Dear Washington: The Time to Prepare for Zika Has Come and Gone
Act now, or bear the blame for the virus's devastating effects.
Dear presidential candidates, senators, and congressional representatives:
Dear presidential candidates, senators, and congressional representatives:
Get your butts back to Washington immediately.
The time you’ve had to get a preparedness plan in order but have wasted twiddling thumbs and shifting around budgets to make it look like you were taking the threat of Zika seriously is over. So, go behind closed doors to negotiate if the glare of the media and prying eyes of your constituencies is uncomfortable — I don’t care. But know this: The goal is to prevent a major pandemic from sweeping the nation, the births of thousands of Zika-deformed and neurologically impaired babies, to forestall adult cases of Guillain-Barré syndrome, eye problems, and other rare disorders caused by Zika infection, as well as to prevent the devastation of other public health and safety programs in cities, counties, and states across America as they shift resources from one account to another.
If I were the referee for your negotiations — which ought to commence this week in light of Florida’s local mosquito-carried Zika cases — the allowable focus for partisan debate between the houses of Congress and the White House would be extremely narrow. I would rule everything from the future of Planned Parenthood to pesticide regulations, shifting money from Ebola responses and existing federal and state accounts, the budget deficit, national debt — all off the table. The one, and only, topic open for debate? How much new money must be allocated on an emergency basis to meet the needs of the nation’s scientists, public health leaders, hospitals, maternal health providers, and mosquito and environmental health experts in order to limit the number of Americans who fall ill to Zika, pass the virus sexually to their partners or in utero to their fetuses, miscarry, or are born with neurological deficits and deformations.
Your mandate starting now: Show me the money.
Partisan bickering about the lives of American babies is unconscionable. This is no time for grandstanding. As of Aug. 1, 161 days have elapsed since the White House requested $1.9 billion in emergency funds for Zika, met by various counterproposals from the House and Senate Republican leaderships. That’s 161 days during which researchers and public health experts have struggled, with no new resources of any kind, to figure out how the virus works, find ways to control it, work on vaccines and treatments, and develop effective mosquito-control tactics.
If, politicians, you truly care about the right of every baby to a healthy life, you have no excuses, no rationales, and, yes, you will pay a price in upcoming elections if you fail. I don’t personally care whether you are Democrat or Republican, and neither will the voters living in regions that get slammed by the virus. The only question pregnant women, worried that they might be carrying a severely deformed child, will be asking is this: What did you do in the first week of August, once Zika was in Floridian mosquitoes, to protect my family from the newly arrived birth-defect-causing virus?
And here’s the thing: Americans aren’t stupid and won’t be hornswoggled. According to recent polls, most people in the United States know what Zika is and were concerned about it well before the virus infected Floridian Aedes aegypti mosquitoes. We have, as a nation, watched the epidemic reach our shores in slow motion, starting in mid-2015 when the Brazilian government issued its first announcements about babies born with microcephaly — literally, squashed brains and misshapen skulls. Six months ago, on Feb. 1, the World Health Organization (WHO) declared a global Zika emergency. Americans looked south throughout our winter as the infected mosquitoes popped up across most of South America, Central America, and the Caribbean and as cases of microcephaly and other tragic disorders mounted.
Shortly after Florida’s governor, Rick Scott, announced on Friday that four people in Miami had contracted Zika from local mosquitoes, the nation’s most venerated epidemic scientist held his own press conference in Washington. Anthony Fauci, who has directed the National Institute of Allergy and Infectious Diseases for more than 30 years, soberly said that “we are watching a pandemic in process” and that he was “almost certain that we will see more cases across the United States.” On Monday, Scott confirmed 10 more homegrown cases of Zika in Florida.
And the rob-Peter-to-pay-Paul approach Fauci’s agency has had to use for 161 days in order to conduct Zika research in the absence of emergency funding? “We are getting to the point very, very soon that we are going to run out of the money that we are borrowing from ourselves,” Fauci said in a Friday briefing at the Bipartisan Policy Center in Washington.
You should pay heed to Fauci — this man has a long and storied track record on epidemics. He has been running the NIAID longer than anybody has ever directed any of the nation’s major scientific institutions, starting in the early 1980s when a mysterious form of cancer and lung disease was cropping up among gay men — that turned out to be the dawn of the AIDS pandemic. And it was Fauci who warned Presidents Ronald Reagan, George H. W. Bush, and Bill Clinton that all three presidencies were failing to grasp the scope, severity, and urgency of AIDS. The first president to take Fauci seriously was George W. Bush, who created the multibillion-dollar President’s Emergency Plan for AIDS Relief (PEPFAR), which today is credited with dramatic reductions in HIV deaths all over the world.
But the Brooklyn-born scientist who has given his entire career to public service wasn’t just right about HIV; Fauci has correctly advised five presidents and hundreds of members of Congress about SARS in China, the 2009 bird flu and H1N1 influenza outbreaks, multidrug-resistant tuberculosis in New York, the dangers of the anthrax spores mailed to media and politicians in 2001, hantavirus in New Mexico, Ebola in West Africa and in Dallas — the list is so long it would fill pages.
So, American politicians, ignore me if you wish, shrug off the Centers for Disease Control and Prevention if you are so inclined, poo-poo the WHO, and turn your back on the Floridian governor if you can — but open your ears when Tony Fauci speaks.
On June 6, Fauci warned Francis Collins, the director of the National Institutes of Health, and his advisors that Zika poses a threat unlike any we have previously faced. Research funds were urgently needed, Fauci said, to understand how the once-benign and largely ignored mosquito virus transformed into the greatest threat to pregnant women and their babies since the 1964 rubella epidemic. In the pre-vaccine 1960s, rubella, or German measles, was the primary cause of child blindness, deafness, miscarriage, and other congenital abnormalities in the United States. But Zika is actually worse than rubella because the virus feeds on neural progenitor cells, turning the would-be baby brain cells into Zika virus production factories and eventually burning the cells out. One by one, a nerve cell destined to control hearing, or vision, or memory, or balance, is killed off. The thousands of microcephalic babies born so far in South America and the Caribbean have had so many of their brain cells devoured by voracious viruses that there literally was insufficient mass to, as happens in normal fetal development, push the cranial bone upward to form a nice round skull.
But we have only begun to appreciate the range of neurological disorders Zika is inflicting on a generation of babies, because most of the afflicted are still too young to have reached key developmental markers, such as the ability to hold their head upright, capacity to recognize their parents, and the full range of hearing, walking, talking, and learning. Taking a page from cytomegalovirus (CMV), which can also be passed in utero from mother to fetus, only a small percentage suffer microcephaly and obvious deformities, while far larger numbers experience a vast array of learning deficits and brain dysfunctions that only become apparent later in childhood. Many psychiatric disorders that may be overlooked in infancy or early childhood are now known to stem from maternal viral infections damaging fetal brain development, including CMV, Borna disease virus, influenza linked to schizophrenia, herpes simplex virus (type 1) linked to bipolar disorders, and a long list of other fetal infections causing everything from autism-like syndromes to acute depression long after the infected child’s birth.
Enough is enough, politicians. Pay heed to Puerto Rico, which, though it is a territory not a state, is inhabited by U.S. citizens. For months, Fauci, the CDC, and Puerto Rican health authorities have warned that a potentially catastrophic Zika epidemic was coming and pleaded for resources to address the crisis. The numbers of infected, symptomatic, and, yes, microcephalic babies were negligible for many weeks. But now, the word “crisis” is literally applicable to the island’s situation, as Zika diagnoses are soaring and the CDC on Friday declared, “The situation in Puerto Rico warrants urgent, comprehensive action to protect pregnant women.”
A month ago, Puerto Rico’s mosquito problems and Zika spread seemed manageable — just as Florida’s now appear — but today, despite aggressive mosquito-control efforts and public education campaigns, the population is beset by viral threat, with the number of diagnosed cases (which represent less than 20 percent of actual infections, most of which are asymptomatic) increasing by 1 percent per week. Consider this: A 1 percent increase in the first week of June may seem trivial, but by the first week of August, it is a 9 percent increase, by Labor Day a 14 percent jump, and soon tens of thousands of Puerto Ricans will have been symptomatically infected with Zika, suffering from symptoms and side effects including mild fevers and rashes, paralysis, miscarriage, and giving birth to deformed babies.
And this entire explosive spread in Puerto Rico will transpire before Congress returns to Capitol Hill from summer recess.
Come on, congressional representatives and senators: This is a pandemic in progress. Reconvene immediately, negotiate a deal, focus on financing, and get the job — your job — done. Failure to do so will mean that every Zika-related birth defect, miscarriage, and paralysis case will be your fault.
Photo credit: TIM SLOAN/AFP/Getty Images
Laurie Garrett is a columnist at Foreign Policy, a former senior fellow for global health at the Council on Foreign Relations, and a Pulitzer Prize-winning science writer. Twitter: @Laurie_Garrett
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