suspected. Rapid, unplanned urbanization and deforestation are disrupting the normal habitats of bats, reptiles and other animals that are major reservoirs of disease. Additionally, human interaction with wildlife is increasing through widespread unregulated wildlife trades. This indicates that the origin of not only the current pandemic but also the potential origins of future pandemics lie in our environment, while currently the only available remedy includes infection prevention via WASH practices.
Given that we do not know how or when the COVID-19 pandemic will end, we must focus on possible ways to lessen its transmission. According to WHO guidelines, practice of the best possible WASH measures at both household and community levels must be prioritized. The COVID-19 crisis must be viewed as an opportunity for widespread global health education regarding the interconnectedness between WASH, infection control, and climate change. Given my experience as a planetary health practitioner and researcher, I believe we must include more WASH interventions within a planetary health lens to prevent further pandemics and promote global health.
Key Words: COVID-19, Water, Sanitation and Hygiene (WASH), Urbanization, Climate Change, Planetary Health