[fblike]
More than a year after the Ebola virus terrified the world, a new virus is instilling fear into the hearts of millions of citizens throughout the Western Hemisphere. The culprit this time is the Zika virus, a mosquito-borne pathogen that was ignored by health experts for decades. However, a spike in the number of births of children with microcephaly, a rare condition that leads to babies being born with abnormally small heads, to women that are thought to have been infected with the virus has created a renewed sense of urgency in the global health community. Zika is not native to the Western Hemisphere and it was first found in Africa more than sixty years ago. Its spread is a testament to how the world is increasingly one without borders when it comes to health issues and Zika creates yet another headache for Brazil, a nation facing significant economic problems and that is hosting the Summer Olympics this year.
This topic brief will provide some background information on the Zika virus, discuss the steps that governments plan to take to combat it, and then assess the implications of the virus.
Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.
Background Information on the Zika Virus
The first fact that extempers should know about the Zika virus is that it is not native to the Western Hemisphere. The Wall Street Journal writes on January 18 that Zika was first identified in Uganda in 1947 and after that it was found in Southeast Asia and the Pacific Islands. It is still a mystery how the virus founds its way into Brazil, but The Guardian explains on January 30 that the 2014 World Cup might be to blame. The article notes that one prevailing theory is that several thousand fans went to the World Cup as carriers of the virus. These carriers were bitten in turn by Aedes aegypti mosquitoes that then spread the virus to the rest of the Brazilian population. It might seem silly that such carriers brought the virus to Brazil, but extempers need to realize that many people that acquire Zika show few outward symptoms. The Guardian notes in a separate article on January 30 that 80% of those infected display no sign that they are ill. This can be a nightmare for health experts since they cannot track infected persons and this makes it hard to contain the virus.
Although health workers have been aware of Zika for decades it received very little attention from the global health community. The reason for this is that up to this point those who became ill displayed very mild symptoms. According to The Los Angeles Times on January 30, these symptoms included a rash and a fever. The Wall Street Journal adds that other patients reported joint pain, redness in the eyes, headaches, and muscle pain. However, all of these symptoms eventually subsided and a death toll as a result of the virus was virtually non-existent. When compared to other mosquito-borne pathogens such as malaria and denge fever, which kill thousands of people per year in Africa and other parts of the world, Zika once appeared to be more of a nuisance that something that warranted a global health emergency.
These assumptions are starting to change, though, due to suspicions that pregnant women that acquire the Zika virus during their first or second trimester have a higher likelihood of giving birth to a child with microcephaly, a rare condition where babies are born with small heads and brain damage. ABC News reports on January 29 that Brazil has seen more than 4,000 infants born to mothers that reported having the virus and it notes that the disease is frightening patients and doctors in the rest of the Western Hemisphere. It is not as if children have not been born in Brazil without microcephaly before, but the rate of children born with this condition has risen exponentially over the last year. The Economist explains on January 30 that in a typical year Brazil would see 200 children born with microcephaly, but that number is now much larger. Still, The Huffington Post reminds it readers on January 30 that only 5% of those who reported being infected with the Zika virus gave birth to a child with the condition. Nevertheless, 5% is very high. Scientists are still looking into a definitive link between the two before reaching definitive conclusions, but some are suggesting that the Zika virus may have mutated into a new strain since the microcephaly condition has not been documented in other regions.
Combating the Virus
Since there is no cure for Zika at the present time, the best step in fighting the virus would be to develop a vaccine. Reuters explains on January 29 that several nations, including the United States, Canada, Russia, and Brazil, are looking into this but human testing is still many months away. In fact, health experts argue that it will be late summer before any trials take place. Even if those trials prove successful, an eventual vaccine would take nearly three years before it became readily available. An additional hurdle for a vaccine is in the testing process since those in the health industry warn that it would need to be given to pregnant women. The Guardian notes that there are significant problems with this from an “ethnical and practical” point-of-view as finding willing women to accept a trial would be one hurdle as would the implications of giving a vaccine with negative side effects for the fetus.
Without a vaccine some of the old methods of eliminating mosquito-borne pathogens will be relied upon by national governments. Thankfully, governments in the Western Hemisphere have a long history of controlling mosquito populations although the energy behind such efforts has been lacking in recent years. The New York Times argues on January 30 that American-led efforts eliminated malaria-carrying mosquitoes in Brazil and killed off dengue-carrying mosquitoes in eighteen other Latin American nations between the 1930s and 1960s. Medical professionals used an aggressive series of measures that included mandated home inspections and eliminated all standing water (which is what mosquitoes require for breeding and laying their eggs). Time writes on January 30 that the United States successfully fought off malaria in the 1920s through the use of pesticides and the draining of breeding sites. Fumigation campaigns are already underway in Brazil, but there are fears that these have not gone far enough. The Christian Science Monitor reports on January 29 that Brazil is raising awareness about how to prevent mosquito bites on radio and television and it will use more than 220,000 troops to educate communities about preventing the spread of Zika on February 13. Additionally, the Brazilian government is recognizing that poorer peoples are more at risk for the disease since they lack homes that will keep mosquitoes out and do not have the funds for repellant. The Economist writes that Brazil will give 400,000 expectant mothers repellent if they qualify for the Bolsa Familia state aid program.
What could complicate these traditional efforts, though, is that the Aedes aegypti mosquito has proven quite adaptable to an urban environment. The New York Times reveals that the mosquito flourishes in an urban setting and that its primary target is humans. Furthermore, it is primarily active during the day and this complicates spraying and prevention efforts because other types of mosquitoes, such as the Culex mosquito, are active at night. The New York Post explains on January 30 that this could create trouble if Zika reaches New York City because the city would have to spray during the day to fight Aedes aegypti and then spray at night to fight the Culex mosquito (which is known to transmit the West Nile virus). The other problem with fighting Aedes aegypti is that it can breed in very small containers. In fact, The New York Times highlights how Aedes aegypti have been observed breeding in rainwater left inside of a soda cap. This can make fighting the mosquito difficult because it is not realistic to remove standing water from structures such as flowerpots, cans, or tires that can become drenched after a thunderstorm.
In light of these difficulties, several radical solutions have been proposed. One is to return to the spraying of DDT, a powerful pesticide that many governments moved to ban after the publications of Rachel Carson’s book Silent Spring in 1962. Carson revealed that DDT had several negative effects which included breaking the eggs of the California Condor. Critics of Carson’s work argue that she took her conclusions too far and according to The New York Times, defenders of DDT allege that many of the problems associated with it in prior decades were caused by the spraying of DDT for agriculture. They argue that DDT this time would be sprayed inside of people’s homes. This suggestion is not necessarily novel or new as DDT advocates have long argued for the wide use of the product in Africa to help communities fight malaria, but there is a growing chorus to return to the product and those cries may grow wider if the public health emergency over Zika persists.
Another radical solution is to use modern technology to alter the ecosystem and kill the Aeges aegypti or make it difficult for the mosquito to transmit Zika. The New York Times highlights how Oxitec, a British company, genetically altered Aedes aegypti to fight dengue fever. The mosquitoes were given a gene to pass to their offspring that would prevent them from reaching adulthood and an experiment in a local Brazilian community reduced the population of dengue-carrying mosquitoes by an estimated 80%. Eventually, the company wants to spread its mosquitoes, which are only male, over a wider area that would encompass nearly half a million people, but there are skeptics of this approach. One argument is people’s constant fear of tinkering with nature. Those who know environmental history may recall what happened with “killer bees,” whereby the cross-breeding of an African honey bee with European honey bees created an aggressive strain that terrorized peoples throughout the Western Hemisphere (although media reports have vastly exaggerated the number of deaths attributable to these Africanized bees that kill less than five people per year). The goal of that experiment was to create a species that would bolster honey production, but before scientists could find an ideal species several swarms escaped into the Brazilian ecosystem in the 1950s and now these “killer bees” are in the Southwest United States. Fears of a replication of this situation might be why Brazil has yet to give Oxitec approval to do genetically modified experiments in urban areas. Similarly, communities in the United States have been less than willing to even listen to Oxitec’s proposals. Therefore, despite showing some initial successes, attempts at fighting Aeges aegypti with genetic intervention might have to stay in the realm of science fiction.
Zika’s Implications
The Zika virus poses significant problems for Brazil, a nation that is already facing major economic problems and a political crisis. In a cynical way, the crisis may allow President Dilma Rousseff to illustrate that she is a competent leader and distract from impeachment proceedings against her. Thus far, the Brazilian government has gotten high marks for its response to the situation (although it has been criticized for reducing funding for mosquito prevention programs over the last year), with The Economist writing that Brazil is actually looking at controlling mosquitoes more than its Latin American neighbors. For example, nations such as Colombia, which is experiencing the second-largest number of Zika cases, are arguing that women need to hold off on having children. Colombia has said that it wants women to wait at least six months to conceive, while Panama is warning women in indigenous communities to avoid pregnancy. El Salvador’s government has been the most radical, arguing that women need to wait until 2018 to get pregnant. The Economist argues that these strategies are not productive since they are bossing women around rather than trying to stamp out the root of the problem. However, Brazil does face a public relations crisis with the Summer Olympics. National Public Radio writes on January 29 that the Summer Games are already enduring $500 million in budget cuts and now the International Olympic Committee (IOC) has expressed concern about the health of athletes at the Games, sending an advisory about the Zika virus to competitors and pledging to do daily inspections of Olympic facilities. Although it is very unlikely that the IOC would cancel the Olympics in Rio, ticket sales have already been slow and if fewer tourists attend the Games it could be an even bigger financial loss for the country.
Extempers should not forget the potential for a more widespread outbreak of Zika. First, medical experts argue that Zika will probably not create a major problem in the United States. The Los Angeles Times reports that the U.S. has been well-prepared for handling foreign viruses due to its precautions against bird flu, SARS, MERS, and Ebola over the last two decades. In addition, the United States has better housing facilities than Brazil and window screens and air conditioning can keep mosquitoes out of homes. If there is an outbreak in the United States it will be concentrated in Southern states such as Florida, Texas, Arizona, Louisiana, and California, all of which have the Aedes aegypti mosquito. A bigger fear of global experts, though, is if Zika was transmitted back to Africa. As noted previously in this brief, the connection between Zika and microcephaly appears to be new and may show a mutation of the virus. The Guardian warns that one of the good things, if such a thing could be said, about the Zika outbreak is that it is happening in a nation – Brazil – with a well-funded health service. African nations are not as well placed to react to such a situation. Remember, more than 11,000 people died in the recent Ebola epidemic in West Africa. If Zika made it back to the African continent, a place that is more fertile than the rest of the world, the effects could be debilitating on some of the peoples there. This is one of the reasons that there are growing calls for a vaccine so that a more concerted global response can take place in more impoverished areas.
As far as environmental effects, Zika’s impact will probably not be known for several more years. Foreign Policy explains on January 28 that no funding currently exists for studying the ecology of Latin America. It is still unknown how Zika might affect other insects, monkeys, or birds and whether these animals could also transmit the virus via biting humans or through another form of transmission. Foreign Policy notes that Brazil’s health minister Marcelo Castro has warned that Zika has become an endemic problem, meaning that it is now part of Brazil’s ecology and if that is true, peoples in the Western Hemisphere must now treat Zika like New York City treats the West Nile virus: as a regularly occurring phenomenon that will require a consistent public response so that it remains under control. And extempers should not forget that if DDT is sprayed again to fight Zika there could be an environmental tradeoff with other wildlife or even people’s health.
Finally, Zika is a test of the World Health Organization (WHO), which received significant criticism for its handling of the West African Ebola outbreak. The WHO recently declared a global health emergency over Zika and it is trying to form a coordinated response to the disaster. This was much quicker than its Ebola response, but time will tell whether the WHO can effectively keep the world focused on finding a cure for the virus and possibly generate financial support for the poor nations that are affected. After all, The Christian Science Monitor reports that there have been cases in Brazil of families abandoning children with microcephaly since they worry about not being able to pay for doctor’s visits and treatment. Brazil has stepped in to allow poor families that have children with microcephaly to receive disability payments, but other poorer nations in Latin America will not be able to provide this assistance.
In the end, Zika is a stark reminder that no area of the world is safe from a foreign pathogen. Zika will not be the last virus to escape its continental confines and move halfway across the world, so global health agencies, national health ministries, and political leaders must begin investing in tracking, response, and prevention mechanisms. Not doing so endangers not only the welfare of their citizens, but of the human race in general. One can hope that Zika will have this long-term effect, but the sad fact is that the world is still reluctant to view health problems as international phenomena and that must change in the future.