If you read the latest news reports on the Zika epidemic, you might notice they bear a striking resemblance to weather reports during hurricane season. Authorities from local, national and international organizations are gearing up for a public health emergency. Damage assessments from areas that have already been hit have yet to be finalized, and forecasters are uncertain where it will make landfall next. Governments are beginning to issue travel advisories and implement protective measures, and the entire world is tuned in to see what happens next.
The latest biological hurricane comes on the heels of the 2015 Ebola crisis, but as epidemics go, Zika and Ebola couldn't be more different. The Zika virus is primarily mosquito borne and usually causes only vague, flu-like symptoms, while Ebola is transmitted through bodily fluids and kills one of every two people infected. Given the two diseases' completely distinctive natures, a simple review of the lessons learned from the Ebola outbreak will not suffice for this year's Zika threat.
Epidemics: A Persistent Threat
Thanks to recent advancements in genetics, scientists are able to understand more every day about how intricately interwoven the human body is with the world of microbes. From birth, microorganisms of all shapes and sizes come to inhabit our bodies. Each human presents something of a gigantic, porous, barrier reef, with every nook and cranny teeming with different combinations of life forms. After millions of years of coevolution, these creatures have adapted to live in relative harmony with the human body. And, as we increasingly discover, more microorganisms than expected are necessary for us to lead healthy lives.
The latest biological hurricane comes on the heels of the 2015 Ebola crisis, but as epidemics go, Zika and Ebola couldn't be more different.
But since 1000 B.C., the delicate balance between man and microbe has been increasingly jeopardized, mainly thanks to the explosion of the human population. In 426 B.C., the first plague on record occurred in Athens: Higher population densities made it easier for diseases to pass from person to person. At the same time, underdeveloped immunological responses weakened the body's natural lines of defense. Ecological changes spurred by man's ascent began to grossly outpace the rate at which the human genome could adapt to microbial changes. As a result, epidemics — much like hurricanes — are here to stay. All we can do is try to stay ahead of them in our unending game of catch up.
A quick look at mankind's history immediately reveals the geopolitical impact that a simple mosquito-borne disease can have. Consider malaria: Some claim the single-cell parasite the Anopheles mosquito spreads may have played a key role in bringing down the great Roman Empire. Others say it halted the Europeans' incursion into Africa. Today, yellow fever, dengue, chikungunya and the West Nile virus afflict the world's mosquito-heavy regions, amid the abandonment of mosquito control programs and neglected vaccination drives.
So, Zika is merely the latest in a streak of African viruses to migrate to the Americas, where it has raged in Brazil since April of last year. The Brazilian outbreak mirrors a pattern seen in Africa, where the Zika virus seemed to follow chikungunya outbreaks. (Chikungunya reared its head again in 2005, infecting over a million people in India in 2006, but it did not make landfall in South America until 2013.)
Generally, Zika epidemics play out without much drama; in the disease's acute phase, its victims typically suffer only a mild form of the flu, much as patients with dengue fever do. In the 60 years since the Zika virus was first identified, there have been no reports of serious complications except in French Polynesia, where an outbreak coincided with a higher rate of Guillain-Barre syndrome. (The bodies of patients with Guillain-Barre syndrome mistakenly attack their own nerves, temporarily paralyzing many different muscle groups.)
However, alongside the Zika outbreak in Brazil, cases of microcephaly — a congenital neurodevelopment disorder that results in a flat skull housing a brain too small — have increased twenty-fold. I have experienced first-hand how devastating this kind of birth can be to a mother and family; the baby born during my first solo delivery in a rural dispensary at the rim of the Algerian desert had this disorder. Though no definitive proof has yet emerged to confirm a causal relationship between the Zika virus and the rare microcephaly malformation, the spike in cases in Brazil is enough circumstantial evidence to put the world on alert, so long as its reaction is proportional to the threat.
Location Affects Geopolitical Impact
In his book Guns, Germs and Steel: The Fates of Human Societies, Jared Diamond explores the geographic factors that play a role in determining the consequences epidemics have on a continental scale. He argues that differences in the size and shape of Europe versus the Americas gave invading Europeans a higher degree of immunity than native American populations, many of which succumbed to diseases brought to the region by colonists. According to Diamond, Europe's particular geography and location fostered higher population densities and a wider variety of infectious organisms, which naturally boosted Europeans' immunological defenses over time.
Geopolitical factors are also at work, albeit on a smaller scale, in the case of the Zika virus. A study by Eduardo J. Gomez recently showed how certain political differences among the BRICS countries (Brazil, Russia, India, China and South Africa) have led to different approaches to preventive health care. Though all of these countries, at least until the present economic crisis, shared an ambition to develop their economies and prosper from growing international trade, their leaders have shown varying levels of desire to conform to international health standards and to work with civil society. For example, Russia and South Africa have rarely felt the need to comply with international standards. This is a stance made clear by former South African President Thabo Mbeki's infamous rejection of the scientific community's warnings about AIDS, or by Russia's general neglect of its tuberculosis crisis until it threatened to weaken the Russian armed forces. By contrast, Brazil, India and China — though also prominent regional powers — have shown an eagerness to garner prestige within the international community, which on its own predisposes them to aligning with global health norms.
However, the degree to which each country's leadership has a social contract with civil society plays an important role in how effective health care prevention programs are. The Soviet-style programs in Russia, the legacy of apartheid in South Africa, the caste culture in India, and the top-down organization of political power in China have robbed these countries of the social setting needed to encourage a constructive quid pro quo between leaders with ambitions for their countries and citizens concerned with the health of themselves and their families.
By comparison, then, Brazil is perhaps the best positioned of the BRICS economies to handle a Zika outbreak. Since the mid-1990s, Brazil has responded to the World Health Organization's calls for action by expanding its national tuberculosis program and mandating the nationwide distribution of the antiretroviral medication used to treat AIDS. Brazil has sought to build on the historical relationship between social movements and the state-founded response to epidemics from a century earlier. Brazilian politicians, keen to be seen as supporting the contract between the government and its people, voted to increase funding for disease prevention. As a result, Brazil's health monitoring system appears to be in working order. And it was clearly sensitive enough to detect the simultaneous peak in microcephaly and the Zika virus. In hindsight, then, perhaps we were lucky that of all the tropical regions in the world, Brazil is where Zika took hold in such a pernicious way.
The Importance of a Proportional Response
Still, at a time when commentators are calling for the cancelation of the 2016 Summer Olympics in Rio de Janeiro, reminders to keep the Zika threat in perspective may fall on deaf ears. Officials are often prone to implementing reactive measures in times of emotional turmoil. After its infamous role in the Ebola debacle, the World Health Organization is doing everything it can to avoid appearing complacent; its Emergency Committee has issued an official international warning and made its usual urgent appeals for more resources. At the local level, instinctual empathy for newborns with severe malformations tends to override the persuasive power of statistics.
Still, at a time when commentators are calling for the cancelation of the 2016 Summer Olympics in Rio de Janeiro, reminders to keep the Zika threat in perspective may fall on deaf ears.
But given what we know so far, the psychological impact of the Zika scare may outsize its direct economic costs to society. Furthermore, the emergency funds that will inexorably be drawn on to fight the disease can only be spent once, sapping the resources countries have available to prepare for other, more important plights.
To put the Zika outbreak in perspective, let us compare it with fetal alcohol syndrome (FAS), the most severe form of infant malformation caused by the overconsumption of alcohol. FAS occurs in roughly one-third of babies born to alcoholic mothers. And its yearly incidence rate in the United States alone is about 10 times that of the peak incidence rate of microcephaly in Brazil; in South Africa, it is almost 100 times higher. The causes of the FAS "epidemic" are clear, and the preventive measures are obvious. One would think that the high incidence rate would merit an ongoing global intervention. Given the lifetime cost per child, estimated to top $2 million, prevention would likely carry a healthy return on investments. And yet according to today's statistics, attempts to contain FAS are having little impact on the problem.
Therefore, it is important not to become mesmerized by the whirlwind of status reports and expert opinions that have accompanied the Zika outbreak. Instead, we should give to Zika what is Zika's, and direct the rest of our emotional energy toward the more persistent and more costly health issues that too often outlast the world's attention span.