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 during recovery from the current pandemic to improve day-to-day lives and as preparedness for future pandemics.


  • This is the first comprehensive review of WaSH & COVID-19.

  • The paper analyses the key ways in which WaSH can help reduce the transmission of COVID-19.

  • The paper presents the analysis of the wider role for WaSH in combatting pandemic disease.

  • The paper analyses the structural deficiencies in the WaSH ‘sector’ that limits its impact on COVID-19.

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Author notes


Authors in alphabetical order.