Health Matters: Zika virus – yet another cautionary tale

240_F_101823488_gNzeVwhfUVEUjHdHVZYdTPni1wEScXv8By Jim Hyde | Contributor

Remember Ebola? Eleven thousand deaths, lingering chronic complications for thousands, billions of dollars in direct and indirect costs? It should have taught us a lesson. Apparently it did not.

Now, just two years later, we are faced with another disease outbreak that has produced thousands of severely damaged infants and children and has quickly moved from Central and South America to Puerto Rico and now to the southern continental U.S. Amazingly we know how to control and prevent transmission of this disease, but Congress refuses to fund control efforts.

Initially an oddity

Zika virus has been around since the late 1940s. Named for the Ugandan forest where it first appeared, it was treated as little more than an oddity for decades. Limited to East Africa and Asia, it didn’t appear to cause serious illness and was often confused with another disease, dengue fever.

All of that changed with an outbreak in Micronesia (2007) and French Polynesia in (2014). Shortly after, in 2015, doctors in Northern Brazil began seeing large numbers of infants born with severe birth defects, most notably with small heads (microcephaly). It wasn’t long before these events were tied to the presence of the Zika virus in pregnant women. In the United States, Florida and the Miami area are especially at risk because Miami is a major travel hub to and from the Caribbean and Latin America and because the local environment supports the mosquitoes known to carry the virus. To date 8,600 cases of Zika have been confirmed in the U.S. and its territories, more than 1,100 of which are in pregnant women. And just last week the Centers for Disease Control and Prevention extended its travel advisory to include all of Miami/Dade County, Florida.

A lot is still unknown about the long-term effects of the virus and its global distribution. But there is a lot we do know: It spreads by the bite of two very hardy and prevalent mosquitoes species: Aedes aegypti and Aedes albopictus. Sexual transmission is also an important route of infection. Male to female transmission can occur up to 12 weeks after infection, while it appears that female to male transmission is possible for up to six weeks. While neither mosquito species is prevalent here in Vermont, sex, contrary to common belief, is. Consequently, partners of persons who have traveled to Zika-affected areas need to be vigilant. In addition, Zika can cause serious neurologic disorders in adults, including Guillain-Barre syndrome. Several rapid tests have been developed to detect Zika, but no vaccine or “cure” is currently available.

Clearly, enough is known about the transmission of the virus to be able to mount effective prevention and control campaigns. Ironically, here is where the trouble begins.

The politics of Zika

Control strategies inevitably lead to a discussion of two “third rail” issues in American politics: sex and abortion. Sex because we now know that the virus can be sexually transmitted, and abortion because women who are pregnant and have been exposed or may have been exposed, may wish to terminate their pregnancies. All of this makes Zika too tempting an issue not to politicize. Unsurprisingly, Congress has risen to the occasion.

In February 2016 President Obama requested $1.9 billion from Congress to fund a comprehensive Zika control program. House GOP members said it was too much. They proposed $600 million but stipulated that funds should be taken from programs like Ebola and Planned Parenthood. The Senate was a little more generous, with $1.1 billion. However, Senate Republicans added riders that, among other things, cut Planned Parenthood funding, cut Obama Care and authorized the flying of the Confederate flag on Federal lands. Congressional Democrats have refused to compromise. The result? Congress recessed twice without action—then left on vacation. The administration has been forced to borrow from existing funds for everything from control efforts to vaccine research and development.

What policymakers fail to grasp is that we live in a global environment. Air travel, environmental and ecological changes, and migration due to war, economic dislocation and personal security mean that people, animals, insects, bacteria and viruses are circulating around the globe at an astonishing rate. Emerging infectious diseases are a reality—and they on our doorstep today. Denial, delay, no-fly lists, walls and politics only potentiate the threats we face.

Ron Klain, the former White House Ebola czar, has appropriately raised the question of why we should even have to ask Congress for permission to act. We don’t consult Congress when the country is faced with a hurricane, in the aftermath of earthquakes or when confronting an imminent terrorist threat. After all, we put in place programs and agencies that are funded prospectively to develop and maintain personnel and equipment to address these emergent situations. Isn’t that what homeland security is ultimately all about?

Here’s what we need to do

First, let the CDC do its job and remove financial and other constraints which seriously impede its ability to act quickly and effectively. Create a public health emergency trust fund that can be used at the discretion of the president. If the Department of Defense and Department of Homeland Security can do it, we should be able to do it with public health. I am not suggesting that congressional oversight be abandoned, but oversight can take place after the threat has passed rather in the midst of a crisis.

Second, in dealing with global disease risks we need to support and fund global public health institutions like the World Health Organization so that they can respond to global threats quickly. Just as with economics and environmental policies we need to abandon the notion that we can isolate ourselves from what is happening in the rest of the world. Isolationism does little to protect us and only serves to delay effective control measures.

It’s not a question of “if” but “when” the next major disease outbreak will occur. Whether avian flu, yellow fever, an antibiotic-resistant infectious disease outbreak or the re-emergence of Ebola, it will happen. Surely there is a better way forward than continuing to allow our health to be held hostage to political expediency.

Jim Hyde lives in Charlotte and is emeritus associate professor of public health at the Tufts University School of Medicine.

 

For Updates and General Information:

U.S. Centers for Disease Control and Prevention, Zika Virus update:

cdc.gov/zika/index.html

World Health Organization, Zika Virus home page:

who.int/emergencies/zika-virus/en/

Pan American Health Organization, Zika virus:

paho.org/hq/index.php?option=com_content&view=article&id=11585&Itemid=41688&lang=en

Stat News, Zika Update Daily:

https://www.statnews.com/series/zika-update/

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