The emergence and spread of COVID-19 highlighted the importance of access to water, sanitation, and hygiene (WASH). Global health officials stressed the role of regular handwashing with soap and water in COVID-19 control and prevention. However, billions of people around the world struggle to meet their daily WASH needs, including large portions of sub-Saharan Africa’s population. COVID-19 had a disproportionate impact on populations in sub-Saharan Africa that have limited access to WASH facilities and pre-existing vulnerabilities. From poor urban residents and migrant and refugee populations to women and girls, vulnerable populations face critical challenges that have been worsened by COVID-19. This chapter uses case studies from the Democratic Republic of Congo, Ghana, Niger, and Uganda to identify the potential impact of COVID-19 on vulnerable and water insecure populations. It examines why well-intentioned WASH interventions to control COVID-19 in the region failed to address the specific needs of poor, under-resourced, and vulnerable populations. The complexity of water provision in terms of source types and locations across sub-Saharan Africa undermine the effectiveness of WASH interventions for COVID-19. Our chapter highlights how these interventions inadvertently privilege affluent households with private taps while overlooking poor households that rely on informal water vendors. These case studies provide lessons for designing effective health interventions for future pandemics or emergencies.