Photographer: Mario Tama/Getty Images

The World Can’t Even Find Pocket Change to Fight Zika

Inertia reigns in the face of an epidemic, and not just in Washington.

More than five months after U.S. President Barack Obama requested $1.9 billion to fight the Zika epidemic, members of Congress are going home to July 4 barbecues without approving a spending bill. While Washington’s dysfunction is predictable given the current electoral climate, less noticed has been the global inertia facing efforts to combat the mosquito-borne disease.

The World Health Organization has only $7.9 million dedicated to fight Zika, which is spreading in 61 countries and blamed for more than 1,600 serious birth defects, mostly in Brazil. The planet has never seen a mosquito-borne virus that causes microcephaly, resulting in babies born with small heads and brain damage. In the Americas, Zika is racing through populations that have never been exposed before and thus haven't developed any natural immunity.

To put the lack of funding in perspective: The three-month Olympic torch relay that ends with the start of the games in Rio de Janeiro this summer, sponsored by the Coca-Cola Co., Nissan Motor Co., and Brazil's Banco Bradesco SA, has a bigger budget than the WHO’s strategy to fight Zika over two years. 

“Activities proposed by WHO and its partners have been underfunded to date, and without sufficient funding the response is likely not to succeed,” the WHO wrote in its Zika Strategic Response Plan.

One lesson from the Ebola epidemic in West Africa is that the world must respond swiftly to outbreaks, said Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control. “We need the world to surge, and we can’t wait for all the politics and all the issues to get worked out,” Schuchat said in an interview earlier this month. While health authorities are responding with the money they have, no surge has materialized. “It’s a little bit stalled right now, in terms of that real response.”

The WHO, part of the United Nations, sought $25 million for the first six months of the crisis, which it declared an international public health emergency on Feb. 1. Governments and philanthropies have pledged just $4.1 million to date, with donations from Australia, Canada, Japan, New Zealand, Norway, and the Bill & Melinda Gates Foundation. The U.S., U.K., and major powers of the European Union haven’t contributed at all.

To try to make up for the shortfall, the WHO borrowed another $3.8 million from an emergency fund established after the Ebola epidemic—a fund set up because of the delay in funding and inadequate global response to that crisis. The Geneva-based organization said it expects to require another $122 million for Zika through the end of next year. “We have to shuffle funds and staff from other programs to be able to support the response,” WHO spokeswoman Nyka Alexander said in an e-mail. “This is not sustainable long term.”

Zika Virus: What You Need to Know in Two Minutes

The situation shows that the one global health authority charged with battling epidemics isn’t equipped for the challenge, said Lawrence Gostin, professor of global health law at Georgetown Law.

“If you look at its record in response to diseases, whether it’s yellow fever, Ebola, now Zika, you’ll find that they constantly underestimate the amount that it will cost, and then are unable to mobilize the funding for the small amounts that they even said they need,” Gostin said. The WHO “doesn’t have the political clout or leadership to actually get donors and particularly countries to invest in ongoing crises.” 

The world consistently underinvests in preparation for outbreaks, resulting in real economic harm, he said. In January, a commission on global health security estimated that the world should invest $4.5 billion a year for pandemic preparedness to avert after-the-fact costs that can reach 10 times that sum. "We don’t perceive a health crisis until it’s actually here, in which case it’s too late," said Gostin, who sat on the commission.

The World Bank made $150 million in financing available to Zika-affected countries in February. That followed the development bank’s calculation that the short-term economic costs of Zika would be about $3.5 billion, an estimate “predicated on a swift, well-coordinated international response.”

Such a response hasn't come to pass. A separate mechanism called the UN Zika Response Multi-Partner Trust Fund was announced May 6 to provide “a rapid, flexible and accountable platform to support a coordinated response from the UN system and partners,” according to the organization. So far, the fund remains empty.

The gridlock in Washington and impotence in Geneva show the world is working without an insurance policy for unexpected infectious outbreaks. There’s no pot of money to pay for surveillance, testing, public education, mosquito control, vaccine research and development, and medical care.

The stalled flow of funds has real consequences. “We’re simply just going to see more disease,” said Oscar Alleyne, senior adviser for public health programs at the National Association of County & City Health Officials. “With more disease we’re going to see a lot more children with negative birth outcomes.”

In the U.S. and its territories so far, four infants have been born with birth defects linked to Zika, and malformations were evident in another five lost pregnancies as of mid-June, according to the CDC. The virus has been circulating widely in Puerto Rico, while the mainland has so far recorded infections only in people who traveled abroad or in their partners. Almost 500 women with evidence of Zika infection during pregnancy are being monitored in the U.S.

The delay between when a woman is infected and when the virus’s worst consequences become evident at delivery may be contributing to the sense of complacency. “It’s terrible what’s going on in Brazil. We’re starting to see the increase in other countries now, as the months go by,” said the CDC’s Schuchat. “Puerto Rico’s going to be really bad several months from now, because we already know so many people have been infected.”

In America, a new poll of 1,200 adults by the Kaiser Family Foundation found that majorities of Democrats, Republicans, and independents want the U.S. to invest more in Zika research and prevention. And while three-quarters agree the disease poses a major threat to pregnant women, only 13 percent said it threatens them personally. That frame of mind, both in Washington and across the country, could be adding to the problem.

“People can very easily compartmentalize things. ‘I’m not a pregnant woman, I’m not of childbearing age, so why do I need to worry about this?’” said Umair Shah, executive director of Harris County Public Health & Environmental Services in Texas. The agency is in charge of mosquito control for an area bigger than Rhode Island and home to 4.3 million people, including the city of Houston.  

Shah said he’d like to add 20 to 30 people to his team of 60 fighting mosquitoes during the summer season. It’s hard to predict what kind of resources he’d need if Zika begins spreading locally, which he expects to happen somewhere in the U.S.: “It’s not an ‘if’ but a ‘when.'"

For most of the western hemisphere, the question of when Zika will arrive has already been answered. But just like Washington, much of the rest of the world doesn't seem to be listening.

(Updates number of countries with Zika transmission in second paragraph.)
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