A new technology has dramatically increased rates of handwashing in a trial in Tanzania, and could be key to preventing spread of infectious diseases.

Researchers at Imperial College London and the London School of Hygiene & Tropical Medicine (LSHTM) have designed a handwashing technology that could help halt the spread of COVID-19 and other deadly diseases by encouraging handwashing in developing countries where uptake is low. A pilot study found that the new system, which is underpinned by behavioural science, prompted people who previously did not wash their hands to begin handwashing with soap on average one-to-two times a day.

 “Sometimes we think of innovation as the latest cutting-edge engineering coming out of the lab. But that’s not always the innovation we need to solve the most pressing behavioural issues in the world."

In Tanzania, where the study took place, only four to eight per cent of the population in low-income communities regularly practices handwashing with soap, despite World Health Organization guidance that hand hygiene is one of the best ways to prevent transmission of germs. Within these communities, shared bars of soap are perceived to create a risk of people infecting each other, and when soap is a limited resource its use is prioritised for other purposes such as dishwashing and laundry.

The new technology consists of single-use tabs of soap and various mechanisms for dispensing them. It overcomes the limitations of ordinary soap because the tabs do not need to be shared and are designed only for handwashing. “Cross-contamination is more salient during a pandemic but is always on people’s minds. The design uses a single-use tab of soap, so every time you wash your hands you’re using a fresh, clean soap,” said project lead Dr Weston Baxter, a behavioural designer in Imperial’s Dyson School of Design Engineering.  He added: “Due to its design, the soap can only be used for its intended purpose, hand-washing.”

Taking the technology to market

The team estimates that the soap can be produced for around one US cent per tab, making the patent-pending system affordable for consumers and profitable for sellers even in low-income communities. “We’ve aimed to design a solution with a sustainable business model behind it – something that fits into the price range that people have in that demographic so that it perpetuates itself rather than requiring charitable funds,” said Dr Baxter. 

The team is currently looking for partners that can help them take the technology to market in time to help prevent deaths from COVID-19 and estimate that once investment is in place the products can start being manufactured within two weeks.

They believe that the products will continue to save lives once the pandemic ends. “There are other diseases like diarrhoea and cholera that are going to be there long after COVID-19 disappears or becomes just another of the endemic diseases that we have to worry about. A lot of people are talking about a ‘new normal’. We want our product to be part of that. We can create a new mode of behaviour that continues after the current coronavirus goes away,” said Ed Brial, a design researcher at Imperial who was involved in developing the new product.

Behavioural science innovation

While the solution draws on relatively simple technology, it is underpinned by important insights from research conducted by Dr Baxter, Ed Brial, and co-lead Dr Robert Aunger, a public health and behaviour change expert from LSHTM.

 “Sometimes we think of innovation as the latest cutting-edge engineering coming out of the lab. But that’s not always the innovation we need to solve the most pressing behavioural issues in the world. Sometimes what is needed is to develop more appropriate technologies and make something that is simple and elegant that can really solve the problem,” said Dr Aunger.

He added that the design approach used in this project is more likely to produce interventions that people will take up and use regularly. “It’s not usually enough to just teach people something, or give them a new technology. You have to understand the psychology of behaviour. Behaviour-change theory is at the core of this design,” he said.

“We have behaviour change tools and methods to evaluate the efficacy of the approach elsewhere, and tell whether it will still be useful in other contexts. We want to pilot this in other low-income countries where this may be valuable, such as India.”

Dr Ben Tidwell, the Senior Technical Advisor for Water, Sanitation and Hygiene Research at World Vision, is enthusiastic about the product: “While the installation of public handwashing facilities is feasible in some contexts, keeping soap at these facilities is a major challenge. In low income communities, where physical distancing is impractical, the lack of ability to wash hands alone will greatly exacerbate the impact of COVID-19.

"I’m very excited about this innovation, because it uses principles of behavioural design to provide a high-quality product that people will be willing to purchase and that will allow people to take their health into their own hands, rather than suffer due to improperly maintained public handwashing facilities or competing priorities for soap within the home.”

Dr Baxter added that the team is able to identify settings in which the solution will likely be an effective and commercially-viable intervention. “We have behaviour change tools and methods to evaluate the efficacy of the approach elsewhere, and tell whether it will still be useful in other contexts. We want to pilot this in other low-income countries where this may be valuable, such as India.”

The team has also considered the business model behind the product. Ed Brial said: “A key part of this innovation is leveraging different channels to get to consumers. You can start selling individual handwashes. At one cent per hand wash, that’s a low barrier to entry even in developing markets. It also means we can use multiple channels for selling the soaps, including traditional methods like door-to-door sellers.”

Partnering opportunities for industry

Dr Simon Hepworth, Imperial’s Director of Enterprise, said: “This solution is an important intervention for the current pandemic and the long-term, backed by innovative research and a strong business model. It is a prime example of how at Imperial we work with investors and industry partners to turn our research into commercial applications and in so doing bring real benefits for society.”

Businesses interested in working with the team to take the technology to market can learn more by contacting Imperial's Industry Partnerships and Commercialisation (Faculty of Engineering) team. They can contact Dr Laura Cabo-Fernandez for more information.