WHO Declares Zika a 'Public Health Emergency'
The World Health Organization on Monday declared the sharp rise in birth defects suspected to be tied to the Zika virus a "public health emergency of international concern" – one requiring a coordinated effort to understand the nature of the epidemic and how to curb its explosive spread.
WHO Director General Margaret Chan, eager to restore her organization's credibility following its widely criticized response to Ebola, issued the declaration at the urging of an 18-member scientific advisory committee, which met behind closed doors.
The committee decided that the close correlation between the spread of Zika virus and congenital brain malformations in Brazil and French Polynesia – along with the probability that birth defects will also occur in other countries – represents a global emergency warranting action.
"It's an extraordinary public health threat," Chan said.
Chan's decision marks just the fourth time the WHO has invoked a global public health emergency in its history. Previous declarations came in 2009 during the H1N1 swine flu pandemic, and twice in 2014 with a resurgence of polio in Syria and the Ebola crisis in West Africa.
For decades, Zika has been linked only with mild symptoms, such as fever, rash and joint pain. But the new declaration reflects the strong suspicion that what was once regarded as a benign infection is also associated with birth defects when women are infected early in pregnancy, as well as a neurological ailment in adults called Guillain-Barre syndrome, which can cause paralysis.
"I think WHO was right to raise the global alarm," says Lawrence Gostin, faculty director of the O'Neill Institute for National & Global Health Law at Georgetown University, and the author of recent commentary in the Journal of the American Medical Association calling upon Chan to act. "Zika is a classic example of a global health emergency. It's never been seen before, [and] most of the world is susceptible to the virus."
At least 25 countries and territories, mostly in the Americas and Caribbean, are reporting local transmission of the Zika virus, which may infect up to 4 million people during the next year. Public health experts say there's a high likelihood that the mosquito-borne virus will spread to other regions as well. It is transmitted from person to person by the Aedes aegypti mosquito, which is ubiquitous in many countries around the world.
The worst complications range from a congenital brain abnormality called microcephaly – which causes a small cranium and brain in newborns – to paralysis in adults. So far, these conditions are believed to have occurred only in a small number of affected countries in connection with the recent Zika outbreak. Microcephaly has only been found in babies in Brazil, beginning last year, and in French Polynesia in 2014. Brazil, French Polynesia and El Salvador have also reported clusters of Guillain-Barre syndrome in adults. But officials say it is likely the complications will occur in other countries where the virus is circulating.
The emergency committee, convened by Chan under international health regulations, called for intensive mosquito control efforts and enhanced, standardized surveillance for microcephaly and other neurological complications of the Zika virus in countries where transmission is occurring. Members also called for additional research to prove that Zika causes microcephaly and Guillain-Barre syndrome.
The close correlation between viral infection and the neurological complications is suggestive, as is evidence of infection in pregnant women, their affected newborns and people with paralysis. Only longer-term studies will provide proof, says David L. Heymann, the WHO's assistant director-general for health security and environment.
Dr. Jorge Kalil, director of the Butantan Institute, one of Brazil’s leading vaccine and research production centers, welcomed the WHO declaration as a critical step. “It will certainly enhance international collaboration and data gathering on Zika infection,” Kalil says. He urged the organization to back up the declaration with research funds and to make it easier for Brazilian scientists to obtain patient samples and other materials needed for research.
Kalil also says the declaration will likely end foot-dragging by local officials and “push Brazilian authorities to act.”
Gostin was critical of Chan’s declaration, however, saying that she failed to provide any specifics of how the organization plans to fund these studies or carry out other control measures. Battling a new epidemic so soon after Ebola will be a challenge, he says.
"WHO resources are depleted, and there's no action plan for how they're going to get into these countries, declare war on the mosquito population, help with surveillance and above all carry out the research needed to get to the bottom of the link between Zika and microcephaly," he says.
Unlike the U.S. Centers for Disease Control and Prevention, the WHO did not issue any new travel guidance for pregnant women who might visit Zika-affected countries.
"That was a significant omission," Gostin says. "If we're going to protect these women, they need to avoid travel." On Monday, following Chan's declaration, the CDC added American Samoa, Costa Rica, Curacao, and Nicaragua to its list of places with travel alerts. The agency had previously recommended that pregnant women consider postponing travel to South America, Central America, the Caribbean, Mexico and Cape Verde.
Failing to act decisively, Gostin warns, would be immoral. The biggest challenge is figuring out how to advise women who live in Zika-affected regions, Gostin says. Many of these women are young and very poor, and are being advised to avoid pregnancy. But birth control is tightly restricted in many Latin American countries, he says.
"It's a complete contradiction," he says. "You tell women they can't get pregnant, but don't give them the means to avoid it."
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