2015–16 Zika virus epidemic
An epidemic of Zika fever, caused by Zika virus, began in Brazil and affected other countries in the Americas from April 2015 to November 2016. The World Health Organization (WHO) declared the end of the epidemic in November 2016, but noted that the virus still represents "a highly significant and long term problem".[2] It is estimated that 1.5 million people were infected by Zika virus in Brazil,[3] with over 3,500 cases of infant microcephaly reported between October 2015 and January 2016.[4] The epidemic also affected other parts of South and North America, as well as several islands in the Pacific.[5]
Date
April 2015 – November 2016
Zika virus spread to Brazil from Oceania in 2013 or 2014. Brazil notified the WHO of an illness characterized by skin rash in March 2015, and Zika was identified as the cause in May 2015. In February 2016, the WHO declared the outbreak a Public Health Emergency of International Concern as evidence grew that Zika can cause birth defects as well as neurological problems.[6][7] The virus can be transmitted from a pregnant woman to her fetus, and can cause microcephaly and other severe brain anomalies in the infant.[8][9][10] Zika infections in adults can result in Guillain–Barré syndrome.[10] In approximately one in five cases, Zika virus infections result in Zika fever, a minor illness that causes symptoms such as fever and a rash.[11][12] Prior to the outbreak, Zika was considered a mild infection, as most infections are asymptomatic, making it difficult to determine precise estimates of the number of cases.[13]
The virus is spread mainly by the Aedes aegypti mosquito, which is commonly found throughout the tropical and subtropical Americas. It can also be spread by the Aedes albopictus ("Asian tiger") mosquito, which is distributed as far north as the Great Lakes region in North America.[14] People infected with Zika can transmit the virus to their sexual partners.[15]
A number of countries were issued travel warnings, and the outbreak was expected to reduce tourism significantly.[7][16] Several countries took the unusual step of advising their citizens to delay pregnancy until more was known about the virus and its impact on fetal development.[17] Furthermore, the outbreak raised concerns regarding the safety of athletes and spectators at the 2016 Summer Olympics and Paralympics in Rio de Janeiro.[18][19][20]
Prevention and treatment[edit]
While there are no known cures for Zika, there have been recent developments in Zika vaccination. Three vaccine designs are showing high confidence levels of protection against the Zika virus. Scientists have conducted tests on the rhesus monkey, and human trials began in late 2016.[187]
This preventative treatment is promising, but it will take years before it is available for widespread usage.[188]
British experts are clear that any of the vaccines would take considerable time to develop. Dr Ed Wright, a senior lecturer and virologist at the University of Westminster, said: "All of the vaccines currently under development are many years away from being licensed and available for widespread public use." Jonathan Ball, professor of molecular virology at the University of Nottingham, said: "We knew that these vaccines worked in mice and now the researchers have shown that they also protect non-human primates from Zika virus infection." "The next step will be to see if these vaccines are safe and the scientists hope to start early trials in humans to address this."[189]
Kineta, a Seattle-based biotech company, is actively working on treatments and has received an undisclosed amount of funding from National Institute of Allergy and Infectious Disease, one of the National Institutes of Health, to carry on the research. Kineta CEO Dr Shawn Iadonato said in a statement. "We are eager to expand testing of our broad spectrum antivirals in Zika virus as they have shown compelling efficacy across other flaviviruses such as Dengue and West Nile and have the potential for long-term development."[190]
As of July 26, 2016, Inovio Pharmaceuticals, Inc. dosed the first subject in its multi-center phase I trial to evaluate Inovio's Zika DNA vaccine (GLS-5700). In addition to the previously announced US FDA approval for the conduct of the study, Health Canada's Health Products and Food Branch has also approved this study, which will be conducted at clinical sites in Miami, Philadelphia, and Quebec City. The phase I, open-label, dose-ranging study of 40 healthy adult volunteers is evaluating the safety, tolerability and immunogenicity of GLS-5700 administered with the CELLECTRA-3P device, Inovio's proprietary intradermal DNA delivery device. In preclinical testing, this synthetic vaccine induced robust antibody and T cell responses – the immune responses necessary to fight viral infections – in small and large animal models.[191]
Direct Relief, an emergency response organization, established a Zika Fund and fulfilled requests for supplies in 14 affected countries.[192]
Challenges to US response[edit]
In May 2017, the Government Accountability Office published a report, "Emerging Infectious Diseases: Actions Needed to Address the Challenges of Responding to Zika Virus Disease Outbreak", to correspond with an associated House subcommittee hearing. The GAO said that even though scientific breakthroughs have increased in recent years, the United States remains unprepared to handle a Zika virus outbreak.[193]
Timothy Persons, head scientist at the GAO, listed areas of limited research that damage the United States' ability to effectively respond to a Zika outbreak, including an accurate record of the number of cases in the United States, components associated with transmission from mothers to children (especially regarding pregnancy), risk of transmission through bodily fluid as related to the potential for sexual transmission of the virus, impact of prior exposure to Zika and other arboviruses, and both short-term and long-term outcomes. Recent outbreaks have been connected to an alarming a spike in microcephaly, a birth defect that inhibits the proper development of a baby's brain, and Guillain-Barré syndrome, which causes paralysis.[193]
Other challenges include the lack of a safe and effective vaccine, a complicated diagnostic process, and faltering support for research funding in the federal government. Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (NIAID), said "There aren't any federally licensed vaccines or specific therapeutics currently available to prevent or treat Zika." Zika is often difficult to distinguish from other illnesses that are spread by mosquitoes, like dengue, West Nile, and chikungunya, among others. President Trump's budget proposal for 2018 proposed stripping $800 billion from Medicaid over ten years. Democratic Representative Frank Pallone of New Jersey said that this decision "endangers our ability to manage public health emergencies like Zika."[193]
Controversies[edit]
Some efforts to contain the spread of Zika virus have been controversial. Oxitec, the company behind the "self-limiting" mosquitoes, which pass on a fatal gene to their offspring, released in Brazil, has faced criticism from environmental groups, who fear that releasing a new mosquito strain into the wild will damage the ecosystem. In the short term, the concern is that a drop in the mosquito population could affect the populations of other species. Supporters claim that the environmental impact of the "self-limiting" mosquitoes will be minimal, since only one species of mosquito is being targeted and the genetically modified mosquitoes are still safe for predators to eat. Oxitec Product Development Manager Derric Nimmo likened the process to "going in with a scalpel and taking away Aedes aegypti, leaving everything untouched."[194] Since Aedes aegypti is an imported invasive species in Brazil, some experts expect that its eradication will have little impact on the environment. However, other environmentalists emphasize that the long-term consequences of eliminating an entire species cannot be predicted.[195]
Government recommendations that women delay pregnancy have also proven to be controversial. Human and reproductive rights groups have deemed the recommendations irresponsible and difficult to follow, since women alone are tasked with avoiding pregnancy despite having little control to do so.[196] A 2012 study suggests that 56% of pregnancies in Latin America and the Caribbean are unplanned (compared to an average unplanned pregnancy rate of 40% worldwide).[197] Access to contraceptives might be limited in regions where the Roman Catholic Church is predominant, such as in El Salvador.[198] Anti-abortion laws in much of the region leave women with no recourse once they become pregnant. Aside from three countries where abortion is widely available (French Guiana, Guyana, and Uruguay) and three countries where abortion is allowed in cases of fetal malformation (Colombia, Mexico, and Panama), most of the region only permits abortion in the cases of rape, incest, or danger to the mother's health. In El Salvador, abortion is illegal under all circumstances.[196]
On February 5, 2016, the UN High Commissioner for Human Rights urged Latin American governments to consider repealing their policies regarding contraception and abortion, emphasizing that "upholding human rights is essential to an effective public health response".[199] On February 16, 2016, the Vatican condemned the UN for its call to action, deeming it "an illegitimate response" to the Zika crisis and emphasizing that "a diagnosis of microcephaly in a child should not warrant a death sentence".[200]
On February 18, 2016, after a trip to Latin America, Pope Francis stated that "avoiding pregnancy is not an absolute evil" in cases such as the Zika virus outbreak. His comments sparked speculation that the use of contraception may be morally permissible in the prevention of the Zika virus.[201]
Scientific communication and concerns[edit]
The 2015–2016 Zika virus outbreak became an important topic on many social media sites, especially on Twitter. An analysis of Twitter posts on February 2, 2016, showed that 50 tweets per minute were posted about Zika, many of which contained the hashtags #salud, which means health in Spanish as well as #who, which served as a reference to the World Health Organization.[202]
The epidemic also caused a rise in tweets from college students upset that their spring break trips and study abroad plans had been changed or cancelled due to the virus' spread.[202]
Many studies have been conducted on the connections and impact of social media mentions of Zika. One analysis found that the primary topics discussed on Twitter before the peak of the outbreak regarding Zika included Zika's impact, reactions to Zika, pregnancy and microcephaly, transmission routes of Zika, and case reports.[203] During the summer of 2016 when Zika was spreading at a much faster rate, this social media analysis determined that the major topics on Twitter regarding Zika had become concerns about the spread of Zika, criticism of Congress, news about Zika, and scientific information about Zika.[203] The same study also found that tweets from reputable institutions and people holding scientific credentials demonstrated the ability of Twitter as a source to spread information quickly on the internet.[203] Another study found that the Centers for Disease Control and Prevention as well as the general public showed similar concerns about Zika. The CDC's posts on Twitter during the outbreak focused on symptoms and education for Zika.[204] However, the public had more of a tendency to focus concern on the consequences of Zika on women and infants, such as microcephaly.[204]
While there was concern for children on social media, this concern was lacking in countries largely impacted by Zika virus, such as Brazil. In Brazil, struggling mothers of infants with microcephaly caused by Zika have used support systems on social media on the cellphone chat app called WhatsApp or on Facebook pages that can help connect mothers in need of supplies and money to donors.[205]
The heavy traditional news and social media coverage of the virus spreading did cause concern over lack of reliability. Research has found that between May and June 2016, four out of five social media posts about Zika provided accurate information, but inaccurate posts were much more popular. This led many researchers to worry about the quality of information being spread and shared on social media.[206] Google Trends showed that Zika did not become a trending topic for the media until January 2016.[207] A study done found that 81 percent of the most popular posts on Facebook about Zika did contain truthful information, but posts spreading false information were far more popular.[206] Initial media reports on Zika in the United States focused on reassuring viewers and readers that Zika was not a threat in the United States.[207] Studies have found that real-time social media updates are desirable methods for communication during the emergence of infectious diseases. However, misinformation is common and data control in the cyber world has become a growing necessity.[204]
Many people criticized the lack of governmental response from the U.S. Government in the wake of the crisis.[208] The United States was criticized for a lack of preparedness in terms of an ability to contain a virus outbreak in the United States. The Obama Administration requested an emergency supplemental appropriation of $1.86 billion for both domestic and international response to the crisis.[209] In response to this request, Congress redirected $589 million from funds previously dedicated to Ebola instead of allocating new funds.[209] Another criticism regarding Zika funding had to do with the fact that Congress members still took vacation in July 2016 before allocating any of the funds requested in February 2016.[210]
In August 2016, the Centers for Disease Control and Prevention reported that they had spent $194 million of the initial $222 million allocation to fight Zika virus.[211] Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases said that the NIAID was running out of funds, which would substantially slow down the development of vaccines.[212] Although the government faced criticism for not responding strongly enough to the Zika outbreak, the government eventually provided funding of $1.1 billion for Zika in October 2016. It took congress nearly seven months to agree to this allocation, which left many prevention and education projects without funding for a substantial amount of time.[213] Senate Democrats urged Republicans to approve the full amount of funding more quickly rather than waiting for major transmission of Zika virus to begin in the United States.[214]
In 2017, public health experts are still concerned about the failure of the Zika response in the United States.[215] Many officials failed to provide information about Zika's sexual transmission. New York City subway systems had posters about mosquitos while all local cases reported had been picked up elsewhere or transmitted sexually.[215] Many experts believe that the United States lacked severely in providing the public with information to prevent sexual transmission of the virus.[215]