There have been more than 18,000 cases of Zika in the U.S. and its territories. Congress, however, still hasn’t allocated one penny of funding to fight the disease.
Researchers are using what resources they have to better understand both the virus—how it enters the body, how it behaves, and how it’s passed to other people—and the mosquitoes that carry it. While there are many paths to conquering the growing threat, one thing experts agree on is a need for more public education on how to avoid infection. What people will learn is that the seemingly mundane task of making sure your backyard doesn’t have standing water is the most critical component of this strategy.
“The Aedes aegypti,” one of the primary delivery devices of the Zika virus, “is both the easiest and most difficult mosquito to control,” says Joe Conlon, a spokesperson for the American Mosquito Control Association and a retired U.S. Navy entomologist with global experience in mosquito control. “It breeds exclusively in man-made habitats.” Get rid of the habitats, says Conlon, get rid of the mosquito. No mosquito, no Zika.
But eradicating those habitats—containers of standing water that could be as large and purposeful as a water tank or as small and accidental as a Frisbee—is no easy feat. And researchers who have tried to do just that in other countries combating dengue, another virus carried by A. aegypti, say it’s not just a tough battle, but very possibly a losing one.
Fighting bugs with smarts
The virus causes fever, rash, and joint pain in adults that lasts days or weeks, but it can have dire consequences for the unborn children of pregnant women. An anti-Zika educational campaign would have three main messages, says Dan Markowski, vice president of Vector Disease Control International, a mosquito fighting service based in Little Rock, Ark., that has worked with individual cities and the U.S. Centers for Disease Control to help fight the spread of Zika.
“Drain, dress, and DEET,” he says.
First, drain the containers where the mosquitoes live. Then, dress in clothes with long sleeves so they can’t bite you. Finally, spray on the DEET (diethyltoluamide). And of course, other experts add, don't forget the condoms—Zika can be transmitted sexually as well.
While covering up, spraying, and using condoms will protect individuals, draining standing water can protect your neighbors as well. One thing people may not realize is that these mosquitoes don’t flit here and there from town to town: The typical A. aegypti doesn’t go very far—in its lifetime, it probably won’t even cross the street. So getting rid of all the standing water in a block of backyards could seriously limit the exposure of everyone living on your street.
“If we could clean all those containers of standing water,” Markowski says, “it could have a great impact on the incidence of the disease.”
Combined with other preventative measures, public health experts say such steps could have a real impact. “I don’t think the change of a behavior is going to mean you completely eliminate all risk,” says Susan Krenn, executive director at Johns Hopkins Center for Communication Programs. “But I do think it can reduce risk.”
People don’t care
Whether or not such an education campaign can work relies on factors other than funding. First, people have to actually care about Zika. And right now, not enough do: A Washington Post-ABC News poll in June found that two-thirds of Americans were “not too” worried about the disease, or “not at all” worried.
“The effects of Zika seem to be so distant from individuals that it’s challenging to educate and implement public health strategies,” says Dr. Kiran Thakur, a specialist in neuroinfectious diseases at Columbia University and the Zika editor for Medscape Consult, a WebMD-run forum where doctors can ask questions and exchange clinical advice.
In her practice, Thakur sees a lot of travel-related Zika cases. She’s noticed that, while women know they should wear long sleeves and bug spray while in areas with Zika transmission, many don’t follow these instructions every day. Plus, she says, many are also unaware the disease can be transmitted sexually, or that standing water is the mosquito’s breeding ground. “Emptying standing water from flower pots, small pools in your backyard,” she says, “those things seem to be less known.”
The best way to educate the public is also a matter of debate. “Always, the most effective way is going to depend on the behaviors you’re trying to change,” Krenn says. Any national campaign must also gauge who the audience is, how they receive information, and what they consider to be a credible source. Only then can it begin to focus on what that messaging will look like. But experts disagree on each of those prerequisites.
Krenn says awareness of the general public is important, but adds that some populations need the message more than others, especially when funds are limited. “The focus should be on women who are at risk of becoming pregnant or who are pregnant,” she says, given the risk of birth defects for unborn babies of infected mothers. “That’s where I would invest my money if the money was short.”
Just say no
Because mosquitoes carry more diseases than just Zika, Markowski calls for a large-scale, national effort, referring to the “Just Say No” campaign against drugs in the 1980s as a good example. “It would have to be pretty big,” he says. “You have to shock people into reacting.”
Conlon wants to see a federally funded national campaign that stigmatizes standing water, pointing to similar efforts that have made other behaviors socially unacceptable.
For disseminating information, Krenn says television and social media could be the most effective in the U.S., even though in developing countries radio spots and house-to-house visits are more impactful. But Markowski disagrees. In his experience, he says, the most effective tool is getting out in the public and talking to people, whether it’s by setting up a table at someone else’s fair or creating a Mosquito Awareness Day. “Talk to people one on one and explain what they need to do,” he says. “To me, that’s more effective than Facebook posts.”
For now, the CDC is doing what it can to spread the message, including providing audience-specific Zika Communication Toolkits and launching a comprehensive campaign in Puerto Rico targeting pregnant women. But without more money, don’t expect to see a national Zika prevention commercial on television or Mosquito Awareness Day soon.
The dengue lesson
Even in an ideal world, with endless Zika funding and the time and resources to persuade every single American to spill out every last container of standing water, the A. aegypti would most likely still find a way to breed.
Dana Focks is one of the leading global experts on the bug and has led efforts in a number of cities to eradicate dengue by controlling the mosquito population. After a major initiative in Yogyakarta, Indonesia, to destroy the city’s most productive containers, the mosquitoes continued to flourish. He presented his findings in December 2011 at a symposium hosted by the American Society of Tropical Medicine & Hygiene in a session he led entitled, “A Nail in the Coffin: Time for New Approaches to Dengue Vector Control.”
“There was cryptic breeding,” he says, “underground breeding that we could never find.” Despite the World Health Organization’s support for his project and plenty of funding, the approach simply didn’t work. The “WHO has been running around saying clean up the containers, and it’s never produced dengue control anywhere in the world.”
“What we need is a vaccine,” he says. Scientists are certainly trying, but that requires funding, too.