On March 15th, 2016 the Inter-American Dialogue and the O’Neill Institute for National and Global Health Law sponsored a symposium on Capitol Hill on the Zika crisis and its implications for US policy. The event was co-hosted by Congresswoman Susan Brooks (R-IN), Congressman Joaquin Castro (D-TX), Congresswoman Katherine Clark (D-MA), Congressman Eliot Engel (D-NY), Congresswoman Louise Slaughter (D-NY) and Congresswoman Debbie Wasserman Schultz (D-FL). After remarks by four of the co-hosts, presentations were made by Jeffrey Crowley, director of the O’Neill Institute’s National HIV/AIDS Initiative; Jacqueline Pitanguy, founding director of CEPIA in Rio de Janeiro; and Daniel Lucey, adjunct professor of microbiology and immunology at Georgetown University Medical Center. Peter Hakim, Dialogue senior fellow and president emeritus, moderated the event.
Congresswoman Brooks spoke of her role leading a bipartisan effort to include Zika on the FDA’s tropic disease priority review voucher program, which will allow companies to invest money and manpower into R&D for vaccines and treatment. Congresswoman Brooks said that the “really frightening thing” is that there is still a lot that is unknown about the virus. Clark emphasized the need to include family planning assistance in “any response” to the outbreak,” both from US agencies and the international community. Castro highlighted the importance of using “whatever federal agencies necessary” to stop the outbreak and develop a treatment plan, while Wasserman Schultz also mentioned increased education and access to family planning. Wasserman Schultz further emphasized the importance of “robust US investment in global health and development” and the design of an “effective multi-pronged strategy” in response to the disease.
Jeffrey Crowley focused primarily on how the US can draw on past experience with the HIV and Ebola crises that can be applied to Zika.
The most important thing the US can do in response to Zika, or any other global health emergency, is to “show urgency”.
In comparing the timeline of the US government response to the 2014 Ebola crisis to the HIV/AIDS epidemic, Crowley said, “we’re getting better, but we need to keep getting better.” Crowley mentioned his own previous work in the Obama White House as “AIDS czar” as well as the creation of an “ebola czar” during the 2014 crisis. While he said creating a position specific to Zika is not necessary, Crowley emphasized the need to “create a system where we know that crises will occur and that we prepare for them.” He also noted the need to recognize that “people are going to be afraid” and that the dissemination of accurate information will be crucial to solving this crisis.
Dan Lucey, a physician, spoke briefly about the spike in cases of microcephaly in infants in Brazil and how it is linked to Zika. Lucey, who worked in Sierra Leone and Liberia during the Ebola crisis, said that he first saw Zika as a major problem once doctors began making connections between the virus and serious neurological defects in newborns. Lucey complimented the WHO and the Pan-American Health Organization for their quick response to the crisis and noted that their decision to declare a “public health emergency of international concern” quickly, something that did not happen during the Ebola crisis, has helped advance international efforts to combat the disease. Lucey concluded by saying that, while advancements have been made, we are “far away” from a safe vaccine license.
Jacqueline Pitanguy opened by reading a May 2015 newspaper headline from Rio de Janeiro stating that “health authorities alert that new virus called Zika is circulating in Brazil” and that the Minister of Health “was not worried” because the symptoms of the disease are milder than dengue. Pitanguy highlighted four core elements to be considered during this epidemic: the vector, scientific research, communication, and the social environment. The same Aedes aegypti mosquito that carries all four types of dengue, chikunguya, and yellow fever spreads the Zika virus. In Pitanguy’s words, the mosquito has flown “for decades around [the] urban landscape of Brazil,” yet “little has been done” to eliminate it. But as the link between Zika and microcephaly has become clearer, greater scientific research has been done. Pitanguy noted, however, that the economic crisis in Brazil has greatly limited funding for research. Like Crowley, Pitanguy emphasized the importance of disseminating accurate information to vulnerable populations, specifically bringing knowledge gathered in labs and research centers to populations at-large. Her fourth point focused on the “social environment,” namely sanitation and waste management, access to clean water, and access to health services.
Pitanguy also spoke about sexual and reproductive health. While thousands of pregnant women are afraid to leave their homes, she said, the most vulnerable women in Brazil “can’t afford to stay at home, can’t afford to buy repellant,” and oftentimes don’t know that they’re infected. Women of reproductive age are “in a panic” and “being tortured” by the probability of nerve damage in their babies, while current policy in Brazil severely restricts access to abortion. Pitanguy indicated that a growing religious movement within Congress is calling for even more restrictive policies that would lead to jail time for women who interrupt pregnancy because of microcephaly. Pitanguy’s organization, CEPIA and other non-profits are calling upon the Supreme Court to allow for interruption of pregnancy in situations of severe fetal malformation, including microcephaly; demanding that the government provide proper care to newborn babies with microcephaly and their mothers, who are often abandoned by their partners; and, investing in the dissemination of accurate information to vulnerable populations. Pitanguy concluded by echoing WHO officials who warn that Zika is not a Brazilian problem, but a problem of the Americas and a problem of the world.
Audience questions reflected the desire to know more about the virus itself, the likelihood of major outbreaks in the US, and how multinational corporations or the US government could contribute. One participant emphasized that while pregnant women and microcephalic babies are a real emergency, it’s important to remember that eliminating the mosquito is essential to a long-term solution. Pitanguy added that the uncertainty surrounding the virus and the fact that new information is being discovered almost daily–for example that the virus can be transmitted sexually and the possible link between Zika and Guillain-Barré Syndrome—makes it difficult to formulate a response. Crowley and Lucey emphasized that Zika is not chronic but can persist in blood for seven days and in saliva and urine for up to 35 days. Both agreed that there will be increased cases of Zika and microcephaly in the United States, but not as many as other countries in the hemisphere. Crowley said that it’s important for the US to do “a little bit of everything” and that “no other country has resources like we have,” specifically referencing the NIH, NIAID, and the CDC. He ended by praising Brazil for their rapid decision to declare microcephaly a health emergency in November 2015, leading other nations to invest in Zika prevention and bring international attention to the emerging health crisis.