The COVID-19 pandemic makes it clear that health workers need access to all infection prevention and control tools in the toolbox. In the face of the novel virus, which most certainly won’t be the last, it’s all about the basics. Until a vaccine is widely available, health workers are limited in how best to combat the spread of the infection and care for those that are ill. Whether it’s masking up, washing their hands, or keeping surfaces clean—every measure that can be deployed to keep them and their patients safe is a necessity.

But what do you do as a health worker when you don’t have access to these basic measures? Globally, one in four health facilities are without basic water services. In sub-Saharan Africa, that number is as high as half of health facilities. Over 40% of health facilities do not have hand hygiene materials like hand sanitizer at points of care, where doctors and nurses and other frontline health workers need them. And smaller health facilities and facilities in non-urban settings have even poorer services. Without water, health workers are unable not only to wash their hands, but they also cannot disinfect medical equipment, or clean surfaces and floors.  

Past epidemics have demonstrated the dangers of poor water, sanitation, and hygiene (WASH) on infection prevention and control. With a high density of patients and pathogens in a confined space, there is a greater possibility for infections to be passed from one person to another. During the 2014-16 Ebola outbreak, health workers were up to 32 times more likely to contract Ebola than non-health workers. In this current outbreak, the WHO Africa Regional office reported in July that more than 10,000 health workers across the continent have been infected with COVID-19, citing that infection prevention and control measures are not fully implemented. In all likelihood, that number is a low estimate.

The Global Health Security Agenda (GHSA) launched in 2014 to ensure that countries are better able to strengthen systems to prevent, detect, and respond to infectious disease threats. We know that investing in strong health systems is the best and most efficient way to ensure that countries will be able to contain infectious disease threats before they spread. While detect and respond have been the focus of investment in the past, what is needed now is a greater emphasis on prevention, with health workers at the center. WASH and infection prevention and control must be integrated into global health security; failure to do so will result in substantial weakness in the preparedness of health facilities to prevent epidemics.

Last week on the sidelines of the United Nations General Assembly, leaders from global health and WASH came together with frontline health workers to speak out about the importance of WASH in health security efforts and how we can work together to prioritize and invest in these solutions.

Watch an exciting discussion convened by the Frontline Health Workers Coalition, Management Sciences for Health, and Global Water 2020 with keynote Laurie Garrett, a global security authority; Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Global Health Security; Margaret Odera, community health worker in Kenya; Dr. Ann Phoya, clinical director for the ONSE Progam, Management Sciences for Health; Dr. Marcelo Korc, unit chief, climate change and environmental determinants for health, Pan American Health Organization; Dr. Vanessa Kerry, co-founder and CEO of Seed Global Health.

Our excellent speakers left us with some important takeaways:

• You cannot stop a pandemic if you cannot wash your hands. Unsustainable water access and shortages put communities at great risk. 

• These issues are of major concern in low- and middle-income countries, but should not be overlooked in countries like the US, where inequities remain. 

• WASH is foundational and is the intersection between public health and environmental health. We need a true multi-sectoral approach which breaks down the silos and engages a variety of stakeholders.

• Community participation is critical to both behavior change and implementation. Solutions need to be people-centered. 

• The awareness raised around WASH during this pandemic should be leveraged to spark action. However, we must include medium- and long-term solutions in our planning—in addition to immediate response. 

• Investments in pandemic preparedness align with health system strengthening. The tools needed to prevent outbreaks are the same tools used to build trust and confidence in the health system. 

• Health security = national security = individual and community security.

This article was originally published by the Frontline Health Workers coalition on September 30, 2020. Read it here.