Voice

Springtime in D.C. Means Mosquitoes — and Zika

A look at resources dedicated to mosquito control shows that major U.S. cities are vastly unprepared to prevent a Zika outbreak. And Congress just made it worse.

RECIFE, BRAZIL - JANUARY 26:  Aedes aegypti mosquitos are seen in a lab at the Fiocruz institute on January 26, 2016 in Recife, Pernambuco state, Brazil. The mosquito transmits the Zika virus and is being studied at the institute. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. At least twelve cases in the United States have now been confirmed by the CDC.  (Photo by )
RECIFE, BRAZIL - JANUARY 26: Aedes aegypti mosquitos are seen in a lab at the Fiocruz institute on January 26, 2016 in Recife, Pernambuco state, Brazil. The mosquito transmits the Zika virus and is being studied at the institute. In the last four months, authorities have recorded close to 4,000 cases in Brazil in which the mosquito-borne Zika virus may have led to microcephaly in infants. The ailment results in an abnormally small head in newborns and is associated with various disorders including decreased brain development. According to the World Health Organization (WHO), the Zika virus outbreak is likely to spread throughout nearly all the Americas. At least twelve cases in the United States have now been confirmed by the CDC. (Photo by )

When Congress left town before Easter for its spring break, it did so just having refused to take a vote on President Barack Obama’s request for $1.9 billion in special funds to fight the Zika virus. On March 22, House Speaker Paul Ryan told reporters, “There is plenty of money in the pipeline right now, money that is not going to Ebola, that was already in the pipeline, that can go immediately to Zika” and that could be “reprogrammed,” as he put it.

But as the American South warms and mosquitoes swarm out of hibernation, political leaders will discover the folly in failing to front-load Zika control funds. Playing catch-up with mosquitoes is a losing game for humanity: Ask the Brazilians, who have thrown every anti-insect weapon that can be imagined, from a range of pesticides to genetically modified mosquitoes, into their Zika arsenal.

Moreover, what Congress fails to recognize is that most aspects of public health, especially insect control, have long been the responsibilities of states, which, in turn, typically throw the onus down the line to the county or municipal levels. In the absence of federal support, localities are typically hard-pressed to maintain serious mosquito-control programs and year-to-year budgets, allowing loss of civil service expertise over time. At local levels, mosquito control tends to lose financial support and personnel when no crisis is perceived, and city or county governments then respond in haste with poorly trained personnel or outsourced contractors when infestation becomes politically significant. In the absence of federal backing and ongoing funded strategic approaches, local insect abatement is typically reactive and may be executed by workers pulled from entirely different departments in city or county governments. Despite recent invasions of foreign mosquitoes, such as Aedes albopictus, or the Asian tiger mosquito, and the emergence of West Nile virus, dengue, and chikungunya, politicians in all tiers of government routinely ignore the deceptively mundane topic of mosquito control. Worse, they dodge examination of local and state laws that might impede outbreak-control efforts. Some localities, for example, have laws in place that virtually eliminate government access to private property for mosquito spraying or other insect control actions; many have also responded to NIMBY (“not in my backyard”) protests over recent decades by banning or limiting the use of pest-control products that are deemed safe by the Environmental Protection Agency and the Centers for Disease Control and Prevention.

In my scrutiny of budgets across the areas most prone to mosquito-borne disease in the United States, I have found a nonsensical patchwork of spending patterns, public vs. private sector implementation, and local laws that have nothing whatsoever to do with science or public health priorities: It’s pure politics. America is not prepared for Zika because America doesn’t want to be.

Recently, the National Center for Atmospheric Research (NCAR) published a probability map for the potential spread of Zika, based on U.S. rain and mosquito patterns. Not surprisingly, the cities at highest risk were identified as those in Florida, Louisiana, Mississippi, Georgia, and the Carolinas, where summers are hot, wet, and mosquito-dense.

http://zika_riskmap_US_ncar_ucar2016_1500

Using the weather-based projections, we (Research Associate Gabriella Meltzer and myself at the Council on Foreign Relations) examined recent histories of mosquito-borne disease, net budgets for insect control, and estimated per capita spending on abatement in each high-risk area. In addition to scrutinizing public records, we tried to obtain confirmatory information from the relevant departments of health, some of which were noncooperative or unable to parse budget details to reveal spending on mosquito control versus other pests such as rodents.

For example, Tallahassee, located in Leon County, Florida, is among the highest-risk cities, according to the NCAR projection. It has had recurring West Nile virus cases every summer, carried by an assortment of mosquito species. But perhaps because the county spends roughly $23.47 per capita to protect its 281,845 residents from mosquito-borne diseases, Tallahassee has not had any cases of dengue or chikungunya and may be reasonably well-funded for a Zika fight.

The Orlando, Florida, tourist mecca may also be comparatively well-prepared, as its mosquito-abatement programs are fairly well-endowed in order to keep Walt Disney World, Universal Studios theme park, and the vast convention centers free of nasty biting insects. The Orange County mosquito-abatement budget of $10,757,080 protects 1.23 million residents, plus tourists, for about $8.78 per capita annually. Nevertheless, the greater Orlando area routinely confronts dengue and West Nile virus. Jacksonville protects its 842,583 residents with a FY16 budget of $48,546 for mosquito abatement, or roughly six cents per person.

In contrast, Miami, a city with a long history of battling West Nile, dengue, and chikungunya, is protected by Miami-Dade County, which spends a mere $4.40 per capita on mosquito control to protect its nearly 2.7 million residents, spread out over different agencies and executed by private contractors. The Tampa area, in Hillsborough County, which has also done battle of late with all three mosquito-borne diseases, spends $2.09 per capita to control the insects.

We found a similarly odd pattern of spending on mosquito control outside of Florida:

Perhaps most alarming, and likely to directly affect the nation’s leaders, are the mosquito-control situations in Washington, D.C., and New York City. In 2012, a City Council act stipulated that the “[D.C.] Department of Health shall develop and submit to the Council a mosquito-abatement plan, delineated by ward, for the following fiscal year to prevent and abate the infestation of mosquitoes.” The District, which was built upon land considered to be a hot flood plain, has a long and sorry history of mosquito-borne diseases and outbreaks over the nation’s history, including yellow fever, malaria, dengue, and West Nile virus. Yet there is no evidence that the District’s health authorities fulfilled the City Council’s mandate for a control plan, and as of today, the District has no published mosquito budget. Posted District information on Zika focuses on preventive measures individuals may take, such as using repellents and cleaning up yards, but offers no evidence that the government is engaged in mosquito control; Health Department representatives declined to offer further information. The word “mosquito” or any spending line relevant to insect control does not appear in the 902-page FY16 District budget for health, as approved by the City Council.

The situation for 8.5 million New Yorkers is similarly quixotic. West Nile virus first emerged in the city in 1999 and has reappeared annually ever since despite abatement programs that have included larva-killing, pesticide-spraying, and campaigns to remove trash and outdoor items that hold water, i.e., potential breeding sites. The New York City Health Department recently made public a budget that now includes $3.4 million for mosquito control in fiscal year 2016, and this year the city is committing an additional $3.1 million to its mosquito-abatement program to account for Zika preparedness, according to a department spokesman. This new number means that the city is spending 76 cents per capita. In mid-March, Gov. Andrew Cuomo released a six-point plan for Zika prevention statewide: At the time, none of the points was backed by new funding commitments.

In addition to mosquito-control budgets that inexplicably (save politically) range from 4 cents per capita to $23 per person, the relevant areas are governed by quite different laws with respect to abortion, birth control, and fetal research. These could have a stinging impact on research to identify which women are infected during pregnancy with the virus, how likely it may be that the virus will have a deleterious impact on the health of their babies, and whether vaccines are safe and effective for those would-be mothers.

According to Politico, the mélange of legislation across the region, coupled with congressional failure to allocate special funds for research, is likely to impede progress in understanding exactly how the Zika virus does, or doesn’t, afflict fetuses and newborns. For example, state legislatures in Florida, Arizona, Ohio, and Indiana have all banned fetal tissue research, which effectively makes it illegal to conduct investigative autopsies on aborted, miscarried, or stillborn fetuses that may have Zika damage. Texas legally permits study on only miscarried fetuses.

Just before Easter vacation, Florida Gov. Rick Scott signed legislation that bans the use of aborted fetal material for any type of research. Given the likelihood that Florida will be the first state to experience locally acquired Zika, the American Public Health Association is worried that this will delay research, thereby imperiling other states. According to the Guttmacher Institute, five states had complete bans on fetal tissue research before the Florida law was signed, and eight required written consent from the mother for the fetus’s tissue to be examined. In late March, Rep. Marsha Blackburn (R-Tenn.) announced that a special House committee investigating Planned Parenthood will subpoena the names of all scientists doing research that uses fetal tissue. Such a step, House Democrats say, will terrify would-be Zika researchers.

States also differ widely in their interpretation of the legality of pregnancy termination due to the likely malformation of the fetus. Focusing on later-term abortions, when sonograms might reveal microcephaly, or yet-to-be-developed tests could provide parents with Zika-relevant neuro-diagnostic information, a patchwork of laws exist nationally. Forty-three states prohibit abortion either in the third trimester or after the point at which the fetus might be viable outside the womb (typically, 20 to 24 weeks post-fertilization) for any reason other than protection of the life or health of the mother.

Prior to the late-term cutoffs legislating abortions, over the past few years several states have outlawed performance of abortion at any stage for reasons of genetic malformation, and it is unclear how such laws might apply to nongenetic conditions such as abnormalities due to infection like Zika. In 2013, North Dakota outlawed all pregnancy termination for fetal abnormalities, including those likely to result in a baby’s death within the first months post-birth. Last year, Indiana followed suit. The Ohio state legislature passed similar law in 2015, but it awaits the signature of presidential candidate Gov. John Kasich. To date, no member of Congress elected on an anti-abortion ticket has publicly committed to backing exceptions in the case of Zika infection.

And now, Zika is lapping at our shores, already threatening to sicken hundreds of thousands of Puerto Rico residents, according to the CDC. The U.S. commonwealth is struggling to control a disease that is known to be transmitted by mosquito bites, from mother to child in utero and through sexual intercourse: Other rare modes of transmission might also exist but aren’t known at this time.

The bankrupt U.S. territory is struggling for cash and strategies to control aggressive mosquitoes. In order to minimize sexual transmission of the virus, the government has imposed cost controls on condoms, asked women to delay pregnancies, and executed every form of mosquito control it can afford. The Puerto Rican experience is a cautionary tale to states that are routinely infested with Aedes aegypti or albopictus mosquitoes, species known to carry Zika in South America and Puerto Rico.

But there is increasing concern among experts that the control failures seen across Latin America may mean that in fact a broader range of mosquito species are carrying and transmitting the virus than was previous estimated. In particular, many fret that Culex mosquitoes may also be vectors, which would be very bad news for North America because Culex mosquitoes can be found all over the United States and Canada, even in areas that are snowbound for months out of the year. The ubiquitous presence of Culex, which are native to the Americas and well-adapted to feed on a wide range of indigenous birds, animals, and people, is the key reason West Nile virus control has proved impossible and the virus has taken hold in most of the United States. Brazilian scientists have found infected Culex in that country and believe it can transmit Zika. A small but vocal minority of scientists are now asking whether the entire World Health Organization Zika-control strategy is falsely resting on control of an overly narrow range of mosquito species. As I predicted in January, Zika could become a permanent feature of the North American public health landscape, carried by Culex, in the absence of bold control measures.

Temperatures are rising, both on North American thermometers and in U.S. politics. As cherry blossoms bloom and robins build their nests, the first mosquitoes are coming out of their winter hibernations in the country’s southernmost states. Partisan politics are overheated in election years. With each day of bickering between the political parties on Capitol Hill and in legislatures and Boards of Supervisors’ chambers across America, the advantage moves to the insects.

The easiest time to wipe out mosquitoes is during the spring — right now — before they have an opportunity to lay larvae and reproduce. Come June, across much of North America, the easy options must yield to far more labor-intensive, expensive efforts. And by the time July rolls around, it’s every DEET-slathered, mosquito-repellent-spraying man, woman, and child for his or herself, doing what each one can to swat the bugs before they bite.

Given the baffling range of financing states are supplying for mosquito control across the United States, the challenging fetal research restrictions and pregnancy termination options state by state, the unfolding crisis in Puerto Rico, and the distinct possibility that Zika could take hold in indigenous Culex mosquitoes, congressional inaction is astounding. Come August, America’s peak mosquito season, political leaders may find themselves hard-pressed to explain why their particular jurisdiction had no money to spend on mosquito abatement in the spring, why research funds for development and mass production of Zika tests weren’t forthcoming, and what options pregnant women may have if a third-trimester sonogram reveals fetal microcephaly.

This White House is undertaking measures that the Executive Branch can execute without congressional approval: accelerating CDC activities, coordinating information on Zika for use by state governments, and convening a national summit in Washington on April 1. Congressional leadership continues to oppose any consideration of Zika-specific federal budgeting. And as collegiate Spring Breakers frolic in Florida, the state has counted 75 Zika cases so far — all acquired while traveling outside the United States or through sexual transmission. With little money at the state level, and a patchwork of capacities for mosquito control in its localities, Florida is counting on citizens to call its Zika hotline with insect tips.

Photo credit: MARIO TAMA/Getty Images

Clarification, April 19, 2016: After this article’s publication, Christopher Miller, press secretary of the NYC Department of Health and Mental Hygiene, provided the following statement regarding the city’s plan for mosquito control. “The Health Department projected budget for mosquito control is $3.4 million in fiscal year 2016, and this year the city is committing an additional $3.1 million to our mosquito-abatement program to account for Zika preparedness. We project the agency will spend more than $5 million in additional funds for vector-related disease surveillance, management, and control in fiscal year 2017, and up to $20 million over the next 3 years.”

Since this article’s publication, the U.S. Census Bureau released a new population estimate for New York City of 8.5 million, up from 7.5 million. The story has been updated to reflect that change.

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