If you thought the Zika virus was only a threat in Brazil, think again.
The Zika virus, the first known mosquito-borne virus that causes birth defects, has spread to 59 countries and territories as of March 2016. In addition to causing microcephaly, a condition in which a baby is born with an abnormally small head, the Zika virus can also cause temporary paralysis, or Guillain Barre Syndrome, in people of all ages. The chief of the World Health Organization (WHO) declared Zika a public health emergency in February, and El Salvador advised women to defer pregnancy until 2018.
Two hundred travel-related cases have been reported in the U.S. so far. “I’m very worried that we’re going to start seeing Zika transmission in the U.S., and I’m concerned that people aren’t really anticipating how destabilizing that is,” said Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, in Reinvent’s recent video conversation. “If we start seeing microcephaly cases appear in obstetrical wards in Houston, New Orleans, and Mobile hospitals towards the end of this year, it’s going to have an enormous ripple effect, and it’s going to be spoken about in the same context as the BP oil spill or Hurricane Katrina. I think what we now need to do is recognize that this is a train that’s coming, and it’s a crisis.”
Our discussion covered how well-equipped the world is to handle Zika, and how our global health infrastructure can be improved to prevent and respond to future pandemics. Reinvent summarized five of the most important points below.
1. Zika will hit the U.S. and continue to spread.
In the summer of 2003, Houston, Texas, had its first dengue outbreak since the early 1900s. The combination of warmer temperatures, the presence of the Aedes aegypti mosquito (the mosquito that transmits Zika), and the acute poverty of poorer neighborhoods contribute to the Gulf Coast’s extreme vulnerability.
“Both within the Gulf Coast region and outside, there’s a lack of awareness of how profound the poverty level is in some poor neighborhoods,” said Hotez. “Next to the Aedes aegypti mosquito, which is on the Gulf Coast, it’s that extreme level of poverty—where women have no window screens, where you can walk into areas like the fifth ward of Houston…you find piles of discarded tires filled with water, no gutters, just drainage ditches filled with water.”
Betsy McKay, a senior global health reporter for The Wall Street Journal, pointed out that many of these poorer, vulnerable populations—in Latin America as well as the U.S.—may be less informed about Zika than populations that are better protected. “You have people who live in nice neighborhoods in air conditioned homes with lots of screens, who are well-stocked with mosquito repellent, very worried about the Zika virus, and then you have people who don’t have those resources, the types of people that Peter Hotez is referring to.”
Exacerbating this potentially disastrous situation is the fact that mosquito control in the U.S. is extremely fragmented, with authority dispersed among 700 different entities. Insecticide also poses challenges where long-term mosquito control is concerned. “Mosquito control is not what it apparently once was,” said McKay. “There is the issue of insecticide resistance—I know that mosquito control officials in the U.S. are very worried about that. There are a lot of issues that need to be worked out, and worked out quickly.”
2. The global effort to fight Zika is imbalanced and underfunded.
According to Hotez, the U.S. provides 70 percent of funding for global health innovation. “I would argue that other G20 countries should be contributing similar percentages of their budgets to what the U.S. is doing right now,” Hotez said. He pointed out that the World Health Organization (WHO) budget is less than half that of America’s Center for Disease Control and Prevention (CDC). Despite the fact that many G20 countries conduct high quality scientific research, the U.S. contributes the lion’s share of funding for global pandemics.
According to Anne Schuchat, Principal Deputy Director of the CDC, the CDC has committed 800 people to the Zika response, including 100 people on the ground in Puerto Rico. “Going forward, I think every country needs that same kind of response,” Schuchat said. “They need the ability to protect their own people.” The Global Health Security Agenda, launched by the Obama administration in 2014 to build health security capacities in poor and middle income countries, was created to help address this problem.
“We need stronger capacity between these epidemics that’s better able to prevent, detect, and respond,” Schuchat said. “That’s what the Global Health Security Agenda is all about. We need the global community to pull together in support of the most vulnerable in times of difficulty.”
3. We are developing the science to fight Zika but still need the political will.
It’s not just a resource problem, said Hotez, it’s a political will problem. Most of the Western hemisphere’s neglected tropical diseases can be found in Latin America’s three wealthiest countries: Argentina, Brazil, and Mexico. And the U.S. has political will problems of its own—a $1.9 billion proposal to fight Zika is currently stuck in Congress.
Schuchat argued that the problem in the U.S. isn’t a complete lack of political will, but rather that policymakers must make tough decisions about the allocation of resources. “We have to be able to manage more than one threat at the same time,” Schuchat. “I think this is an issue where there is some political will, but the budget challenges that policymakers are facing and competing priorities can make it difficult.”
McKay suggested mandating global epidemic responses rather than depending solely on good will. “Epidemic response globally and international health regulations are to a large degree voluntary efforts. No one is obligated. It’s becoming clearer and clearer that a voluntary response [isn’t enough]. There has to be something that compels it.”
4. What we’re seeing globally is just the tip of the iceberg.
Researchers and scientists are working frantically to publish new studies about Zika. The scientific community is using a program called bioRxiv (bio archive), Hotez said, in order to disseminate urgent information before papers have been peer reviewed.
According to Sylvain Aldighieri, Unit Chief of International Health Regulations/Epidemic Alert and Response in the Department of Communicable Diseases and Health Analysis at the Pan American Health Organization (PAHO), recent developments in the scientific literature about Zika include a paper about Guillain Barre Syndrome and another about microcephaly from French Polynesia, as well as two nearly-concluded case control studies in Brazil. Aldighieri emphasized the importance of conducting studies in regions that are most vulnerable, particularly studies pertaining to birth defects and gestational age.
“It’s not only microcephaly,” said Aldighieri of Zika’s side effects. “It’s the Zika virus congenital syndrome. The spectrum of the disease will be important. At this moment, what we see, even considering Northeast Brazil, is just the tip of the iceberg.” Aldighieri expects that we will soon see another wave of Zika transmission and microcephaly cases in Northeast Brazil, as well as a first wave in other countries.
5. We need to reinvent our global infrastructure for dealing with epidemics.
Many experts believe it to be highly unlikely that a Zika vaccine is a just few months away. “We’re back in a situation where there’s a long path to getting vaccines,” said J. Stephen Morrison, Senior Vice President at the Center for Strategic and International Studies (CSIS).
“This is not a profitable business—epidemics are sporadic and unpredictable,” said McKay. “How can you make money on this? Most people seem to agree that government needs to play a bigger role in creating stockpiles and creating better incentives for industry to get involved. Industry is certainly calling for this.”
According to Hotez, an article published in Nature in 2003 contained the technology necessary to create the Ebola vaccine; however, the technology wasn’t licensed until 2014, when the U.S. Biomedical Advanced Research and Development Authority (BARTA) put up $100 million for the development of the vaccine. The investment came too late—by the time clinical testing was underway, Ebola was largely gone, and over 11,000 people had died.
Hotez believes the model for creating vaccines is broken. “The technology is there, but it’s outpaced the political, social, financial, and business instruments,” Hotez said. He suggested two new actors that could bring much-needed innovation to the practice of creating vaccines: developing country vaccine manufacturers and product development partners (PDP). Funding poses perhaps the most significant challenge, not only for these newer entities but also for more well-established corporations. Channeling more private and investment capital into researching and developing epidemic vaccines is one way to generate this capital.
The CDC’s Zika Action Plan Summit on April 1st will bring together state and local leaders with the aim of improving Zika preparedness and response. Until a vaccine is developed, disseminating knowledge among vulnerable populations as quickly as possible is imperative for slowing the spread of Zika.