Abstract:
The COVID-19 pandemic placed hygiene at the centre of disease prevention. Yet, access to the levels
of water supply that support good hand hygiene and institutional cleaning, our understanding of
hygiene behaviours, and access to soap are deficient in low-, middle- and high-income countries.
This paper reviews the role of water, sanitation and hygiene (WaSH) in disease emergence, previous
outbreaks, combatting COVID-19 and in preparing for future pandemics. We consider settings where
these factors are particularly important and identify key preventive contributions to disease control
and gaps in the evidence base. Urgent substantial action is required to remedy deficiencies in WaSH,
particularly the provision of reliable, continuous piped water on-premises for all households and
settings. Hygiene promotion programmes, underpinned by behavioural science, must be adapted to
high-risk populations (such as the elderly and marginalised) and settings (such as healthcare
facilities, transport hubs and workplaces). WaSH must be better integrated into preparation plans and
with other sectors in prevention efforts. More finance and better use of financing instruments would
extend and improve WaSH services. The lessons outlined justify no-regrets investment by
government in response to and recovery from the current pandemic; to improve day-to-day lives and
as preparedness for future pandemics.
