CMWG: Funding a Comprehensive Response to the Zika Virus

The Dialogue's Leadership for the Americas Awards Gala 2016. Washington, DC, Nov. 16, 2016. Photo: Jay Mallin

On November 15, 2016, the Inter-American Dialogue’s Congressional Program and the O’Neill Institute for National and Global Health Law convened a private roundtable discussion on funding for the current Zika virus outbreak in the Americas. In September 2016, the US Congress approved $1.1 billion for the emergency Zika response, which raises a number of important questions around funding allocation and priority setting, both domestically and globally. The discussion was part of the Dialogue’s Congressional Members Working Group (CMWG) series.

Peter Hakim, president emeritus of the Inter-American Dialogue, opened the discussion by welcoming Drs. Vanessa and Hélio Van Der Linden and thanking the O’Neill Institute for co-sponsoring a second event with the Dialogue. Hakim also thanked the congressional co-hosts of the event, Congressman Eliot Engel (NY-16), Congressman Joaquin Castro (TX-20), Congressman Sam Farr (CA-20), and Congresswoman Debbie Wasserman Schultz (FL-23). Dr. Daniel Lucey of the O’Neill Institute then offered a brief introduction of Dr. Vanessa Van Der Linden.

Van Der Linden, who practices pediatric neurology in Recife, Brazil, detailed the progression of events that prompted her to alert Brazilian health officials of an emerging Zika virus epidemic in the state of Pernambuco. She first described the specific cases that led her to link the Zika virus to certain congenital disorders—including microcephaly—explaining her collaboration with her mother and brother, both also pediatric neurologists, throughout the process.  She noted that in late October 2015, she tended to 26 women from three maternity wards with symptoms suggestive of a Zika virus infection. Upon notifying the Brazilian Minister of Health of the alarming nature and scope of the cases, the government of Pernambuco became involved.  Dr. Van Der Linden proceeded to describe the complexity and variety of the congenital conditions she observed among affected babies. She emphasized that for many babies born to mothers infected with the Zika virus, such disorders emerged as late as ten months after birth.

Dr. Hélio Van Der Linden, who practices pediatric neurology in Goiânia, Brazil, noted that in Goiânia, there have been fewer Zika cases than in Pernambuco. He also echoed his sister by emphasizing the importance of recognizing that babies may develop symptoms of the congenital Zika syndrome up to ten months after birth. He stressed that pediatricians must actively look for such symptoms and make early diagnoses. He also noted that because the pattern of disorders linked to congenital Zika virus infection is only just now being researched, it is very possible that symptoms may appear even later in a patient’s life. 

Further compounding the issue is that significant amounts of incorrect information on the Zika virus are available on the internet. They also emphasized that a woman’s vulnerability to the Zika virus is determined by where she lives, not by her socioeconomic status. Both doctors also felt that increased education across all levels was necessary to help limit the virus, including education related to mosquito deterrence and repellent strategies, family planning, and better information about microcephaly and other congenital disorders linked to the Zika virus.

Both doctors praised the response of local governments, particularly the government of Recife, for their swift response to the virus; however, Vanessa Van Der Linden noted that resources are limited. The city of Recife only has three public hospitals with access to pediatric neurologists, which is not sufficient enough to address patients’ needs. They also emphasized the multidisciplinary nature of the treatment, including access to psychologists, given the stigma surround disability in Brazil.

Jeff Crowley, the program director of the National HIV/AIDS Initiative at the O’Neill Institute, then briefed the attendees on the funding needed for a comprehensive response to the Zika virus. Crowley mentioned that President Obama requested almost $1.9 billion in emergency Zika funding for 2016 in February 2016. Following the president’s request, Congress did not approve any additional funding until the end of September 2016. While Congress debated supplemental Zika funding, the administration announced it had identified almost $700 million in existing sources to be used to address immediate Zika activity needs.

Crowley also highlighted that the US must consider Puerto Rico when planning the domestic response to Zika, noting that the US territory has experienced approximately 30,000 reported cases of Zika. The US has an obligation, he stated, to take care of its citizens, especially marginalized populations, instead of placing all responsibility on WHO and PAHO.