WASH: a protective vaccine responding COVID-19

5 min read
Community Clinic in Tahirpur
Image: WaterAid/HSBC/MR Hasan

World Health Organization (WHO) is mandated to address global health priorities, provide due leadership and guide global health stakeholders on health issues; and play critical, strategic and special role during any emergency; likewise, for COVID-19, WHO adopted key steps, disseminated guidelines and analysed data to update periodically. They have been sharing those with the governments for planning actions. Parts of the process were incorporated during the recently held 73rd World Health Assembly (WHA73) on 17 May 2020, virtually for the first time. It encountered condensed agenda to fit into two days.

Most of the agenda revolved around COVID-19 pandemic, the nature of novelty of virus and prevailing public health challenges globally. The novelty of COVID-19 might avail many aspects of combatting this flu in reality but importance of water, sanitation and hygiene (WASH) remains as an urgent priority as believed by many public health professionals.

The two-day sessions covered many discussion, including vaccine, universal health coverage (UHC), tuberculosis (TB), Cholera, neglected tropical disease (NTD), ageing, routine organisational issues and many speeches in different sessions and responses from member countries.  Due to prevailing COVID-19 pandemic, the agenda 3 as discussed on 19 May 2020 during WHA73 with a paper shared by European Union (EU), got huge attention by public health professionals and created the space for further discussion.

Why is WASH a backstage agenda?

The general session of WHA73 started with speeches of the Director General (DG) of WHO and other dignitaries. The speech of the DG, Dr. Tedros Adhanom was very comprehensive, covered most part of the issues encircling COVID-19 pandemic and contained around 4,000 words while just once used the word ‘hand hygiene’ and once again ‘clean water’ but no issue on WASH and priorities. On the contrary, most preventive approaches of COVID-19 lie in hygiene and broader WASH factors, particularly in communities, public places and densely populated slums. WHO also, since the very beginning of COVID-19 problem, prioritized the basic hygiene awareness and disseminated messages related to these, but this forum did not focus the importance on hygiene where all member’s states were present and listened to the key points at this high profile platform.

During April 2020, at least 10 countries (mostly Latinos) proposed for supplementary agenda to invite Taiwan in the WHA73; unfortunately, no proposal found from any of the 190 member state countries to include a petition to highlight WASH or hygiene agenda within the papers or documents to be disseminated during WHA73.

Bangladesh is one of the 34 board members and Bangladesh got only 2 minutes’ time to share their stand and in the written statement, the Bangladesh team-lead, the hon’ble Minister, ministry of health and family welfare (MOHFW) uttered the “Whole-of-the-Government” approach and narrated the adjustment plan to COVID-19 in terms of mostly at clinical settings with intensive care unit (ICU) beds, recruitment of health work force but the preventive approaches were not present unfortunately; neither focused nor indicated. On the contrary, the preventive approach was highlighted majorly in all messages, i.e., hand hygiene, face hygiene and cough etiquette or the personal hygiene issues. Availability of clean water or environmental cleanliness were also part of the preventive approach by the government. This absolute no-mention of WASH related matters during WHA73 clearly indicates to lesser attention provided by the top level of the ministry of health through cascade-down effects towards public health professionals of the country. This surely induced frustration to both health and WASH sector; in larger development sector.

While over 70 countries responded to the draft resolution on agenda item 3. Surprisingly again the absence of broader WASH issues mentioned and only key points mentioned including hygiene in only at OP7.4. Several countries specially put note on this agenda item 3 and they are Cuba, Argentina, Brazil, Philippine, USA etc. Brazil though agreed to co-sponsor and explained their position but focused on SRHR gap; while USA put emphasis on international health regulation.

The WASH issues were also not addressed adequately in the UN resolution 74/270: Global solidarity to fight the COVID-19, nowhere mentioned on the importance of very basic needs of life including WASH to address to tackle this. Rather the UN resolution 74/274 very elaborately described the need of medicine and equipment while apparently this is actually required by only 10-15% of the COVID-19 patients. Most of community level preventive approaches against COVID-19 are related to WASH being the first line of defense for COVID-19 hygiene awareness in most marginalized communities and therefore it requires heavy engagement in terms of both of awareness raising and service delivery to ensure in the communities, for all even in underserved and resource poor settings.

At this situation, it appeared that WASH is fundamentally neglected during WHA73 and revealed that integration of WASH and health is miles away from each other. Having realized this also sheds a positive light, it creates ample opportunities for the WASH actors and advocates towards string more intense and productive debate and dialogue for integration.

Government of Bangladesh has developed the ‘National Preparedness and Response Plan for COVID-19, Bangladesh’ (Version 5: March 2020) and has captured several important aspects of the COVID related preventive approaches and management guidelines. The plan depicted six priority activities where MOHFW will respond against COVID-19. It is to mention that until the Version 3 of this document, WASH was not broadly included but national level advocacy by WaterAid Bangladesh and other key actors continued relentlessly with the MOHFW over the past months and the Version 5 entails ‘WASH’ convincingly in the document. It is inspiring to all of us and we mark it as turning point of integrating health and WASH.  

However, the plan still requires detailing of the measures as indicated in the document and further advocacy will continue by WaterAid with MOHFW as COVID-19 seems to stay for a relatively longer duration and lot many actions relate to managing the COVID issues effectively.

During the WHA73, lot of health-related issues were discussed profoundly but majorly roamed around vaccines or medicines; but not on WASH as a means of saving mass people lives and thus a kind of important protective vaccine as well. Even during the closing remark, the DG of WHO mentioned of the essential health services yet not again his speech encompassed WASH related components. Indeed, technology, vaccine, system issues are important but WASH as a cross cutting basic service amenities should have a position and be discussed and mentioned within broader agenda, particularly in this kind of top-level forum and discussion board. Thus, huge advocacy is required in future to further promote WASH agenda in both national and global meetings.    

Written by Dr Nurullah Awal and Dr Abdullah Al-Muyeed