Zika Virus – Challenges and Opportunities

Published September 16, 2016

The 2016 Summer Olympics focused the eyes of the world on the city of Rio and its attention on the emerging threat of Zika. There were calls to cancel the Games because of the virus. Brazil represents the most recent failed front in the battle to contain and protect us from this emergent threat.

Zika is a mosquito borne virus that infects humans and results in mothers having babies with severe brain – related birth defects. The biggest risk from Zika involves unborn babies. An unknown but certain percentage of pregnant moms will pass the virus to their children which can result in either spontaneous terminations or serious developmental brain disease such as microencephaly.

Mosquitos are very effective human infection machines. They are pervasive and thrive in warm climes. They proliferate easily, love feasting on warm blooded mammals and are hard to control. Now, assisted by the intransigence of Congress, Zika is spreading.

Our political response to Zika is dangerous. Congress played politics with the President’s emergency funding request last Spring. Opponents inserted provisions to block access to contraception, weaken pesticide regulations, and cut funding for the Affordable Care Act –knowing Democrats could not agree.

To date no new funds have been approved, and the virus continues to grow. The Center for Disease Control re-directed funds from Ebola eradication and those funds are running low. The administration diverted other critical funds within the NIH to fund vaccine development and now those funds are running out. The first cases of Zika in Florida were reported this summer.

A Brief History of Zika

Zika virus was first identified in the late 1940s by researchers studying Yellow Fever in the Zika forest of Uganda. Soon after, the same researchers discovered the virus in Aedesmosquitoes, and clearer picture of the virus and its transmission emerged. The first human cases were described in the early 1950s.

Today we understand that Zika is transmitted to humans primarily by mosquitoes. However, in 2016 epidemiologists confirmed the first cases of sexual transmission of the virus. Although Zika appears to have little effect on normal adults, for the affected children it results in devastating long term disability.

Our response to Zika is modeled on our experience with previous public health emergencies. We have learned valuable lessons from our experience with West Nile Virus and SARS. We know how to respond. As former Obama Ebola czar Ron Klain put it, “ Outbreaks are inevitable, but epidemics are preventable.”

The West Nile Virus Story

Like Zika, West Nile is a mosquito-borne illness that originated in sub-Saharan Africa and most infected individuals have no symptoms. However, those with weak immune systems and other chronic diseases can become severely ill or die. The most recent outbreak of West Nile in the US lasted from 1999 and 2009. Bird testing for viral infection is the first step in detecting outbreaks. Mosquito control efforts follow, such as draining pools of stagnant water and local insecticide spraying.

The SARS Story

In late 2002, a mysterious respiratory illness appeared in China. Named Severe Acute Respiratory Syndrome (SARS), the outbreak was quickly associated with a new member of a well-known family of viruses. SARS turned out to be very serious: around 10% of those infected died.

The response to the SARS outbreak could be described as controlled panic, perhaps understandably. Airlines began taking the temperatures of passengers boarding planes in China. Those with fevers were denied boarding passes. Business travel ground to a near halt. False rumors about infected meat in the US hurt business in the Chinese food industry. People who appeared to be Chinese reported difficulty hailing taxis.

By 2004, the SARS epidemic disappeared as mysteriously as it appeared. A total of fewer than 1000 people died world-wide. No deaths were reported in the US.

SARS, Ebola and West Nile all represent various versions of public health success. Although each case is slightly different the one universal public health lesson that we should have learned about this kind of crisis is as public health guru Dr. Larry Brilliant explains, “Early detection, early response.”

Learning from the Past

The severity of the current Zika epidemic likely falls somewhere between West Nile and SARS. The consequences of the infection will be dire for affected unborn babies. Some cases of the neurological complication Guillain-Barre Syndrome have also been reported. But it is not time to panic, as long as we provide public health officials with the resources and tools to do their jobs.

As Bush’s Health and Human Services Secretary Mike Leavitt explained, “ There is a dilemma in dealing with pandemics. Before a pandemic strikes everything proposed seems alarmist. After a pandemic strikes everything seems insufficient.”

Lets take this serious threat for what it is. The CDC must be provided now with the funding to do what it does best: gather data and analyze it. Good public health efforts begin with good information. A detailed registry of infections and Zika-related birth defects exists. Once we have a clearer picture of the virus and its consequences, we will be better informed to direct the needed resources towards eradication and treatment.

As professional politicians plan on how to complicate and divert the discussion from public health to partisan advantage, they are ineluctably increasing probability of more American children born with brain damage. As Congressional leadership considers its priorities for this Fall, let us all hope they focus a bit more on the health of the unborn.