Why Zika Needs An Ounce of Prevention

Giraldo Carratala, an inspector with the Miami- Dade County mosquito control unit, looks through a fence into the back yard of a home while doing a routine inspection earlier this month. Giraldo Carratala, an inspector with the Miami- Dade County mosquito control unit, looks through a fence into the back yard of a home while doing a routine inspection earlier this month. Lynne Sladky/AP

In all likelihood, Congress was never all that close to finding a way to push past factional politics and fund efforts to fight Zika. Lawmakers have adjourned for recess after a failure to find common ground on the issue, and as my colleague Nora Kelly notes, the divide comes mostly over the same political issues that hold up any congressional productivity. Despite ample evidence of the virus’s severity, Republicans balk at the idea of expanding public-health funding and executive spending, or they propose “poison-pill” measures—such as raiding the Ebola fund—as counterproductive solutions. Congress seems relatively lukewarm about finding a solution, but that inactivity could cost it much more in the long run. 

Aside from the besieged citizens in Puerto Rico, the impacts of Zika are distant concerns for most Americans. So far, it has been a disease that has mostly affected poor people in Latin American countries, a virus that—like Ebola—embodies the stereotype of developing-world plagues. It has feasted on favelas in Brazil and has been carried through the Caribbean, enabled by environments where mosquitoes thrive and public health is under-equipped, prompting travel warnings from the Centers for Disease Control for pregnant women or couples who may be considering conceiving, but not much in the way of concern for health in the country more broadly. Congress’s lack of concern about Zika mirrors that of the public. In a recent Kaiser Family Foundation tracking poll, only 16 percent of all people are very worried about Zika as a public-health threat.

There is a great deal of risk to these attitudes, however, and Congress knows well from delayed action on previous epidemics that the American health-care system makes rapid responses to established diseases difficult and costly. The chances of spreading Zika have been low during the winter, as the Aedes aegypti mosquitoes that spread it are largely limited to breeding clusters in south Florida and southern Texas. But the virus’s range and ability to find footholds in those states will undoubtedly intensify as the summer comes. My colleague Adrienne LaFrance has identified the virus’s potential to “rival Hurricane Katrina” as a socioeconomic burden with wide distribution in poor mosquito-ridden areas across the country, especially in summer outbreaks. Summer months are also prime months for international travel—and this summer will involve particularly high rates of travel to and from Brazil, the site of the 2016 summer Olympics and the epicenter of the epidemic. From a public-health perspective, these factors alone justify a real investment in prevention, research, and mosquito control, but legislators are not public-health officials.

If a public-health argument does not persuade Congress, perhaps a cost argument might. The World Bank estimates that Zika might cost around .06 percent of the GDP of Latin American countries, with a grand total of $3.5 billion for the region. However, that estimation is optimistic, as it assumes a wide-scale, coordinated response and a possible vaccination to be developed. Brazil’s struggles to properly address its outbreak cast doubt on these assumptions, as does the lack of interest from rich countries in building coalitions to address the virus. Ongoing vaccine development is inherently risky, and researchers have been concerned with the risk of inoculation being connected to Guillain–Barré syndrome, a rare paralytic disease. All things considered, there is a real possibility of Zika becoming locally endemic—and a seasonal cost burden—throughout Latin America and the Caribbean.

That possibility informs the economic reality for the United States. Even assuming a much lower impact on GDP at one-tenth of the percentage cost to Latin America, Zika could cost the United States a billion dollars in a year, a number that should serve as a baseline and does not factor in long-term costs of care for people who develop Guillain–Barré or microcephalic infants. If the fight against the virus aids in the collapse of Puerto Rico’s economy and a humanitarian crisis there, the costs of rescuing the territory—already in the billions and rising—will skyrocket. The country-wide economic recovery is fragile, and a significant public-health scare could scale back some gains in productivity and unemployment. Specifically, especially as farm labor enters high-productivity months, mosquito-borne diseases among laborers have been shown to reduce profits. For areas like California—already embroiled in costly intersections of public health, labor, water, and agricultural issues—Zika is a problem that just makes everything else worse.

The long-term externalities are globally significant as well. Establishing endemic Zika clusters on both sides of the equator will make it that much harder to fight, as the virus could hide in one hemisphere and come back in the other with inverted seasonality. It is not a stretch to imagine Zika costing the United States billions over decades, especially as the climate becomes more and more amenable to mosquitoes. A similar example can be found in the costs of West Nile Virus, another mosquito-borne disease that has established itself in the country.

These projections all assume that Zika remains a relatively mild virus that is mostly spread by mosquitoes and confers a fairly rare chance of microcephaly for infants conceived within a somewhat narrow window from infection. If any of these things change—and viruses are well-known for mutation—and Zika becomes more severe, leads to Guillain–Barré or microcephaly more often, or increases the rate of interpersonal transmission by sexual contact or other means, the public-health and economic implications are serious. Every day that the country waits to implement a rigorous preemptive strike against Zika (and aid those suffering directly in Puerto Rico) is another step toward a potential public-health and fiscal disaster. But playing politics is much easier when the disaster hasn’t happened yet.

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