Zika: A multifaceted response

In the last few months the Zika virus has swept from obscurity to the forefront of global discussion. Predominantly present in South American Nations but now seeing reports of cases in the United States and France, it is thought to have infected over 1.5 million people in Brazil alone. 80% of carriers are unlikely to display symptoms, and those that do only experience mild ones such as fever or conjunctivitis. However, despite these seemingly minor effects the World Health Organisation has declared the virus an International Health emergency due to its suspected link with birth defects.

Whilst causal links to these defects are not formally proven, the Brazilian Health Ministry issued a warning in November last year due to a rapid increase in Microcephaly in new-borns from infected mothers. Microcephaly is a birth defect that that leaves new-borns with undersized craniums due to underdevelopment of the brain during pregnancy. Those with the condition face a variety of possible problems for the rest of their life, such as development delay, intellectual disability and physical inabilities. The number of reported cases in Brazil 2015 sky rocketed from an average of 163 cases per year to over 4,000, with many of the mother’s carrying the Zika virus. This circumstantial evidence alone was described ‘worrisome” by the WHO’s Director General and has motivated a global response in anticipation of an estimated global spread to 3-4 million people by January 2017.

Zika’s impact cannot be combatted best only through the lens of a public health approach. Like most outbreaks of this type, its causation and remedy comes from various cross cutting policy areas. Whilst the UN has implemented action across various agencies, the short-term responses of various Latin American governments have failed to tackle the intensified impact the virus has upon women and those under the poverty line.

Governments from various affected countries such as Colombia, Ecuador and Panama have advised women to avoid becoming pregnant for roughly 6- 8 months in an attempt to reduce the number of new-borns affected whilst research on the virus’s risks is still young. El Salvador’s Deputy Health Minister, Eduardo Espinoza, has even urged women to delay pregnancies for a whole two years. These time frames are not only arbitrarily selected, as the virus’ global research leader, the Butantan Institute, has claimed that a Zika vaccine won’t become available for an estimated 3 to 5 years, but the request itself reflects a short-sighted contradiction with national policy.

Many of the nations advising delayed pregnancies fail to provide easy access to contraception, sex education or, in necessary cases, abortion. El Salvador in particular denies access to abortion under any circumstances including rape or danger to the mother or fetus. 95% of abortions carried out in Latin America already take place under unsafe conditions, and the renewed sense of desperation for fear of being unable to provide the necessary care for a child with Microcephaly has caused rights campaigners to speculate that these numbers will only increase. This not only puts the health of scores of women at risk, but sees them possibly face legal consequences. The UN’s own High Commissioner for Human Rights, Cecile Puilly, has criticized this contradiction of policy and advice, saying “it’s not enough for health officials to tell women to postpone pregnancy without also offering them contraceptives and termination as a final solution”.

The advice is also characterised by naïvety. Without providing access to contraceptive methods, the implied expectation of abstinence as the main means of delaying pregnancy is unrealistic. An estimated 56% of pregnancies in Latin America and the Caribbean are already unplanned, and many pregnancies (especially in teens), are a “product of sexual violence and abuse” according to the US-based Center for Reproductive Rights.
Even in countries where there is access to contraception, distribution centres are often physically inaccessible to those living in areas of poverty. Such areas also tend to be at higher risk of Zika infection due to the prevalence of stagnant water pools which the Aedes Albopictus Mosquito (the main carrier of the virus) thrive in. Their prevalence is largely due to lack of infrastructural piping in poorer areas, such as towns in Brazil’s North East. This means not only are many in poverty left without access to contraceptives to prevent pregnancy and Zika’s possible impact, but are also more likely to contract the virus itself in the first place.

The United Nation’s various departments have sought to target not only immediate healthcare provision for those affected but also these more far-reaching issues to curb the spread and impact of Zika. The United Nations Population Fund (UNFPA) has placed renewed emphasis onto its existing mandates and is working to increase access to contraceptives and family planning information under the WHO’s ‘Global Zika Strategic Response Framework and Joint Operations plan’ in Latin American and Caribbean Nations. Under this plan the emphasis of education will be on both men and women, shifting the onus of responsibility and opening the narrative about sexual health. The Food and Agriculture Organization of the United Nations (UNFOA) is also targeting vector management by spreading household advice on how to clean and store water containers in high risk areas.

Government’s cannot tell people who are sitting in a sinking boat and can’t swim that the best way to stay safe is to avoid going swimming. The options are to provide them with a life jacket, teach them how to or, better yet, repair the boat. The United Nations and its cross agency response, which targets sexual education, contraception provisions and vector control, has done well to capture this notion. Now, with the Zika outbreak forcing sexual health and abortion policies into the international spotlight, it is time for Latin American Governments to do the same.

by Grace Carroll


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