Policy Alert #120 | March 11, 2016

Last month, the World Health Organization (WHO) declared a global public health emergency in response to the outbreak of the Zika virus in Brazil and other Latin American countries. The WHO estimates the virus has spread to 52 countries to date and can infect up to 4 million people by year’s end. While the symptoms of the virus are moderate, it is “strongly suspected” the disease causes brain damage in newborns. In this Policy Alert, we examine commentary from Brazil, China, India, Russia, Japan, and South Korea on the Zika outbreak.

BRAZIL

Brazil has been the country most affected by the Zika outbreak so far. The outbreak coincides with a concurrent political and economic crisis in the country and has catapulted Brazil’s public health capacity into the global spotlight just months before Rio de Janeiro is set to host the Olympic Games.

The Brazilian government has taken increasingly drastic steps to slow the spread of the disease, including deploying 220,000 soldiers along with public health experts to teach Brazilians how to eliminate breeding grounds for mosquitoes.

• President Dilma Rousseff met in late-February with the director of the World Health Organization, Margaret Chan, to discuss Brazil’s efforts so far and strategies for combating the disease as it spreads across the Americas.
• The Zika crisis has emerged amid Brazil’s most severe recession since the Great Depression and an ongoing fiscal consolidation which threatened efforts at combating the virus. On February 19th, the Minister of Planning Valdir Simão and the Secretary of Social Communication Edinho Silva, both promised that budget cuts would not affect Zika fighting efforts, with Simão declaring “there will be no shortage of resources for fighting Zika or Aedes aegypti [the mosquito that carries the virus]”.

Some commentators explored the link between the Zika and the country’s poverty, abortion policies, and upcoming Olympic games.

• Alex Cuadros, an American journalist for Bloomberg based in Brazil, examined the roleinequality has played in the spread of Zika in Brazil. In particular, he noted how not only are wealthier Brazilians better able to protect themselves from the disease by being able to afford basic things like screens on windows and insect repellant, they can access high-quality private healthcare facilities while the poor end up in overwhelmed public hospitals.
• The apparent link between Zika and brain damage in newborns known as microcephaly has reignited the debate over abortion in Brazil, a country with some of the strictest abortion restrictions in the world. Feminist groups in the country have attempted to leverage the possibility of these birth defects to liberalize abortion laws or, at a minimum, carve out a specific exception. However, public opinion remains largely against these moves and some conservative members in Brazil’s Congress have proposed legislation increasing punishments for women receiving abortions.
• With the Olympics coming up in July in Rio de Janeiro, the government emphasized Zika will not affect the event. President Rousseff said “we will achieve, up through the Olympics, a considerable success in exterminating these mosquitoes.”
• According to the BBC, Brazilian health ministry officials believe the relatively cooler, drier winter temperatures during the Olympics will significantly reduce any risk posed by Zika and other mosquito-borne illnesses, such as dengue or chikungunya.

CHINA

As of March 7, a dozen cases of the Zika virus have been reported in China, many after individuals returned from travel to South America. The National Health and Family Planning Commission warned the further “spread of the illness cannot be ruled out in some regions where the mosquito population will increase as the weather warms.”

The Chinese government has tried to alleviate public concerns and demonstrate the situation is under control.

• Li Bin, Chair of National Commission on Health and Family Planning, said China was moving on a campaign to clear public areas of conditions that allow viruses like Zika to flourish. The government also promised quarantines for the infected and urged citizens to declare themselves if they suspect there are symptoms present. There are reports that travel agents in China are warning tourists traveling abroad to be wary of the Zika virus especially during the 2016 Olympics in Rio.
• On the other hand, Dr. Peter Piot, a virologist and Director at the London School of Hygiene and Tropical Medicine, cautioned Taiwan and southern China could see an outbreak of Zika due to the high concentration of the disease-carrying Aedes aegypti mosquito and the warmer season ahead.

Several commentators highlighted China’s contributions to the Zika response and how the crisis fits into Beijing’s overall international strategy.

• Last month, scientists at the Chinese Center for Disease Control and Prevention sequenced the genome of the country’s first imported case of the Zika virus, promising a better understanding of the disease’s variations and developing means to fight it.
• Xi Zhiyong, professor at Sun Yat-sen University, noted China’s role in battling the disease, saying “the technology we have researched and developed can be used to prevent and control all mosquito-borne diseases, including Zika, malaria, dengue, and yellow fever.”
• Xinhua contended international crises such as the spread of the “Zika virus have affirmed the validity of the ‘common destiny’ theory” and support China’s diplomatic effort to “build global community.”

INDIA

The Union Minister for Science and Technology in India, Dr. Harsh Vardhan, said India already has a robust integrated disease surveillance network that will prevent a major outbreak of Zika in the country. Nevertheless, the Indian health ministry reported the “potential for further international spread given the wide geographical distribution of the mosquito vector.” India has been long aware of the Zika virus with studies done as far back as the 1950s with a vial of the pathogen stored at an institute in Pune.

Although there have been no reported cases of the Zika virus in India – according to Health Minister J.P. Nadda – several commentators debated the threat posed to India.

• Dr Shelly Singh, senior consultant, Obstetrics and Gynecology, Primus Hospital, Delhi was optimistic, saying “Zika is not life-threatening like dengue and chikungunya, and it is a self-remitting disease, so – at this point – there is nothing to panic about.”
• At the International Congress on Infectious Diseases held in India earlier this month, Soumiya Swaminathan, director general of the Indian Council of Medical Research, was less concerned about Zika than other infectious diseases in India. This view was echoed by Ramanan Laxminarayan of the Public Health Foundation of India.
• However, Lawrence Madoff of the Department of Public Health at Massachusetts thought India was at risk of Zika due to the frequency of other mosquito-borne diseases such as dengue and chikungunya.
• K.H. Vasudeva Naidu, Microbiology head at Sri Venkateswara Medical College, warned the Rayalaseema region of India could be a “sitting duck” for an outbreak, specifically due to the prevalence of the Aedes Aegypti mosquito that can serve as a vector for disease.

Others narrowed in on what India should do moving forward to prevent an outbreak.

• The WHO reported U.S. government scientists and an Indian biotechnology firm (Bharat Biotech) were “currently front-runners in the race to develop a vaccine” to the virus.
• Vivek Gupta, a Member of Parliament from the Trinamool Congress and editor of the SANMARG newspaper, questioned if the India government was waiting for an outbreak to take place in the country before finally taking steps to act.
• The Indian Medical Association recommended the New Delhi adopt Brazil’s Zika virus awareness model to fight other diseases carried by mosquitoes such as dengue.
• One biotechnology firm based in Maharashtra, GBIT, has been trying to breed genetically modified mosquitoes to slow the growth of diseases such as Zika. Others, however, doubt whether these would serve as a “silver bullet.”
• NK Ganguly, visiting professor at the Policy Centre for Biomedical Research, Translational Health Science, and Technology Institute, called on India to “seize this opportunity to impress upon the various stakeholders the critical role of vaccination as a comprehensive preventive healthcare strategy that may be needed more and more in the years to come.”

RUSSIA

Russia confirmed one Zika infection case. Health Minister Veronika Skvortsova ensured the Zika epidemic “does not threaten” Russia, because the country does not have mosquitoes to spread the disease. The Russian government has taken countermeasures, including development of pilot samples of vaccines which it says “could be very effective in a specific therapy” for the virus.

• Health Minister Skvortsova claimed it is “quite realistic” to create “bio-molecular markers that could be applied for preventive purposes.” She also said, “we believe that the virus danger is being hyperbolized. I do not think that any of the athletes or countries are likely to cancel their trips to the Olympics.”
• Russian Deputy Prime Minister Olga Golodets said the Russian government was discussing with the WHO the implementation of diagnostics of the Zika virus developed by Russian scientists during the Olympic Games.
• Gennady Onishchenko, Russia’s former chief sanitary doctor, suggested “demarcation zones can be created around accommodation centers and competition venues” to protect the athletes during the Olympics.

JAPAN

Japan had one case of the Zika virus since the latest outbreak. Minister of Health, Labor, and Welfare Yasuhisa Shiozaki reassured the Japanese public the risk of an epidemic is “extremely low,” since mosquitoes are not active now. The Japanese government announced $1 million in emergency aid to the WHO to contain the outbreak while strengthening quarantines at airports and warning people – particularly pregnant women – not to visit endemic areas.

Newspapers in Japan discussed the country’s countermeasures against Zika.

• Asahi Shimbun argued because there is no available vaccine for the virus, the “most effective defense against the disease” is to refrain from traveling to affected areas and “preventing bites by mosquitoes carrying the virus.” A “fundamental solution to the problem,”Asahi claimed, is to raise “public health standards in developing countries that tend to be the birthplaces of infectious diseases.”
• The possibility of a Zika epidemic in Japan “cannot be ruled out,” claimed Mainichi Shimbun, “because the virus can spread through Asian tiger mosquitoes that inhabit Japan, like the dengue fever virus.”
• Sankei Shimbun warned the risk of an epidemic in Japan will increase during the summer. The “most realistic countermeasures for the time being” is preventive mosquito controls, such as removing pools of water, where mosquito larva grow.

SOUTH KOREA

South Korea has confirmed no Zika virus cases so far. The Ministry of Health and Welfare dismissed fears about the spread the virus in Korea, saying the country does not have its main mode of transmission, Aedes aegypti mosquitoes. The Korean government has designated the virus as a legal infection disease and implemented countermeasures, such as airport quarantines and mosquito control programs.

Korean experts and media, however, remained cautious and debated the impact of Zika on the national health policies.

• The Korea Centers for Disease Control and Prevention (KCDC) advised Zika epidemics “cannot be completely ruled out” on the Peninsula. “Even if we check the body temperatures of incoming visitors at airports, many would not show symptoms due to the latency period,” said Jun Ki-suk at the KCDC.
• “Korea, which had 186 patients who were infected with MERS and 38 deaths last year, cannot afford to consider the Zika crisis as if it is none of its business,” claimed Dong-A Ilbo. In light of the Korean government’s failure during the MERS crisis, the paper wrote “the public can hardly trust the authority about its ability to block the Zika virus from entering the country through watertight preparedness.”
• The Korea Times argued the “best” countermeasure, in the absence of vaccine for the Zika virus, is to prevent mosquito bites. JoongAng Ilbo agreed, recommending state and local governments to “sterilize all waterways and drains and double-check areas for mosquitoes before the weather warms.”
• The Zika outbreak has also sparked national debates on abortion in Korea, where abortion after the first 24 weeks of pregnancy is illegal. Neither the Ministry nor the KCDC has commented on possible legal revisions to create an exception for mothers infected with Zika.