Public health experts urge World Health Organization to ramp up Zika response

By Neil Murthy

Public health experts are calling for the World Health Organization to step up efforts in the fight against the Zika virus outbreak.

In the Journal for the American Medical Association viewpoint article published Wednesday, a doctor and public health lawyer urge WHO to utilize lessons learned from the Ebola epidemic and formulate immediate steps to respond to the Zika outbreak. Dr. Daniel Lucey and attorney Lawrence Gostin of the O’Neill Institute for National and Global Health Law at Georgetown University wrote the article in JAMA’s Viewpoints section.

Others, however, disagree that the epidemic should fundamentally change standard public health or medical practice. Despite the fact that two cases of Zika have now been diagnosed on Illinois soil, some local Chicago medical professionals have stated that the outbreak will not change the way they treat and counsel patients.

“Currently there is zero risk [of transmission] in Illinois but that may change over time,” said Dr. Emily Landon, assistant professor of Medicine, Hospital Epidemiologist, and medical director for Infection Control at the University of Chicago Medical Center. “Our preparedness is about educating faculty and health care staff on what it is,” she said.

“Zika is something to be aware of, but I don’t think we have to be afraid of it,” said Shirley Stephenson, a nurse practitioner who works at a travel clinic at the University of Chicago. “There are lots of mosquito-borne illnesses and Zika is just getting coverage right now.”

The recent Zika virus epidemic first began in early 2015, when clusters of the disease occurred in northeastern Brazil. Since then the mosquito borne illness spread rapidly throughout the Americas. Two cases have been diagnosed in Illinois, although both cases were imported to the state and were not acquired locally.

Zika Affected Areas – Countries and Territories Reporting Active Transmission

Courtesy of CDC
Courtesy of CDC

The Zika virus is carried by the Aedes Aegypti mosquito, and does not spread by human-to-human contact.  The mosquito’s geographic range extends throughout the tropics but stretches into the southeastern United States. Although the illness only causes mild flu-like symptoms (such as fever, rash and joint pains), the impacts of the disease can be devastating. Preliminary reports show that pregnant mothers who contract the virus during any trimester of their pregnancy are at an increased risk of delivering babies with small shrunken heads and severe mental disabilities—a condition called “microcephaly.”  The virus is also associated with Guillain-Barré Syndrome—a condition that paralyzes a stricken patient’s arms and legs.

The executive board of the World Health Organization is currently meeting in Geneva, Switzerland, and many are waiting to see what the world’s preeminent health organization is going to do from a policy standpoint about the burgeoning Zika virus epidemic. Both the World Health Organization and the Centers for Disease Control and Prevention provide information to clinicians and the general public about Zika virus on their websites.

In response to the outbreak, the CDC activated its Emergency Operations Center on Friday, which rapidly increased the organization’s capacity to track and respond to the outbreak. Public health officials are wondering if the WHO will follow suit and activate a similar emergency response.

However, the preliminary agenda of the executive board meeting posted on the WHO website, does not list Zika virus as a topic at the meeting. With representatives from 34 nations, the WHO Executive Board has listed other—albeit equally pressing—issues on the agenda, including air pollution, antibiotic resistance, and HIV prevention.  The organization has scheduled a press conference and informational session Thursday at 3 p.m. Geneva time to discuss the ongoing outbreak.

“At the request of member states’ representatives present in Geneva for the Annual WHO Executive Board Meeting, the World Health Organization is organizing an information session for Member States on Zika virus,” WHO said in a statement.

In their article, Lucey and Gostin are calling for Dr. Margaret Chan, Director-General of WHO, to convene an emergency meeting to see if Zika virus should be declared a Public Health Emergency of International Concern, or “PHEIC.”  WHO has only declared PHEICs three times since the organization implemented the International Health Regulations of 2005. The three previous PHEICs include  swine flu in 2009 and Ebola and the polio resurgence, both in 2014.

WHO defines a PHEIC as “an extraordinary event which constitutes a public health risk through the international spread of disease and which potentially requires a coordinated international response.”

Declaring a disease to be a PHEIC raises the bar on a number of levels. First, it establishes the disease as a matter of global health security. This would result in daily communication channels between the WHO and individual nation states, allowing for greater information transparency. Second, a PHEIC catapults WHO into “action mode,” where the organization provides specific recommendations to nation states, and encourages the mobilization of resources to engage in a more robust public health response in the field.

“It would be unconscionable if a lack of preparedness resulted in hundreds of unnecessary cases of Zika and potential congenital abnormalities in newborns,” said Gostin in a press release for the article.

“The international community cannot afford to wait for WHO to act,” wrote Lucey and Gostin in their article.

Photo at top: Aedes Aegypti mosquito, courtesy of Flickr