Zika is here — why is Congress not?

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In his weekly address Saturday, President Obama again chided Congress for failing to take necessary action against the Zika virus epidemic. The U.S. legislature remains on a seven-week break, even as mosquitoes carrying the disease have begun spreading in the continental United States. No matter how the drama plays out, the President is right — Zika is a threat to national security.


In the United States and its territories, more than 11,000 people have been infected, causing illness for some and tragedy for the many parents of babies lost or severely harmed by the virus. More than half a year after Zika hit U.S. territorial soil, the minimal necessary federal funding to respond is still stuck in political gridlock.


{mosads}Infectious disease is not a threat that can be shortchanged. If this had been a military attack against the United States, no matter the scale, Congress would be in session – but to fight a new epidemic, one that has already taken several lives, why will they not act?

We are unprepared

The Zika crisis is just the latest outbreak to remind Americans of the inadequate resources in this country for fighting infectious diseases, and the unpreparedness of most county and state agencies. There are now locally acquired Zika virus cases in Florida and three territories, and as researchers learn more about the virus, the scale of the threat becomes even more ominous.


It was in 2015 that the medical community in Brazil started connecting Zika virus infection with Guillain-Barré syndrome, and later with microcephaly. Zika virus is not new. It was first identified in 1947 in a rhesus monkey in Uganda, but there are now at least 50 countries and territories across the globe with active local transmission. There is no vaccine yet available, despite work in progress. The virus has been making its way across the globe since its identification – the recent Brazil outbreak appeared just one year after the illness reached the western hemisphere.

As doctors began identifying the virus spreading from mosquitoes to mothers to their unborn children, a disease that had only rarely caused health concern suddenly emerged as a major threat.  Like most infectious disease, Zika virus is not restricted to geography, traveling with human carriers and even transmitted on occasion sexually, present as long as six months in semen.

The impacts cannot be ignored. During pregnancy, the virus can cause abnormal fetal brain development, as well as miscarriage, and in newborns vision, hearing deficits, and impaired growth and development. Because the Zika virus disease remains poorly understood, the full range of impacts is unknown.

Compounding the crisis is the simple fact that Zika virus’s threat to pregnancy is not unique. There is little awareness or research support for other infectious diseases that are managed in the medical community every day but rarely make it to the popular press. For example, cytomegalovirus (CMV) infection affects 1 in 150 U.S. births, about 30,000 children each year. Of those children, 20 percent develop neurological problems from infection resulting in deafness and in some developmental delay.

Similar risk comes from congenital syphilis, an illness that has become the poster child for what can go wrong when Congress fails to respond to an emerging infection. The defunding of local public health programs in 2008—via reduced funding to the Centers for Disease Control and Prevention (CDC), which supports state and local health departments—and a collapse in state government support for local infectious disease programs have let this completely preventable and curable illness re-emerge.  In a pattern too often repeated, as governments cut services following a drop in the economy, infectious disease prevention was left wanting, leading to unacceptable loss of life.


National support must reach local resources


The last 2 decades saw many mistakes with investment into infectious disease research and response – those mistakes must not be repeated. Initially following 9/11 and the bioterrorism response, agencies were created to tackle public health crises both natural and malevolent, and many of us in the medical and public health community were hopeful that such efforts would be transformational. Perhaps, we thought, the new attention would lead to the modernization of U.S. public health. That is not what we saw.

Instead, a significant amount of those funds went to U.S. contractors to develop and implement interventions of questionable value such as sniffing devices on street corners, devices that have not resulted in a day-to-day improvement in public health. Additional funds were set aside for highly specialized responses, like stockpiled antibiotics and anthrax or smallpox vaccines, but those, too, had no sustainable impact. Emerging from the 9/11 tragedy, the allocation of resources was a completely missed opportunity. We should not allow the awareness brought by the growing Zika epidemic to also pass us by.

When resources are made available for a more appropriate response, they are effective. At the federal level, from the CDC to the Food and Drug Administration (FDA), some of the world’s leading experts on infectious disease are constantly vigilant for new threats and countermeasures. Just Friday, the FDA made national recommendations for blood products in response to the spread of Zika, and the continued uncertainty over its spread. The FDA recommended that “all states and U.S. territories screen individual units of donated Whole Blood and blood components with a blood screening test”, an approach that is appropriate, necessary and targeted. But the uncertainty remains — with continued Congressional delay, the necessary resources to speed the delivery of vaccines and other long-term solutions are just not there.  


Federal agencies awaiting Congressional funds are equally critical to the local Zika response, particularly in the face of limited, or even non-existent, infectious disease resources at the county and city level. Local public health officials must invite the CDC to get involved to mount an effective response, but those resources grow strained as cases spread from region to region. It’s akin to asking the FBI to perform local policing efforts, and then expecting that need to fade away in between crises. The problem is exacerbated by the limited local public health infrastructure. In many counties, the public health officer is a part-time employee or consultant – akin to a part-time sheriff who’s the only trained first responder.


Many counties along the U.S. Gulf Coast, the ones most likely to experience the Zika epidemic, have also not had mosquito-control programs in decades. It’s not just a problem in that region — where I live in Los Angeles, I see cases of West Nile virus all summer and into the fall, and prevention is similarly inadequate.


All of those challenges are in addition to a widespread lack of focus on interventions to maintain public health: monitoring, surveillance, epidemiology, case finding, awareness, education and close collaboration with medical providers. For too many local jurisdictions, those activities just don’t exist anymore.


Investments that must be made


It is critical that this country’s decision makers, from Congress to counties, take the long view towards infectious diseases, an approach that is sustainable. Every few years, a new pathogen emerges — SARS, drug-resistant TB, MRSA, Ebola. Those events should no longer be a surprise. The United States must move from a reactive response to a proactive one. In recent decades, careful national planning and preparation has been replaced by “hoping for the best”, a philosophy that does not work.


Even as Zika virus is screened from the blood supply, federal agencies must also have the resources to look at other infections that are problematic in our country, and the required responses. CMV, Epstein–Barr virus, herpes viruses are associated not only with adult disease but also with complications in pregnancy and poor health outcomes in immune-suppressed patients. The usual pushback is cost, but there’s a great cost of doing nothing.


In the near term, Congress should provide the FDA with the resources to create a task force of internal and external experts to consider infections that are still not screened in the blood supply. When one looks at the list of currently screened infectious diseases, it’s pretty small, and smaller than that of nations in Europe and elsewhere. West Nile virus was recently added, HIV was added 30 years ago, but too many remain unaddressed. The illnesses remain a threat, whether acknowledged or not.


Perhaps the Zika crisis will finally catalyze a sustained, well-funded effort to rebuild local public health infrastructure and the federal agency efforts that support it. Members of Congress look at the total Zika response budget and seem shell shocked, not realizing the direct impact of the funds. If a military assault on the United States required a $2 billion shift in funds, the threat would be addressed. With the potential for an increased number of babies being born with severe defects, or pregnancies terminated, it is hard to not see the situation as equivalent to a military attack.


There is almost certainly another infectious disease waiting to emerge, gradually developing and spreading while we focus our attention on the latest publicity-spawning threat. If the nation does not improve its overall response to infectious disease from the ground up, then this next threat will again catch us by surprise and wreak havoc before we effectively respond. When it does, one can only hope that Congress won’t be on vacation.


Dr. Jeffrey Klausner is a professor of medicine in the division of infectious diseases and in the Program in Global Health at the David Geffen School of Medicine at UCLA. 

The views expressed by contributors are their own and not the views of The Hill.

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