Zika: a challenge for both WHO and EU?

23 Feb 2016 - 08:34
Source: Flickr / Presidencia de la República Dominicana

The Zika virus, which is transmitted by the same mosquito that is the vector for the transmission of yellow fever, dengue fever and chikungunya, is currently spreading rapidly throughout Latin America.

Although the virus generally leads to little more than mild flu-like symptoms, the World Health Organisation (WHO) is considerably worried about the outbreak spreading to other continents.

This is primarily due to the fact that there are strong pointers to the infection being the cause of microcephaly in unborn children, where the pregnant mother is infected. This is a disorder which impairs neurological development. There has been an abnormal increase in the number of children born with microcephaly in north-east Brazil. There may also be a link between infection with the Zika virus and the prevalence of Guillain-Barré syndrome, a condition which attacks the nervous system and can lead to temporary or permanent muscle weakness or paralysis, and which can also occur in other infectious diseases.

What measures has the WHO taken?
The WHO declared the Zika outbreak to be a Public Health Emergency of International Concern (PHEIC) on 1 February.  This means that Zika is now defined as 'an extraordinary event that constitutes a public health threat to other parts of the world due to the international spread of the disease and may well require a coordinated international response'. The WHO is thus stating that investigations into the link between mosquito bites and the neurological complications must be given priority in order for a vaccine to be developed. The WHO is also prescribing a number of measures in an attempt to protect people against mosquito bites and is calling for mosquito populations to be controlled by fogging and the elimination of mosquito breeding sites.

Is WHO the most suitable organisation to eradicate and/or manage the virus in your opinion?
The WHO has declared a PHEIC on several occasions in the past decade. This happened during the Mexican flu epidemic (H1N1) in 2009 and with the revival of the polio virus (after it had been all but eradicated) in 2014.

The Ebola outbreak in West-Africa in 2014, which was declared a PHEIC in August 2014, stands out as an emergency that received a lot of media attention. The WHO was criticised for a slow, uncoordinated and below-par response to containment of the Ebola epidemic. This criticism will, undoubtedly, have been one of the factors leading to the WHO's current, more pro-active stance.

The so-called International Health Regulations (IHR), which govern control of infectious diseases, state, among other things, that countries must report outbreaks of infectious diseases quickly and take appropriate action. However, countries may not impose trade restrictions or shut their borders in response to an epidemic that looks like spreading internationally. One of the central problems of the IHR is that many (generally poor) countries are not in a position to identify and tackle epidemics.

A further large-scale problem is that (generally more affluent) member states have invested too little in the WHO, leading to a large proportion of the staff in the crisis-response department being made redundant in 2013. Furthermore, the WHO has a very de-centralised structure, and not all regional offices function at the same level, one of the reasons impeding an effective response to the Ebola outbreak. It is unclear whether this is or will also be a problem in terms of the Zika outbreak.

The more affluent member states are faced with a recurrence of the same problem. Recent reports argue that there is a significant need for investment in how epidemics are tackled at international level. The WHO is still seen as the most appropriate multi-lateral organisation to coordinate and lead this process. There is also a proposal for the creation of a 'UN high level council on global public health crises'.

What must the EU do now, in your view, to eradicate the virus in southern Europe?
Most of the member states in Europe have a well-functioning public health system. The tiger mosquito, which carries the virus, can be found in certain areas of Portugal, Italy and Greece in summer.

In the past few years this has, indeed, led to a number of small outbreaks of dengue fever. It can thus not be ruled out that the Zika virus will spread to south Europe. The European Centre for Disease Prevention and Control (ECDC) and the Health Security Committee of the European Union are ready to lend support to countries facing a potential outbreak.

The Netherlands, the current holder of the European Union presidency, is devoting attention to safeguarding public health, the most important area being how to tackle resistance to antibiotics. The Netherlands is also taking a pioneering role to strengthen European capacity via the One Health approach. Another EU key focus area is to make the WHO 'fit for purpose' by increasing funding from European member states and by technical support. Germany has taken a strong stance on this within G7 talks.