Bad local health systems and an extremely slow international response contributed to the rapid spread of Ebola in West Africa in 2014. Evaluations of the global response exposed significant failings by groups like the World Health Organization, who bore the brunt of the criticism. When reports emerged late last year that the Zika virus was linked to birth defects in Latin America, the international community acted as quickly in response.
“You don’t ever want to get behind the problem. You really want to get ahead of the problem,” said Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), in a media call yesterday. “And that’s the reason why you are seeing such attention being paid. And why you have a level of activity from the president himself, through the Congress, and through agencies.”
The immediate attention is evidenced by the $1.8 billion requested by the White House for emergency Zika funding. More than half of the money is directed to the Centers for Disease Control and Prevention (CDC) and the U.S. Agency for International Development (USAID) to improve the domestic response to the mosquito-borne virus and support the countries currently affected in order to prevent the problem from getting worse. Fauci said the NIAID’s priority is developing a vaccine that can prevent people from getting sick with Zika.
Both Fauci and CDC head Tom Frieden agreed that the U.S. response is proportionate to the problem. They do not think that the money allocated and warnings about travel are an overreaction. Frieden reiterated the agency’s recommendation that pregnant women from the U.S. should not travel to Zika-infected countries and should not have sex with men who may be or are infected with the virus.
“With Ebola, we had a very clear set of knowledge about what was needed. Zika is very different,” said Frieden. “The threat appears to be currently to pregnant women.”
There are concerns that Zika may cause Guillain-Barré syndrome, a link Frieden says would not be surprising if true, but it is not all that dangerous to the majority of people. Its link to microcephaly, a birth defect, in children of mothers infected with the virus during pregnancy is most troubling. Efforts are under way to determine the causal link. New research found the virus in the amniotic fluid of two women who had had Zika-like symptoms during their pregnancies.
A recent theory is that larvicides used to kill insects in Brazil are the culprit for the birth defect. Fauci said that it is hard to disprove the theory, but impossible to ignore the fact that evidence of the virus is turning up in mothers and their children born with microcephaly. A vaccine could be available in a few years, but that will depend on how the trials go and whether the outbreak persists. Ebola vaccines were under way by the time the West African outbreak worsened, but there was little research due to the sporadic instances of Ebola outbreaks. Zika is starting behind and could see a similarly slow path of development if the spread is managed.
For Frieden, the spread of Zika is a reminder of the need to invest in global health systems. Like Ebola, weak health infrastructures make it hard to manage the spread of a virus and track it. He said it is quite possible this problem existed well before now, but we are only just finding out because it reached a tipping point. Better access to health care is crucial.
Puerto Rico is a particular concern for the CDC. There are now eight confirmed cases of Zika spread by local mosquitoes in the country so far. More than 20 CDC staffers are in Peurto Rico to assist the 50 staff already in the country responding to the spread of dengue. The country is a popular destination for American travelers, particularly college spring breakers who are set to go there in the next month.
“We will only be safe in this country when we have a safer system around the world to find and stop health threats,” Frieden said. “Both Ebola and Zika remind of us the importance to strengthen health systems, find problems early, and prevent them before they get worse.”
