Bigger Than Pasteur

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Bigger Than PasteurBigger Than Pasteur

by Raywat Deonandan
June 4, 2003

This is an original Podium article.

“Just long enough to sing happy birthday,” suggested a Toronto radio personality. She had been asked about the appropriate duration for washing one’s hands, sufficient for disposing of topical SARS viruses. It seems that many took her suggestion to heart, since my recent visit to Toronto involved the shaking of countless dry and rashy hands, rendered thus by both frequent washing and the liberal use of alcohol wipes.

The dry hands will heal. But here’s hoping the new hygiene fad is a lasting one, since hand washing is now being recognized as one of the most remarkably efficient and inexpensive methods of combating disease worldwide. In the words of British researcher Val Curtis, “this is as exciting as the discoveries of Pasteur.”

Speaking from a meeting of the Global Health Council in Washington, DC, Dr. Curtis presented findings from her review of hand washing studies in the poorest regions of the developing world. Co-authored by Sandy Cairncross, the results were published in the prestigious medical journal The Lancet in May. They found that by simply advocating the washing of hands with soap in a given household, the risk of a child developing a diarrheal disease decreased by 47%.

This is a remarkable finding, since diarrhea kills over 5000 children every day, or 2 million every year. For comparison, SARS has so far killed 772 people worldwide, according to the WHO.

Hand washing is also proving to be an effective preventative against respiratory illnesses, a category of disease to which SARS and the common cold belong. According to Dr. Curtis, hand washing with soap produces a risk reduction of 37% with respect to such infections. It is important to realize that, respectively, respiratory and diarrheal diseases are the number one and two killers of children under five years old. Epidemiologically, these estimates of risk reduction are astounding, especially given the simplicity of the intervention. See, there’s a good reason that health ministries require restaurant employees to wash their hands after using the toilet.

One of the problems with implementing the strategy globally is, of course, supply. Much of the world is without access to soap, despite it being one of the earliest human inventions. In the words of Dr. Curtis, “soap was probably invented by caveman, or, more likely, cavewoman.” The advent of soap increased early humans’ life expectancy, gave us a weapon against microbes and aided us in our conquest of the globe. Soap’s manufacturing essence is the addition of animal fat to wood ash. Yet, in much of the developing world, both animal flesh and wood are difficult to acquire. Moreover, the knowledge of how to make soap is rapidly disappearing from communities. Soap, this thing we mindlessly buy for pennies and steal from hotels, is an unaffordable luxury to many.

Hence the refreshing inclusion of private partners in a bold initiative sponsored by the World Bank, the UN and several NGOs. The project aims to disseminate soap to selected communities in Africa, Asia and South America, in order to reduce the incidence of hygiene-related illnesses. Health workers have always known that hand washing can be beneficial; that’s not new. The truly innovative aspect of this new project is the role of the private sector –soap manufacturers– in donating large quantities of the life-saving stuff.

No doubt, the private sector partners will reap rewards in terms of advertising capital and new market share. The sensibilities of altruistic aid workers will be offended. But that hardly seems relevant given the potential to literally prevent millions of deaths.

Soap is not a panacea, of course. Efforts to improve sanitation through latrine construction and better sewage must continue. The biggest barriers to good global public health remain poor infrastructure and insufficient clean water. Indeed, water is so scarce in some regions that none can be spared for washing –with or without soap. UNESCO estimates that 40% of human beings presently do not have access to sufficient clean water, and the scarcity is deepening.

But for those with water –even dirty water– news of soap’s healthy effects can only be encouraging. It is mildly ironical that to combat the plagues of the 21st century, we must turn to a technology that predates civilization itself.


Dr. Raywat Deonandan is a Canadian epidemiologist living in Washington, DC. Visit him online at www.deonandan.com.