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Zika Virus: A Global Health Emergency

By Anas Mateus

April 6, 2016

On February 1, 2016, the World Health Organization declared Zika virus, a virus new to the
western world, as a global health emergency.1 Termed as the new Ebola, Zika is infecting
millions of people in Latin America, and Asia at an alarming rate, particularly pregnant women
and infants.2 Currently, medical researchers are working on a cure for the virus, but it may take
years to develop. Health organizations around the world have implemented certain methods to
combat the virus, but they have been ineffective. Consequently, people have begun to search for
new alternatives to fight the virus, such as contraceptives and abortions, to avoid birth defects,
which some may consider controversial. People are considering not attending big events, such as
the Summer Olympics in Rio de Janeiro, in fear of contracting Zika. The publics response
showcases that current methods are obsolete and need to be replaced with a new solution, such as
the one presented by Eliminate Dengue.

Zika Virus: The History


Named after the Zika forest where it was discovered, the virus was first identified in Uganda in
1947 where it was initially found in rhesus monkeys.3 Since then, it has gradually spread to the
western world. In 1952, the virus was first identified in humans in Uganda and Tanzania. From
the 1960s to the 1980s, human infections of Zika were found across Africa, Southeast Asia, and
the Pacific Islands, and before 2007, at least fourteen cases of Zika have been recorded.4
Although that may be a very low number to be considered as a world health crisis, many
symptoms of Zika are very similar to those of many other diseases, and as a result many cases of

Zika Virus: A Global Health Emergency | Anas Mateus

Zika may not have been identified.5 The first large outbreak of Zika was on the Island of Yap, a
small island in the Pacific in 2007, with as much as forty-three people infected by the virus.6

During the Zika outbreak of French Polynesia in 2013-14, researchers began to assume that the
virus was the cause of other illnesses such as Guillain-Barr Syndrome: a neurological disorder
in which the bodys immune system attacks part of the peripheral nervous system.7 GuillainBarr Syndrome is a rare non-contagious disorder affecting one in every 100,000 people.8 Those
who have the disorder experience muscle weakness, loss of reflexes, numbness or tingling in the
arms, legs, face, and other parts of the body, as well as paralyzation. Experts have not found a
cure for the disorder, but treatments include plasma exchange or immunoglobulin therapy.9

Ranges of Microcephaly in newborn infants | Photo provided by the CDC.10

Until recently, the virus hadnt seen the western world. Now, the virus has been under the
international spotlight due to its widespread outbreak in South America. The first early reports of
Zika in South America emerged in Brazil in May 2015. Since then, Brazil has reported links
between Zika and Guillain-Barr Syndrome. The virus has also been linked to microcephaly: a

Zika Virus: A Global Health Emergency | Anas Mateus

condition where a babys head is much smaller than expected, mainly due to lack of brain
development during pregnancy or after birth.11 Medical researchers believe that the cause of the
disease may be due to changes in the babys genes, certain infections during pregnancy,
malnutrition, exposure to harmful substances, or interruption of blood supply to the baby during
brain development.12 Despite the many cases of these illnesses in Zika patients, there has been no
proven link between microcephaly and Zika.

In May 2015, the Pan American Health Organization (PAHO) issued an alert regarding the first
confirmed case of Zika virus in Brazil.13 Since then, approximately 1.5 million people have been
affected in Brazil alone, with the World Organization (WHO) declaring the Zika virus as an
emergency of international concern, and a global health emergency.14 According to the
CDCs website, the Zika virus will likely spread to new areas.

What exactly is Zika Virus?


The Zika virus is a disease that is primarily spread to people through the bite of an infected
Aedes species mosquito- these are the same mosquitos that transmit other diseases such as yellow
fever, west nile, chikungunya, and dengue.15 Zika is only carried and transmitted by female
mosquitoes, as they need blood to lay their eggs.16 The virus is carried in their salivary glands,
and is transmitted when saliva is transferred in a mosquito bite. Other forms of transmission of
the virus include: pregnancy, sexual contact, and blood transfusion.17

Who is affected?

Zika Virus: A Global Health Emergency | Anas Mateus

Since its introduction in Brazil, over 1.5 million people are thought to have been affected, and it
has quickly spread to Latin America and the Caribbean, including US territories such as the
Commonwealth of Puerto Rico, the US Virgin Islands, and American Samoa.18 With Zika being a
disease mainly transmitted through mosquito bites, it is a virus that can affect anyone
disregarding age, race, and gender.

Potential Zika-infected areas within the coming months due to the range of the Aedes aegypti mosquito.
By The New York Times | Source: Moritz U. G. Kraemer et al., eLife Sciences; Simon Hay, University of Oxford 19

By Summer 2016, the World Health Organization expects Zika to spread to all countries in the
Americas except for two: Canada, and Chile. This is due to different types of mosquitoes, such as
Aedes aegypti, and its ability to carry the virus. These mosquitoes can travel as far as New York

Zika Virus: A Global Health Emergency | Anas Mateus

and Connecticut during the summer, potentially infecting mass amounts of people in those areas
in the coming weeks.20

Whats Being Done About It?


Currently, there is no vaccine to prevent, or medicine to treat Zika virus. On February 8, 2016,
President Obama announced a request for $1.8 billion in emergency funds for several agencies to
accelerate research into a vaccine and educate populations at risk for disease.21 Although
scientists are working on discovering a vaccine, it will take years to find one. Until then, the
World Health Organization and the CDC have devised plans to combat the virus, with both
organizations strongly advising travelers, and pregnant women in particular to refrain from
traveling to Zika infected areas.

In February 2016, the CDCs Emergency Operations Center (EOC) moved to a level 1
activation.22 The EOC is the command center for monitoring and creating an emergency
response, and is now operating at its highest level. The EOC has visions to: develop laboratory
tests to diagnose Zika, conduct studies to learn more about Zikas links to microcephaly and
Guillain-Barre syndrome, monitor and report cases of Zika, provide guiding to Americans,
especially pregnant women, traveling to and living in Zika infected areas, and surveillance for
the virus in US and US territories.23

CDC Director Dr. Thomas Frieden has said that health departments need to take a four corners
approach: combat Zika carrying mosquitoes indoors and outdoors as well as killing larvae and
adult insects.24 Frieden also claims that these mosquitoes are resistant to many types of

Zika Virus: A Global Health Emergency | Anas Mateus

insecticides with Frieden calling them the cockroach of mosquitoes because they are so hard to
kill.25 Although they have widespread resistance to some insecticides, that doesnt necessarily
mean that this method to prevent infection is impossible.

Similar to the CDCs approach, the World Health Organization plans to: surveille the virus and it
potential complications, strengthen the capacity of labs to detect the virus, and support local
health authorities in affected areas to implement vector control strategies to reduce the Aedes
mosquito populations such as providing a larvicide to treat still water sites that cannot be treated
in other ways, such as cleaning, emptying and covering them.26

The Ethical Issues


Since the outbreak in May 2015, Zika has spread to many Latin American countries with
countries like El Salvador devising of different policies to combat the issue. Deputy Health
Minister, Dr. Eduardo Espinoza of El Salvador has advised women to wait until 2018 to get
pregnant.27 By then, they will know more about the virus, and hopefully found a cure. El
Salvador is an extremely conservative country where abortion and contraceptives are banned
under any circumstances, with abortion leading to long jail sentences. With many other Latin
American countries carrying the same ideals, it is not a surprise that they have followed suit
countries like Colombia, the Dominican Republic, and Jamaica have strongly advised women to
avoid getting pregnant until scientists have learned more about the virus. Like many other Latin
American countries in El Salvadors case, these conservative views leads to a series of
problematic and ethical issues.

Zika Virus: A Global Health Emergency | Anas Mateus

In recent times, these ethical issues have been part of a larger case: Should people use abortion
and contraception as ways to fight against the virus? Pope Francis recently turned heads by
stating that women using birth control to prevent Zika would be the lesser of two evils and that
he would approve of contraception to fight Zika in this case. He then claimed that abortion is still
not an option, and that it is an absolute evil.28

The Rio Dilemma


With the Rio Olympic games coming up this summer, there has been widespread concern
amongst athletes and the risk of contracting Zika. Experts estimate that with approximately
16,000 athletes, and 600,000 visitors, there is great uncertainty in mass amounts of people
getting infected.29 As a result, many athletes, including US soccer star Hope Solo have come out
and said that they would consider skipping the 2016 Olympic games in Brazil over the Zika
outbreak, telling SI.com,
I would never take the risk of having an unhealthy child. I dont know when that day
will come for [husband] Jerramy [Stevens] and me, but I personally reserve my right to
have a healthy baby."30
(Hope Solo, SI.com)
In light of rising concern, national olympic committees including the United States Olympic
Committee told US sports federations that athletes and staff concerned about Zika should
consider not going to the games in August, and with that, many other countries may follow suit
and abstain from sending athletes to the summer games.31

What does this mean for the Olympics? Although the mosquito population will reach its lowest
numbers during the Brazilian cool season at the time of the olympics, mosquitoes still bite yearround which still puts athletes in visitors at risk of infection. Some have even gone to suggest

Zika Virus: A Global Health Emergency | Anas Mateus

that Brazil and the International Olympic Committees should call off this years games to avoid
putting peoples lives at risk even calling called Brazil irresponsible for not calling off the
games. New York University bioethicist Art Caplan has accused Brazil of being irresponsible
and that the country shouldnt be trying to run an Olympics and battle an epidemic at the same
time. 32

As a result of the concern surround the spread of Zika, the tickets to this summers games arent
selling, with under half of the total amount of tickets sold. And with Brazil going through its
worst recession in over 25 years, people refraining from attending the games can largely damage
Brazils economy. 33A damaged economy would mean a lack of funding in research of the virus,
and halting the potential development of a vaccine. This factor will predict how the Brazil battles
Zika virus in the future, and leaves the country with a complicated economic dilemma.

So, What Should Be Done?


In the coming months, Zika will continue to spread to new areas, and medical researchers
estimate that it may take years to develop a Zika vaccine, let alone a cure. Consequently, we
must focus on what we can do in the present to stop the virus from spreading. The current
strategies of the World Health Organization and the CDC regarding containment and the use of
insecticides are undoubtedly ineffective-- and with Tom Frieden of the CDC calling the Aedes
aegypti mosquito as the cockroach of mosquitoes, health officials are even calling for the use
of highly dangerous pesticides such as DDTs to halt the virus from spreading to new areas.34
Dichlorodiphenyltrichloroethane (DDT) is a controversial insecticide that has been illegal in the
US for more than 40 years and is infamously known for its mentioning in Rachel Carsons Silent

Zika Virus: A Global Health Emergency | Anas Mateus

Spring.35 Though it is a strong and persistent pesticide, it has the potential to kill many species,
and if an individual is exposed to the chemical it can stay in the body for long durations of time.
It is also reported that DDT can negatively affect the fetus during pregnancy if the mother is
exposed to the chemical.36

In addition, the implementation of containment in Zika affected areas have lead to multiple
issues with some believing these methods to be unethical and immoral. Advising women to avoid
getting pregnant until 2018 and warning travelers to stay away from certain regions doesnt solve
the problem as the virus will continue to spread regardless as a result of the widespread mosquito
migration to the Northern Hemisphere during the warmer months, making it difficult to achieve
the goal of containment in the fight against the virus.

As previously stated, this is a complex virus to combat, and certain methods can potentially
cause more issues to arise. While searching for a vaccine, it is in best interest for WHO and the
CDC to find a low-risk method to help the fight against Zika.

One method has been in the making for about five years. Dr. Scott ONeill of Monash University
in Australia began Eliminate Dengue: Our Challenge; a non-profit organization that has been
researching a natural bacteria called Wolbachia.37 Wolbachia pipientis are bacteria that live
within insect cells and are passed between generations through insect eggs. The bacteria were
first discovered in mosquitoes in the 1920s, and early studies showed that it is a harmless
symbiotic bacterium in insects. Wolbachia is extremely common in insects and is present in up to

Zika Virus: A Global Health Emergency | Anas Mateus

sixty-percent of all insect species, except for the Aedes aegypti. the mosquito that carries viruses
such as Zika, dengue, chikungunya, and yellow fever.38
The organizations overall aim is to,
seed wild mosquito populations with Wolbachia in areas where dengue is endemic. We
do this through controlled releases of Wolbachia mosquitoes that then breed with the wild
mosquitoes. Our prediction is that if Wolbachia can establish in the wild mosquito
population in a local area then there would be reduced transmission of dengue
between
people.39
(Eliminate Dengue, par. 2)

How Wolbachia would affect the wild mosquito population over time. | Picture from Eliminate Dengue40

So, as a result of the Wolbachia bacterium present in some mosquitoes, the team hopes to test
whether the spread of these diseases can be slowed or halted by introducing these mosquitoes
and hoping that they come in contact and breed with virus-carrying mosquitoes.41

ONeill and his team have conducted numerous trials in dengue-infected communities in
Australia, Indonesia, Brazil, Vietnam, and Colombia since 2011.42 Although this project focuses
on dengue, it can still help in the fight against Zika, since they are relatively similar viruses, with
Cameron Webb of Sydney University claiming, ...if you are controlling dengue, you are
controlling Zika. 43 Since the projects birth in 2011, the organization have only run trials in

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small-scale areas, but they achieved great successes in their methods. The teams first trials were
run on the coast of Cairns, Australia in 2011, and Kate Retzki of the Eliminate Dengue program
has confidently states that, There havent been any reported cases of locally transmitted dengue
in those areas in five years. 44

Over the next few years, ONeill and his team aim to implement large-scale projects across urban
areas, such as the largely Zika-affected areas in South America. The only factor halting the team
from progressing is the cost. ONeill and his team are seeking to run a low-cost, large scale
projects to help fight mosquito-born viruses.45 With money being an issue, the funding from a
large organization such as the World Health Organization or the CDC could surely aid
Eliminating Dengue in running these large-scale projects with the hopes of stopping the spread
of Zika and the suffering of millions of people. And since the Aedes aegypti carries
approximately ninety-nine percent of all mosquito-borne viruses, this project can ultimately end
the global burden of those viruses, and potentially save millions of lives in the future.46

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Endnotes

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Zika Virus: A Global Health Emergency | Anas Mateus

1 Sabrina Tavernise and others, "Zika Virus a Global Health Emergency, W.H.O. Says," available at
http://www.nytimes.com/2016/02/02/health/zika-virus-world-health-organization.html (last accessed April 2016)
2 Joanne Kenen and others Is Zika the New Ebola? available at http://www.politico.com/story/2016/01/iszika-the-new-ebola-218362 (last accessed April 2016)
3 CDC, About Zika Virus Disease, available at http://www.cdc.gov/zika/about/index.html (last accessed April
2016)
4 Ibid.
5 Ibid.
6 World Health Organization, Zika Virus available at http://www.who.int/mediacentre/factsheets/zika/en/ (last
accessed April 2016)
7 Ibid.
8 National Institutes of Health, Guillain-Barr Syndrome Fact Sheet, available at
http://www.ninds.nih.gov/disorders/gbs/detail_gbs.htm (last accessed April 2016)
9 Mayo Clinic Staff, "Guillain-Barre Syndrome," available at http://www.mayoclinic.org/diseasesconditions/guillain-barre-syndrome/basics/treatment/con-20025832 (last accessed April 2016)
10 CDC, About Zika Virus Disease, available at http://www.cdc.gov/zika/about/index.html (last accessed
April 2016)
11 Center for Disease Control, "Facts about Microcephaly," available at
http://www.cdc.gov/ncbddd/birthdefects/microcephaly.html (last accessed April 2016)
12 Ibid.
13 CDC, About Zika Virus Disease, available at http://www.cdc.gov/zika/about/index.html (last accessed
April 2016)
14 Sabrina Tavernise and others, "Zika Virus a Global Health Emergency, W.H.O. Says," available at
http://www.nytimes.com/2016/02/02/health/zika-virus-world-health-organization.html (last accessed April 2016)
15 Donald G. McNeil Jr., et al, "Short Answers to Hard Questions About Zika Virus," available at
http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0 (last accessed April 2016)
16 Ibid.
17 Ibid.
18 Center for Disease Control, "Areas with Zika," available at http://www.cdc.gov/zika/geo/ (last accessed April
2016); Donald G. McNeil Jr., et al, "Short Answers to Hard Questions About Zika Virus," available at
http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0 (last accessed April 2016)
19 Donald G. McNeil Jr., et al, "Short Answers to Hard Questions About Zika Virus," available at
http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0 (last accessed April 2016)
20 Tom Miles and others, "Zika Virus Set to Spread across Americas, Spurring Vaccine Hunt," available at
http://www.reuters.com/article/us-health-zika-idUSKCN0V30U6 (last accessed April 2016)
21 Center for Disease Control, "What CDC Is Doing, available at http://www.cdc.gov/zika/cdc-role.html (last
accessed April 2016)
22 Ibid.
23 Ibid.
24 Ibid.
25 Julie Steenhuysen, The U.S. Needs New Strategies To Fight Zika Mosquitos, available at
http://www.huffingtonpost.com/entry/the-us-needs-new-strategies-to-fight-zikamosquitos_us_5702911be4b0a06d5806308d (last accessed April 2016)
26 World Health Organization, "Zika Outbreak: WHO's Global Emergency Response Plan," available at
http://www.who.int/emergencies/zika-virus/response/en/ (last accessed April 2016)
27 Donald G. McNeil Jr., et al, "Short Answers to Hard Questions About Zika Virus," available at
http://www.nytimes.com/interactive/2016/health/what-is-zika-virus.html?_r=0 (last accessed April 2016)

28 Ines San Martin, "Pope Francis Signals Openness to Birth Control for Zika Virus," available at
http://www.cruxnow.com/church/2016/02/18/francis-signals-openness-to-birth-control-for-zika-virus/ (last

accessed April 2016)


29 Dr. Ford Vox, "Zika and the Rio Olympics: Is There a Threat?" available at
http://www.cnn.com/2016/02/12/health/zika-olympics-threat/ (last accessed April 2016)
30 ESPN, "Hope Solo Thinks All Athletes Should Have a Safe Olympic Environment," available at
http://espn.go.com/espnw/sports/article/14746774/hope-solo-go-olympics-today-due-zika-virus (last accessed
April 2016)
31 Daniel Bases and others, Bases, "Exclusive: U.S. Athletes Should Consider Skipping Rio If Fear Zika,"
available at http://www.reuters.com/article/us-health-zika-usa-olympics-exlusive-idUSKCN0VH0BJ (last
accessed April 2016)
32 Dr. Ford Vox, "Zika and the Rio Olympics: Is There a Threat?" available at
http://www.cnn.com/2016/02/12/health/zika-olympics-threat/ (last accessed April 2016)
33 Jackie Wattles, "Tickets to the 2016 Olympics Aren't Selling, and Brazil Is Scrambling to Boost Demand,
http://money.cnn.com/2016/04/03/news/world/olympics-rio-ticket-sales/ (last accessed April 2016)
34 Ray Sanchez, "Zika Virus: Is DDT an Option? available at http://www.cnn.com/2016/02/04/health/zikavirus-ddt-what-you-need-to-know/ (last accessed April 2016)
35 Ibid.
36 Ibid.
37 Monash University, "Professor Scott O'Neill - Researcher Profile, available at
https://www.monash.edu/research/people/profiles/profile.html?sid=48727&pid=6194 (last accessed April 2016)
38 Eliminate Dengue, "Our Research: Wolbachia," available at http://www.eliminatedengue.com/ourresearch/wolbachia (last accessed April 2016)
39 Ibid.
40 Eliminate Dengue, "Our Research," available at http://www.eliminatedengue.com/our-research (last accessed
April 2016)
41 Michelle Innis, "In Australia, a New Tactic in Battle Against Zika Virus: Mosquito Breeding." available at
http://www.nytimes.com/2016/02/05/world/australia/zika-virus-australia-mosquito-experiment.html (last
accessed April 2016)
42 Eliminate Dengue, "Our Research," available at http://www.eliminatedengue.com/our-research (last accessed
April 2016)
43 Michelle Innis, "In Australia, a New Tactic in Battle Against Zika Virus: Mosquito Breeding." available at
http://www.nytimes.com/2016/02/05/world/australia/zika-virus-australia-mosquito-experiment.html (last
accessed April 2016)
44 Ibid.
45 Eliminate Dengue, "Our Research," available at http://www.eliminatedengue.com/our-research (last accessed
April 2016)
46 Ibid.