A quarter of the world’s population is at risk of the COVID-19 coronavirus due to a lack of access to effective handwashing, according to a new report published in the journal Environmental Health Perspectives.

The report, titled “Handwashing Is Crucial for Combating Coronavirus” by researchers at the University of Washington's School of Medicine’s Institute for Health Metrics and Evaluation (IHME), specifically looked at handwashing access in household settings. 

The World Health Organization recommends people wash their hands for at least 20 seconds with soap and water to protect against coronavirus. But for many of the more than 2 billion people who live in low- and middle-income countries who are more susceptible to the virus than those in wealthy countries, this is not an option. 

More than 50% of people in sub-Saharan Africa and Oceania lacked access to effective handwashing, and more than half of the people who lacked access to soap and clean water live in 46 countries around the world, the report found. It is estimated that more than 50 million people without handwashing access live in Nigeria, China, Ethiopia, the Democratic Republic of the Congo, Bangladesh, Pakistan, India, and Indonesia. 

Access to handwashing tends to be unavailable in countries that also have weak health systems, and the consequences can be life-threatening, Dr. Michael Brauer, a professor at IHME and a contributor to the report, said in a news release. 

“One of the things that we've known all along is that lack of access to handwashing is a risk factor for all kinds of diseases, especially diarrheal diseases, but also ongoing respiratory infections that we have every year,” Brauer told Global Citizen.

By putting people at risk of diseases, contributing to stunting, and making it more difficult to reach their full potential, poor access to water and sanitation also traps people in poverty. 

While the report focused on access to handwashing basics like soap and water, behavior change also plays a role in turning handwashing into a healthy habit.

“Before you can even think about behaviors, you need to have access,”  Brauer said.

For people who rely on communal water and sanitation facilities, it is especially difficult for handwashing to become second nature, he pointed out.

In 2017, lack of access to handwashing was linked to a total of 707,000 deaths globally. To slow the spread of #COVID19 around the world, increased access to handwashing is critical. @Pathways2Equity@EHPonline@ubcspph@EPHIEthiopiahttps://t.co/z08xLel1Ha

— IHME_UW (@IHME_UW) May 21, 2020

“If you're talking about needing to walk to the school every time you want to wash your hands, that may work if you're talking about washing your hands before mealtime,” Brauer said. In the context of a pandemic, however, when people are advised to wash their hands very frequently, easy access is even more crucial.

Long-term solutions are necessary to protect against COVID-19 and to prevent the more than 700,000 deaths each year due to poor handwashing access, Brauer said in the news release. He warned distributing hand sanitizer and setting up water trucks in communities are only “temporary fixes.” 

“If you make a change that's sustainable, you're not only dealing with the immediate concern, which is the pandemic, but then that also has all kinds of benefits over a longer timeframe,” he said.

“Perhaps this could be an opportunity, rather than just another instance where we're providing sort of band-aid, temporary solutions.”