World Health Organization leadership on water, sanitation and hygiene reducing COVID-19 impacts

Most people working in the water, sanitation and hygiene (WASH) sector are familiar with the Water Safety Plan (WSP) approach that was developed and proactively promulgated globally by the World Health Organization (WHO).

The WSP approach involves identifying reasonably foreseeable contamination events and then reducing the risks posed to acceptable levels by implementing operationally reliable and technically credible barriers. Importantly, the WSP approach isn’t reactive in that it doesn’t await the occurrence of contaminating events or the detection of contamination. Rather, the approach anticipates their potential occurrence, and the maintenance of adequate barriers, in a preventive manner.

Building upon the successful WSP program, WHO more recently developed and promulgated the Sanitation Safety Plan (SSP) approach. This adopted the same preventive risk management principles as the WSP approach.

WHO played the leading role in undertaking proactive work for over 20 years in developing and promulgating first the WSP, and then the SSP, approaches which are now firmly embedded globally. This work has involved review of evidence, advocacy, guideline development, training and dissemination programs, setting up partnerships and a wide range of supporting activities. The guidance is subjected to ongoing review and revision.

The focus on preventive barriers, rather than reactive response to the detection of contamination, is relevant to the COVID-19 outbreak. Fortunately, transmission via drinking water and wastewater is not considered an important or significant transmission route for the COVID-19 virus. But importantly, even if it were, the WHO’s WSP and SSP approach requires first and foremost consideration of risks from pathogens. The more numerous, environmentally robust and disinfection-resistant ‘worst case’ pathogens set the standard that needs to be achieved for the assessment and mitigation of such risks. Evidence to date suggests that a technically sound and robustly implemented WSP or SSP, developed to meet current good practice standards, provides a framework that also protects against transmission of the COVID-19 virus via drinking water or sanitation pathways.

This case study provides a useful illustration of the benefits of the WSP and SSP approach. The requirement to implement preventive barriers to the ‘worst case’ of the better-understood pathogens provides an inherent ability to mitigate many emerging pathogens. Under this preventive risk management paradigm it wasn’t necessary to detect the COVID-19 virus before water-related transmission could be mitigated. The only note of caution is that future emerging pathogens, or changes in environmental or other circumstances, might create challenges not adequately addressed by current barriers.

Another area in which WHO’s leadership has been very much in evidence during recent months is their rapid review of the evidence and development of WASH sector guidance relating to COVID-19. Once again, whilst water and wastewater haven’t emerged as important or significant transmission routes for the disease, there were concerns among communities and workers that needed to be addressed. In addition, hygiene has emerged as a major component of controlling the spread of the COVID-19 virus. WHO’s statements have been extremely reassuring and helpful to the WASH sector and the communities that are looking for reliable advice. As is common practice for WHO, they drew from a wide body of global experts within the WASH community of practice (such as Dr David Cunliffe from Australia) in developing their response.

In considering the implications for COVID-19 for the WASH sector WHO began by firstly understanding the concerns and questions that needed addressing to help prioritise its review of evidence and development of guidance. Secondly, WHO put together guidance that drew from the best existing evidence and information. Finally, WHO disseminated that information rapidly through their global networks and in multiple languages. As is normal practice for WHO, that guidance is subject to rolling review and revision in response to feedback from its intended audiences – both to incorporate new evidence, and to respond to feedback on user needs. The guidance includes advice on drinking water, sanitation, safety of workers and various aspects of hygiene. Importantly, the guidance is evidence-based, is subjected to extensive scrutiny by a global body of experts, contributors and users, and is proactively disseminated throughout the world. Despite this technical rigour, the guidance was developed and issued rapidly.

The WHO WASH resources are made freely available to all and in many languages. They can be accessed on the internet (here) and a recent update of note is the WASH and COVID-19 resources page. The site can be kept handy for the latest updates and revisions to documents but you can receive automatic updates simply by emailing with the text “subscribe WATERSANITATION” in the body of your email.

There are a wide range of resources available to support WSPs and SSPs. In addition there are various simple guidelines and posters on matters such as hand hygiene and use of gloves. We’ll leave you to browse more at your leisure, as well as to think about how you can contribute your evidence and case studies; and to provide feedback to WHO on the sort of guidance and support that you think is needed.

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