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| EDITORIAL |
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| Year : 2016 | Volume
: 4
| Issue : 2 | Page : 87-89 |
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Better than before and yet no quick fix: Zika virus outbreak and its containment efforts
Habida Elachola1, Samba Sow2, Jaffar A Al-Tawfiq3, Ziad A Memish4
1 Atlanta, GA, USA
2 Director, Center for Vaccine Development, Vaccine Research Institute, Bamako, Mali
3 Department of Specialty Medicine, Johns Hopkins Aramco Healthcare, Dhahran, KSA; Indiana University School of Medicine, Indianapolis, IN, USA,
4 Ministry of Health, College of Medicine, Alfaisal University, Riyadh, KSA
| Date of Web Publication | 7-Apr-2016 |
Correspondence Address:
Ziad A Memish
Ministry of Health and College of Medicine, Alfaisal University, Riyadh
KSA
DOI: 10.4103/1658-600X.179824
How to cite this article:
Elachola H, Sow S, Al-Tawfiq JA, Memish ZA. Better than before and yet no quick fix: Zika virus outbreak and its containment efforts. J Health Spec 2016;4:87-9 |
How to cite this URL:
Elachola H, Sow S, Al-Tawfiq JA, Memish ZA. Better than before and yet no quick fix: Zika virus outbreak and its containment efforts. J Health Spec [serial online] 2016 [cited 2016 Apr 23];4:87-9. Available from: http://www.thejhs.org/text.asp?2016/4/2/87/179824 |
Over the last century, protection of human health started as an individual's profession to become state-owned enterprises such as ministries of health and currently with significant international stakeholders, beyond state infrastructure. This transition brought along respective implications that crosscuts global politics, trade, economy, travel and religion. Severe acute respiratory syndrome (SARS) 2002, swine flu (pH1N1) 2009, Middle-East respiratory syndrome (MERS) 2012 and Ebola 2014 serve as the zenith of impetus for this transition. Zika virus outbreak is the 4th declared public health emergency of international concern (PHEIC) in human history, its elevation to global prominence has been relatively swift and the calls for prevention and control are extensive.[1],[2] The response to the Zika virus epidemic appears to be benefiting from (1) the recent alertness and preparedness for Ebola outbreak, (2) the knowledge base on Zika vectors and (3) the availability of global frameworks and initiatives.
The emergence of public fears about Zika virus coincided with the end of the epidemic phase of the West Africa Ebola crisis. With sufficient global public and policy attention, Ebola did generate the development of, or at least stimulate debates and discourse on, public health alert and preparedness framework in most countries.[3] In fact, even in the least developed countries of West Africa, Emergency Operations Centres have emerged and operationalised. In most countries around the world, rudimentary public health preparedness strategy documents have been developed, International Health Regulations (IHR) focal points designated, flow of surveillance information streamlined or electronic data transfer systems established, laboratory infrastructure empowered and the concept of epidemiology workforce has emerged. Some epidemiology short courses have been provided to senior staff. The political leadership is not detached from the need for control of emerging diseases. Although the preparedness landscape is no way perfect in most countries of the world, it is a topic in the political and legislative agenda providing a friendly platform to establish control measures. Each one of the recent disease outbreaks of global visibility did contribute to the introduction, development or implementation of various elements needed for disease control and containment in varying capacity in several countries. These elements range from better understanding and coordination of border control measures and international passenger flow dynamics (advisories to avoid travel by people at risk, border screening during SARS, H1N1 and Ebola outbreaks), innovative logistical methods to move laboratory specimens from remote areas to urban centres (such as the motorbike riders in Liberia who transported blood specimens during the Ebola crisis), production and distribution logistics of personal protection materials (such as hand sanitisers during Ebola and face masks during SARS), community and religious engagements (fatwa on dead body management among Muslims in West Africa) and community mitigation strategies (intermittent days of curfew or movement restrictions in Sierra Leone). Although the utility of these measures may not be proven, and not all measures are applicable to all PHEICs, they offer valuable lessons and boost our collective confidence in addressing pandemics.
Unlike in the case of MERS, we are fortunate to have sufficient information on the natural history of the Zika virus vectors making it possible to predict the geographic spread of the disease.[4] The mosquitoes Aedes aegypti and Aedes albopictus are known vectors of dengue virus, yellow fever virus and chikungunya virus. Modelling strategies that used data related to the occurrence of the vectors and environmental correlates resulted in the prediction of the occurrence of these two vectors around the globe. The availability of such maps is valuable to prioritise surveillance activities to further understand the vector-virus transmission. These studies may also identify areas of persistent Aedes spp. to proactively prevent vector establishment. In relation to the development of Zika virus vaccine, the nearly 20-year experience in dengue virus vaccine development gives a jump start to Zika virus vaccine development. As such, the world has expertise, technologies and commercial infrastructure complemented by an early declaration of the Zika virus as a PHEIC. Moreover, global concern on delayed action and other irregularities on recent PHEIC's have prompted the scientific community and policy makers to take efforts to minimise administrative delays in the approval process of vaccine and research studies and engage in early debates on access to and pricing of potential products so that developing country populations have equal access to them at fair prices.
However, beyond human compassion, eagerness and systems, the most critical element in moving science and vaccine efforts is the matching financial landscape. On January 22, 2016, the U.S. National Institute of Allergy and Infectious Diseases issued a call to the research community indicating the availability of Zika research dollars.[5] Precipitated by past experiences, politics is catching up with science in a proactive mode. Soon after the PHEIC declaration on Zika, the U.S. Presidency requested the U.S. Congress for $1.8 billion in emergency funds for Zika that will partially fund vaccine development. Zika virus research prioritisation consultations were held independently by the U.S. National Academy of Sciences (February 16), U.S. Pan American Health Organization (March 1) and World Health Organization (WHO) (March 7-9). WHO released WHO's Global Emergency Response Plan on March 3, 2016, that includes budgetary forecasts ($55 million).[1] Unlike past PHEICs, the Zika specific surge in funding is superimposed on ongoing infusion of research and program dollars on vaccine development, preparedness, epidemic monitoring capacity and epidemiology and laboratory workforce development. These include the unique 2014 Global Health Security Agenda that has a generic non-disease-specific focus, Ebola funding and several predecessor initiatives such as the U.S. Presidential Malaria Initiative, U.S. Pandemic Influenza Initiative, President's Emergency Plan for AIDS Relief, Global Alliance for Vaccines and Immunisation, and philanthropic initiatives including Bill and Melinda Gates Foundation, as well as Google Foundation and various bilateral funding initiatives by Organization for Economic Cooperation and Development countries with developing countries.
The global community today is indeed better prepared to respond to pandemics such as the Zika virus than during the past 3 PHEICs. Yet, each PHEIC is uniquely different, and each one brings distinct challenges. For Zika, we know the vector, but not the full spectrum of pathophysiology of the virus in humans.[5],[6] Intense epidemiologic intelligence activities are needed to understand its transmission, infection, replication, virulence and other viral survival skills. Conducting basic research on the virus including animal models that mimic Zika virus infection in people can complement the knowledge base on both treatment and prevention efforts. Development and marketing of sensitive, specific and rapid clinical diagnostic tests are critical to help interrupt the transmission using many control measures. Given the availability of dengue vaccine, evaluating the relative immune responses to Zika and other flaviviruses in the same geographical areas may identify some opportunities for combined vaccine use. While focused efforts on vaccines should be a long-term goal, there is a more imminent need for broad spectrum antiviral agents. Until antivirals and vaccines become available, our urgent priority is to rely on mosquito control and mosquito bite prevention without the mosquitos developing resistance to chemical approaches within environmentally and ecologically sound parameters. Innovative approaches on mosquito control such as the feasibility of carefully orchestrated release of genetically modified mosquitoes that will neutralise the reproductive cycle of harmful mosquitoes have received significant attention.
We are indeed at a stage of a fishing expedition with respect to understanding the natural history of Zika virus infection in humans and development of vector control measures, antivirals and vaccines. Although the potential Zika virus-microcephaly link propelled the current interest in Zika, unlike Ebola and its 60% fatality rate, 80% of Zika infections are asymptomatic and percentage of neurological or adverse pregnancy outcomes is much smaller.[5] This is not a reason for complacency. While asymptomatic nature of Zika infection offers unsuspecting and undetectable opportunity for the virus to spread extensively, it offers sufficient time and opportunity to better understand the trajectory of the Zika virus infection before it becomes more virulent. For now, making use of our collective capacities in its full extent to contain outbreaks should be our priority, so that we limit the transmission of Zika virus to more countries. We have confidence in our control efforts that even mass gatherings have been conducted amidst ongoing outbreak(s) without leading to additional infections (Maoulood mass gathering in Mali during Ebola, Hajj in KSA during 2009 pH1N1 and 2012 MERS).
| References | |  |
| 1. | WHO. Zika Outbreak: WHO's Global Emergency Response Plan. Available from: http://www.who.int/emergencies/zika-virus/response/en/. [Last accessed on 2016 Feb 03].  |
| 2. | Elachola H, Gozzer E, Zhuo J, Memish ZA. A crucial time for public health preparedness: Zika virus and the 2016 Olympics, Umrah, and Hajj. Lancet 2016;387:630-2. |
| 3. | Heymann DL, Chen L, Takemi K, Fidler DP, Tappero JW, Thomas MJ, et al. Global health security: The wider lessons from the West African Ebola virus disease epidemic. Lancet 2015;385:1884-901. |
| 4. | Kraemer MU, Sinka ME, Duda KA, Mylne AQ, Shearer FM, Barker CM, et al. The global distribution of the arbovirus vectors Aedes aegypti and Ae. albopictus. Elife 2015;4:e08347. |
| 5. | The National Institute of Health. Zika Virus. Available from: http://www.niaid.nih.gov/topics/zika/Pages/default.aspx. [Last accessed on 2016 Mar 10]. |
| 6. | Lucey DR, Gostin LO. The emerging Zika pandemic: Enhancing preparedness. JAMA 2016;315:865-6. |
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