Like many such events, this year's World Water Week (Aug 24–28) conference will now be taking place virtually. Convened by the Stockholm International Water Institute, the meeting gathers scientists, business leaders, and policy makers, as well as civil society, to engage on one of the world's most pressing set of challenges.

It was only just over a decade ago, on July 28, 2010, that the UN General Assembly recognised the human right to water and sanitation, through Resolution 64/292, entitling everyone to acceptable, accessible, affordable, safe, and sufficient water. And in 2015, the global community set a measurable target in the form of Sustainable Development Goal (SDG) 6, which committed countries to ensure the availability and sustainable management of water and sanitation for all by 2030. Where does the world stand now regarding these rights and targets?

According to the WHO/UNICEF Joint Monitoring Programme for Water Supply, Sanitation and Hygiene (JMP) Progress on Household Drinking Water, Sanitation and Hygiene 2000–2017 report, published in 2019, 1·8 billion people gained access to at least basic services between 2000 and 2017. However, in 2017, 2·2 billion people still lacked access to safely managed drinking water, 4·2 billion lacked safely managed sanitation, and 3 billion lacked basic handwashing services. Furthermore, the Programme's WASH in Health Care Facilities global baseline report 2019 showed that one in eight health-care facilities had no water service and one in five had no sanitation service in 2016. The consequences of these inadequacies for infection prevention and control amid a pandemic are clear.

As ever, such global figures mask regional inequities and data gaps. In a geostatistical modelling study of 88 low-income and middle-income countries in this month's issue, Anriuddha Deshpande and colleagues show that access to piped water was lowest in sub-Saharan Africa in 2017 and relatively high in Latin America. Deshpande and colleagues also estimate the number of diarrhoeal deaths in children younger than 5 years that could be attributed to unsafe facilities and found that, in 2017 in sub-Saharan Africa, 143 300 deaths in children were attributable to unsafe water, and 18 100 child deaths were avoided by increased access to safe water. In southeast Asia, east Asia, and Oceania, 9470 child deaths were attributable to unsafe water and increases in safe water avoided at least 1310 child deaths. The authors acknowledge the limitations of this work, including insufficient data to produce reliable estimates.

What we do know is that, during the last century, use of water globally has been growing at more than twice the rate of population growth. Supplies of water are threatened by climate change, population growth, demographic changes, and urbanisation. In recent years, an increasing number of cities have come close to or reached the limits at which they can sustainably supply water services. In January 2018, the announcement that Cape Town was three months away from “Day Zero” (the date when the municipal water supply would be cut off) made headlines around the world—a fate that the city thankfully managed to avoid. Before that, in 2015, São Paulo came within 20 days of its own “Day Zero” and in June 2019, Chennai's main reservoirs ran completely dry. This is a cross-continental trio of reminders that the challenge of achieving water security is here to stay.

Yet could the COVID-19 pandemic mark a step change in the urgency with which the international community addresses these challenges? In a Comment published in this month's issue, Adeladza Amegah notes the “tremendous” improvement in access to handwashing facilities in many African countries, with “handwashing stations noticeably increasing in community centres, schools, markets, bus terminals, lorry stations, and other public spaces”. Moreover, “some African governments, as part of their COVID-19 response plans, took urgent steps to make clean water accessible to all communities by drilling boreholes and mobilising water tankers to supply water.” He urges national and local governments to find the fiscal space to continue these practices and sustain the promotion of handwashing post-COVID.

2 years into the International Decade for Water Action, the complexity of governance of this abundant yet paradoxically increasingly scarce resource cannot be underestimated. But if ever there was a moment to seize upon the small gains prompted by a global event, the moment is now.

Original Paper: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30368-5/fulltext