Over the last six months, many Americans have become aware of a virus they had never heard about before. Now, headlines about Zika are in the news every day and political leaders are talking about how to respond to the spread of the disease. President Obama has asked for emergency funds to deal with this public health outbreak. Congress has still not acted upon this request. Regardless of how this funding battle plays out, federal policymakers must provide funding soon, before Zika threatens the lives and health of people throughout our nation.

Zika has evolved into a virus that we now know causes birth defects such as microcephaly, or literally “small head.” It is the first time we know of a mosquito-borne virus that causes birth defects. Zika is also linked to a number of neurological disorders, such as Guillain-Barré Syndrome. We also know it can even be contracted sexually.  

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The public health workforce is often invisible to the public and yet works diligently every day to ensure that systems are in place to prevent and respond to illnesses and other emerging diseases. Zika – and diseases before it such as Ebola – provide yet another opportunity for public health to do what it does best behind the scenes to protect our communities. Nearly all cases of Zika in Texas and across the nation have been associated with persons who have traveled to or from a place where the Aedesmosquito transmits the virus. However, as the director of a local health department that has a long history of robust mosquito surveillance and control as well as expertise in human health surveillance and beyond, I believe it is not a matter of “if” but rather “when” Zika will be transmitted by Aedes mosquitoes in our country.  And, unfortunately when this happens, “we cannot simply spray our way out of this situation.”  

The primary mosquito that transmits Zika, Aedes aegypti, prefers to live in or near our homes, low to the ground, and close to humans. It is also usually a day-time biter and bites multiple individuals, resulting in a higher transmission risk and an increased ability to infect others. The behavior of this mosquito and its urbanization have resulted in the rapid and wide geographic spread of Zika throughout Central and South America. We believe Zika can forge a similar unprecedented path once it arrives in the U.S. southern states. So now is the time to prepare.

Even our mosquito control program in Harris County, Texas – as renowned as it is nationally and well-supported as it is locally – is 98% funded by local tax-payer dollars and is primarily designed to protect against the Culex mosquito that can transmit St. Louis Encephalitis and West Nile virus. The shift to addressing Aedesand Zika, in addition to other mosquito-borne diseases such as dengue and Chikungunya requires an additional layer of surveillance, trapping, field work, testing equipment, and personnel resources. These resources are needed to identify Zika in our Aedes mosquito population as well as work with our healthcare system to identify and care for individuals diagnosed with Zika.

Further, while Zika funding is aimed at significantly boosting dollars that would go to vaccine development, academic research, and even for global response, we must not forget that much of the “boots-on-the-ground” efforts in the United States will fall on the shoulders of state and ultimately local public health departments. Public health work happens at the grassroots level: conducting public awareness and education campaigns; communicating with various populations and in multiple languages; engaging in robust mosquito disease surveillance as well as epidemiology and human surveillance; and providing the workforce to go out every day to set traps and collect mosquitoes for testing. Most importantly in the fight against Zika, public health is tasked with engaging our local communities to eliminate sources of mosquito breeding and to raise awareness on the use of personal protective measures to prevent the all-important mosquito bite.

Congress must not wait for the first cases of babies with microcephaly in the United States due to exposure to locally-acquired Zika. By then, it will be too late. Adequate funding must be available immediately at the levels required to respond to Zika and in turn to assure the health and the well-being of people and the communities within which they live. Our communities expect it. Our families expect it. Our children expect it. And most importantly, it is the right thing to do.


Dr. Shah is executive director of Harris County Public Health (Houston, Texas) and on the Board of Directors of the National Association of County and City Health Officials (NACCHO).