While responses gather steam, delay in WHO declaration highlights need for larger, long-term changes
In the week that the U.S. Centers for Disease Control and Prevention raised its emergency operations center’s response to the Zika outbreak in the Americas to its highest level, while the White House asked Congress to provide more than $1.8 billion in emergency funding for preparations and responses to the outbreak, CDC Director Dr. Tom Frieden began his address to a House Foreign Affairs joint subcommittee hearing on the epidemic with a look at the bigger picture. The spread of the virus with its potential links to devastating health threats, is, he noted just the latest in a series of health threats that were both unpredicted, and “in many cases” unpredictable.
“It emphasizes how crucially important it is that we continue to strengthen the systems that will find, stop, and prevent health threats wherever they emerge.”
But he also highlighted what can be predicted next.
Noting that Zika is transmitted by the same challenging mosquito that transmits both Dengue and Chikungunya viruses (also no negligible threats — Chikungunya, he mentioned, is a word that means “bent over in pain” while Dengue is also known as “break-bone fever” for the symptoms it brings) he noted that anywhere Dengue and Chikungunya are spread Zika is likely to follow. With maps showing the spread of both viruses across the world, he pointed out that Chikungunya was known in other parts of the world for more than 60 years before it came to this hemisphere.
Things move more quickly now, he and other global health responders have noted. It was 2014 when the numbers of babies born with microcephaly drew notice in French Polynesia, and 2015 when public health watchers began to piece together that increased incidence with the beginning of an outbreak of Zika virus there 10 months earlier. By then the information had drawn the notice of health officials in Brazil following a steep rise in the numbers of babies born with the birth defect there, nine months after the start of the first Zika outbreaks earlier that year in the same mosquito ridden area. On December 1, the Pan American Health Organization issued an epidemiological alert about the potential links between the virus, birth defects and the debilitating neurological Guillain Barre syndrome.
By the time the World Health Organization issued its declaration that the virus and observed increases to the more devastating health threats constituted a Public Health Emergency of International Concern, an opinion piece had appeared in the Journal of the American Medical Association the week before, highlighting the need for the WHO to convene a committee to take a closer look at potential threats.
Written by Dr. Dan Lucey and Professor Lawrence Gostin of Georgetown University Medical School and Law School respectively, it highlighted the need for the actions that such a committee and its findings would set in motion.
Lucey, who had learned about the incidence of microcephaly in French Polynesia the month before, said Wednesday even the opinion piece was late. Speaking from Recife, Brazil (“I learn so much more by being there”) Lucey reflected on his experience in Sierra Leone and Liberia, and the consequences of WHO’s long delinquent response in the West Africa Ebola outbreak. It was a delay, he said, with “real world, catastrophic consequences,” that he felt was echoed in the lag between evidence that surfaced and was noted by other agencies, and WHO’s convening of a committee in the last week of January.
He noted the nine to 10 months that will follow before increases of microcephaly might be noticed in the new places that Zika has continued to spread. He shudders at the thought that another “preventable tragedy” will have to be acknowledged. He noted that Zika has spread in Cape Verde off the coast of West Africa.
“Can you imagine now if there’s an outbreak of Zika, microcephaly and Guillain Barre in West Africa?” he said. “I don’t even want to think about it.”