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Zika marches on: lessons not learnt

By Peter Curson - posted Thursday, 4 August 2016


It is only six months since the WHO declared Zika to be a global health emergency and since then the disease has continued its unrelenting march across the world now affecting more than 65 countries and creating unease, fear and panic particularly among pregnant women and their families.

Up until 2013 Zika was regarded as a largely benign and harmless infection with mild symptoms. All that has now changed and since the WHO's announcement Brazil has suffered tens of thousands of cases and a huge surge in the number of babies born with microcephaly. In addition, at least 14 countries have now reported cases of microcephaly and other central nervous system disorders and 15 countries have reported an increased incidence of Guillain-Barre syndrome.

Despite all this some are now saying that the epidemic has peaked in Brazil and Latin America but in reality it may take years for it to fully disappear and its effects will linger much longer.

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In the meantime work goes on to produce a vaccine. History suggests that a fully effective vaccine that is widely available will most probably appear when the epidemic has run its course and we are confronted by another "new" infectious disease threat.

Do the lessons we have learnt from Zika, Ebola Swine Flu and SARS count for anything and do they offer us an insight into how to contain and stop future epidemics?

The battle to contain and eliminate such epidemics still rages and it is a battle that we are not winning. In the case of Zika we know that it is spread by the aedes mosquito but we are really unable to do much about limiting the distribution of the mosquito. Confronted as we are by a mosquito which over the last two centuries has beautifully adapted to living with and around humans our chances of winning the battle are remote.

The failure of the widespread spraying campaign involving more than 200,000 soldiers in Brazil suggests as much.

Ebola and now Zika demonstrate how much we have to learn and how we can be caught off guard and hindered by the poor surveillance and response mechanisms at our disposal.

The first battle against Ebola has been won but the war continues and the disease has simply retreated back into the security of its natural animal reservoir. How long before it ventures out again to attack humans is anybody's guess and we should not delude ourselves that the war has been won as a large part of West Africa still remains vulnerable to future outbreaks.

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In particular, parts of Africa and Asia suffer from weak government institutions, poor health services, environmental degradation, poverty, human migration and conflict and political instability.

All this creates the perfect storm conditions for an outbreak of infectious disease particularly where such things result in the disturbance of natural reservoirs of disease where infections have been nurtured for centuries.

But at the moment world attention is focussed on Zika. Today, probably two million Brazilians have Zika and now cases are appearing in the USA and Western Europe. In Puerto Rico at least 5,500 people have tested positive for the disease including approximately 670 pregnant women. The disease is also prevalent in American Samoa and the US Virgin islands.

In the case of the USA most Zika infections have been brought back by travellers infected elsewhere. Recently efforts have been made to dissuade people from visiting the Olympic Games in Brazil as well as recommendations that the Games be postponed. While the risk of infection may be low there is no doubting the mosquito population in and around Rio.

One of the great ironies of world public health is that until an outbreak of infectious disease occurs and large numbers of people begin to die the world shows little interest in spending money in trying to contain it.

There seems little doubt that we know what is required to contest our battle with infectious disease. We require the capability and infrastructure to quickly indentify and respond to disease outbreaks and not take refuge in the belief that they are taking place in "remote" locations in parts of Africa or Asia and thus offer little threat to us. Further, we still tend to take refuge in the belief that such disease outbreaks will eventually burn themselves out and offer little threat to developed countries.

As SARS, Ebola and Zika have demonstrated nothing could be further from the truth. There is little doubt that we are desperately still in need of a sophisticated surveillance and response system involving case detection and diagnosis, contact tracing, clinical care and isolation and community engagement. We need a world health authority with the means and power to quickly intervene in disease outbreaks wherever they occur.

Will we ever achieve all this particularly when many countries place emphasis on border security and disengagement from international agreements? While the jury is still out it remains somewhat doubtful. Yet all of the above must be timely and not left until there is a strong fear that the infection will spread to the USA or Europe.

To my mind there is little doubt that with respect to epidemic/pandemic preparedness and response we have learnt very little over the last century. To me such things are an absolutely critical part of human security and lie at the very heart of a nation's and the world's responsibility to protect the social, economic and health circumstances of all their citizens.

The human cost of failing to do this should instil in us the necessity of achieving this. Almost 100 million people died in the flu pandemic of 1918-18 and the HIV/AIDS epidemic and it has been estimated that today the annual losses from pandemics could easily exceed $US60 Billion. Over the last 16 or so years we have been confronted by innumerable global health crises and Zika is only the most recent. Some would say that the era of infectious disease is not over.

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About the Author

Peter Curson is Emeritus Professor of Population and Health in the Faculty of Medicine and Health Sciences at Macquarie University.

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