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Restoring a Medical-Ethical Balance to Zika

by admin on May 18, 2016 No comments
mosquito on zika virus

mosquito on zika virus

By: Dr. Brent Schillinger, Guest Contributor

Zika is the new Ebola.  The media is going crazy with scary stories.  On just one typical day Fox news reported “Brain damage in Zika is far worse than Expected,” CNN announced “South Korea unveils anti-Zika uniforms for the Rio Olympics,” and in the Washington Post, “First Zika virus-related death reported in US in Puerto Rico.”  While there may be some cause for real concern doctors have an opportunity to carry out their ethical obligation to their patients to help balance things out.

The Zika virus was first detected in mosquitoes from the Zika Forest in Uganda in 1947.  Until 2007 there were hardly any cases of human transmission ever reported.  Then an outbreak occurred on Yap Island of Micronesia, which infected nearly three-fourths of the island’s population.  Zika didn’t get much attention then.   Nearly 80 percent of the people who had been bitten by mosquitoes and contracted the virus showed no symptoms and not one person died.

So why all the excitement these days about Zika?  The story starts in Brazil where the nation has been grappling with a growing surge in medical reports of microcephaly.  This is a rare condition in which babies are born with small heads and often it is associated with brain damage as well.   The reports of the microcephaly first appeared in regions of Brazil simultaneously stricken with Zika virus.   Always looking for a cause and effect, public health officials immediately suggested the Zika virus as the culprit.

The Zika to microcephaly link is highly plausible but it is not quite proven. A New York Times article in early February pointed out the Ministry of Health had reported 4,783 cases since October of 2015.  In going back to recheck these reported cases, only 404 babies actually have been confirmed with microcephaly.  Of the 404, only 17 tested positive for the Zika virus.  A report in the World Health Organization’s bulletin points out that a spike in microcephaly cases actually began in 2012, long before reports of a Zika epidemic emerged in 2014.   As is often the case with global health epidemics, all of these numbers have caused confusion.

The link between Zika and microcephaly is not entirely clear, yet media outlets since the beginning of this current “epidemic” have been hyping this relationship as if it were unequivocally proven.  Physicians, more often than not, go along with the popular public outrage, which helps to thrust their patients into a panic mode.  The resulting anxiety leads to a great deal of behavior change on personal and societal levels.

Suddenly people all over are afraid to travel to any locale where there might be mosquitoes, let alone any country in Central or South America. Many of these regions are among the same ones where one can be bitten and contract a much more serious disease such as malaria, dengue, or yellow fever, but it’s the Zika that they are freaking out about.  Some of the major airlines are now offering refunds on tickets already purchased to these locations.  Brazil is being pressured to postpone the Olympic Games scheduled for this summer.   Even in the United States domestic travelers have expressed concern about taking vacations in Florida because they’ve heard we have some mosquitoes here.

In an attempt to avoid any chance of microcephaly, health ministries in Ecuador, Colombia and El Salvador are urging women to postpone pregnancy for the time being.  Since abstinence and rhythm aren’t always effective, even Pope Francis has suggested that he is open to the idea of artificial birth control as a means of trying to combat the spread of the Zika virus.  Even President Obama has asked Congress for $1.8 billion in emergency funding to fight Zika.  That money would go toward expanding programs that control mosquitoes as well as research into vaccines.  That is a lot of money given that the Zika to microcephaly link is still conjecture and this is a disease that no one dies from.

Speaking of dollars, it might be helpful to follow the Zika research money trail.  Recently I heard an interview on NPR with Danny Vellom, senior director of innovation at Sanofi Pasteur, which has a global team working on a Zika vaccine.  When asked by the reporter if there was a motivation to make a profit off of this “epidemic of the moment,” Vellom responded, “No, it doesn’t work that way.  There’s not a profit motive because we’re really looking to provide the vaccine to governments, to non-governmental agencies.  Funding will probably come from all over, from Path and from Gates and from government to make sure that everyone gets it.”  So I guess when private foundation or taxpayer dollars pay for the vaccine, and we know they are not giving the vaccine away for free, Sanofi doesn’t call it a profit.  And I wonder if behind the scenes the pharmaceutical companies are somehow funding at least part of the media blitz on the dangers of Zika.

I’m not an infectious disease nor public health specialist so perhaps I have a different bias from these experts.  Nevertheless I think that physicians need to be a bit more cautious before jumping blindly on the Zika bandwagon.  Our patients rely on our advice and counseling.  We shouldn’t ignore a potential serious problem but we shouldn’t add more anxiety into an arena already filled with uncertainties.

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