Without new funding by Oct. 1, Zika responses will be limited, HHS says

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Zika’s reach expands in neighboring countries and domestically, while search for intersection of politics and public health continues . . .

On one hand, you have the depletion of funds allocated for implementing the Affordable Care Act and controlling Ebola, a barrier to funds for family planning services, a continued cap on Medicaid spending in Puerto Rico, a lifting of Clean Water Act restrictions, and the right to fly Confederate flags in veterans cemeteries. All of those were included in a bill to fund Zika responses that was weighed by the Senate last week on its return from its 7-week recess, and together, factored into another week with no new money with which to confront the continued spread of the virus.

On the other hand, you have 18,000 people in the United States and its territories who have been infected with Zika, 18 babies who have been born in the U.S. with Zika-related birth defects and two neighborhoods where active Zika transmission has prompted the Centers for Disease Control and Prevention to issue its first domestic travel warning, and that now are home to 80 pregnant women who have been diagnosed with the virus, and one baby born with microcephaly.

The Department of Health and Human Services enlisted the help of representatives from women’s and child’s medical providers’ organizations this morning to talk about the latter set of concerns. They detailed the needs the people currently affected by Zika, and others like them have and can be expected to have, and said those needs won’t be met if new funding to monitor and control the Zika virus and its impacts is not available by Oct. 1. That’s when, they said, existing funding that now drives research and development of vaccines and diagnostic tools, makes existing diagnostic tests available, and supports efforts to monitor and respond to the spread of the virus and its impacts, will run out. Without new funding, they said, new Zika-response activities will not be initiated after Oct. 1.

Those activities include developing the capacity to assess all pregnant women in the United States for Zika, Dr. Thomas Gelhaus, President of the American Congress of Obstetricians an Gynecologists, said. Right now, with limited access to testing, the organization recommends prioritizing testing for women with possible exposure to the virus. Affected activities also will include  prevention efforts, he said. “We don’t know how to prevent Zika,” he said, “But we know how to prevent pregnancy.”

Maintaining a comprehensive and up-to-date Zika Pregnancy Registry, which the CDC started in May to better track and understand the impacts of the virus, also will be affected, Dr. Gelhaus said. “Our members see on a daily basis that there are more questions than answers,” he said.

At the same time, new resources will be necessary to assess and meet the needs of Zika-affected children and their families, said American Academy of Pediatrics Executive Director Karen Remley. The virus has been confirmed to be a cause of microcephaly and other neurological defects, including hearing and vision loss, but long-term impacts on development, behavior and learning ability, have not been assessed. “This is going to be a major public health issue,” she said. The $10 million that has been frequently cited as the potential health care costs of each child born with microcephaly doesn’t count the costs incurred by their families and society, she said. The families of children affected by Zika, she added, “will be facing a lifetime of difficult decisions.” The impacts of the current outbreak, she said, will be felt for years to come she said, by “these children, these families and the infrastructure that is needed to support them.”

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Zika in the Western Hemisphere

President Obama requested emergency funding with which to respond to Zika globally and domestically in February. In the months that followed, Zika has spread across nearby countries, has been diagnosed in Americans who traveled to Zika endemic places, and was transmitted sexually in the U.S., before mosquito borne transmission was confirmed in Miami in July. The bill defeated in the Senate Sept. 6 had been defeated twice before, with provisions that included using $117 million that had been allocated to emergency Ebola funding, $100 million that had been allocated to the Department of Health and Human Services, and $543 million allocated to implementing the Affordable Care Act. The bill did not include $246 million requested by the White House to support maternal and child health services in Puerto Rico (the U.S. territory most affected by Zika) and other territories. And it restricted funding from going to organizations that provide family planning services, and included a provision suspending prohibitions of discharging toxic chemicals into waterways. A provision that would allow Confederate flags to be flown in veterans cemeteries appears likely to fall off the next version of the bill, which Congressional leaders have said they intend to pass before taking their next break at the end of the month, and that seems likely to be brought up this week.

For more on how the current spread of Zika became a Public Health Emergency of International Concern, and on research and funding responses, see the IDSA Global Health paper on Zika,  the World Health Organization’s  history of Zika virus, and the WHO timeline of the spread of the virus since 2013.

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