Sean Philpott-Jones: Zeroing In On Zika

May 19, 2016

Every year I spend one to two weeks visiting the Caribbean island nation of Grenada. I don’t go for vacation, despite the allure of that country’s white sand beaches, but rather for work. I spend most of my time in windowless classrooms teaching clinical and research ethics to a number of graduate, medical and professional students from across the region.

One of the worries often voiced by family and friends when I travel to the tropics is about my health and safety. In recent years there have been a number of outbreaks of mosquito-borne diseases across Latin America and the Caribbean, including dengue, Chikungunya and (most recently) Zika. I myself caught Chikungunya during a visit to Grenada a year-and-a-half ago. Despite having a relatively mild case of what the locals call ‘Chick-V’, I still suffer from some lingering aftereffects, including intermittent arthritis-like joint pain in my right hand.

Despite all hullabaloo about Chikungunya in past years, public concern about that disease has largely faded in both the US and in the Caribbean. Most of the people I work with or teach in Grenada caught and recovered from ‘Chick-V.’ While the disease is now endemic in that part of the world, the number of new cases is relatively small since most people are now immune. Moreover, the long-term health impacts of Chikungunya are relatively mild.

Instead, and rightfully so, it is the rapid spread of the Zika virus across the Western hemisphere that is raising so many concerns. Zika, as you undoubtedly know, was first identified as a serious health threat during an outbreak of that virus in Brazil. Although most of the people who became sick with Zika only developed a mild illness – characterized by fever, headache and joint and muscle pain – at the same time Brazilian health authorities also noted a sudden increase in the number of children born with a rare birth defect known as microcephaly. Similar increases were also seen in other Zika hotspots, including El Salvador and Jamaica.

Microcephaly is a neurological condition in which an infant is born with a smaller-than-usual brain. Some children born with microcephaly develop normally, but most will experience lifelong symptoms that include developmental delays and disabilities, difficulties with coordination and movement, hyperactivity, and seizures.

So serious is the problem that some government officials in the region recommended that women avoid getting pregnant until the Zika outbreak is contained. Other (largely Catholic) countries in the region are reconsidering laws that currently outlaw abortion. Health authorities in the US and elsewhere are similarly recommending that pregnant women avoid traveling to Zika-affected areas. Some have even called for Brazil to cancel the 2016 Summer Olympic Games in Rio because of the potential threat that the virus poses to competitors and spectators.

Experts are also raising concerns about the possibility of an outbreak of Zika in the United States and Southern Europe.  To date, over 500 cases have been reported in 35 states, including 48 cases involving pregnant women. While none of these cases were locally acquired – all of these patients were infected while traveling in a Zika-afflicted region of the world – Aedes aegypti, the mosquito that most commonly transmits the virus, is abundant throughout the southern tier of the US. Nearly 700 cases of Zika have also been reported in the American territories of Puerto Rico, Samoa and the Virgin Islands; almost all of those cases were locally acquired.

So convinced are American public health experts that an outbreak of Zika in the US is imminent that doctors at the Children’s National Health System in DC, the Texas Children’s Hospital and the Baylor College of Medicine in Houston, have established specialized programs for diagnosing and treating people with the virus. Similarly, the US Centers for Disease Control and Prevention and the National Institutes of Health have already invested nearly $600 million to study the disease and to develop a vaccine.

Despite this, and despite a $1.9 billion request by the White House to combat the Zika crisis, Congress has largely failed to act. While the Democratic-controlled Senate has authorized $1.1 billion in funding, the Republican-controlled House of Representatives has proposed spending a paltry $600 million. Most of those House-authorized funds would also come from existing public health programs, including $350 million that would be stripped from a program designed to develop a vaccine for Ebola. The only House Republican who supports the Obama’s Administration request for nearly $2 billion? That would be Congressman Vern Buchanan of Florida, whose state has already (and will continue to be) the hardest hit by Zika.

During an election cycle where the most newsworthy candidates are decrying “politics as usual,” our leaders in Congress are nevertheless doing just that. They are risking the nation’s health because they don’t want to be seen as spendthrift politicians who spend taxpayer’s dollars willy-nilly. Only when we have a full-fledged outbreak, when our pregnant sisters and daughters are infected with a dangerous virus, when our children are born with a largely preventable birth defect will they likely act. Unfortunately, as our response to AIDS, to Ebola, and to other public health crises has shown, by then it will be too little too late.

A public health researcher and ethicist by training, Dr. Sean Philpott-Jones is Director of  Research Ethics for the Bioethics Program of Clarkson University-Icahn School of Medicine at Mount Sinai in Schenectady, New York. He is also Acting Director of  the Center for Bioethics and Clinical Leadership, and Project Director of its Advanced Certificate Program for Research Ethics in Central and Eastern Europe.

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