Paulo Prada

By : Paulo Prada

Last January, long lines formed outside health clinics in Recife, a city in Brazil’s northeast hit hard in recent years by outbreaks of dengue, a painful tropical disease.

Doctors were on guard because federal health officials and the World Health Organization (WHO) had warned 2015 would be a bad year for dengue and possibly another viral disease, chikungunya, both spread by the same type of mosquito. But the symptoms of the hundreds of people seeking treatment did not fit dengue. Instead of high fevers and intense muscular aches that dengue is known to cause, patients were running only slight temperatures and complaining of joint pain. Many had rashes sooner than with dengue and chikungunya.

It took until early May for the health ministry to recognize that the Zika virus had arrived in Brazil and to alert the WHO’s regional arm, the Washington-based Pan American Health Organization (PAHO). And it wasn’t until November that a Rio de Janeiro laboratory made a link between the virus and microcephaly, which can lead to abnormally small brains in developing babies.

The WHO has been lambasted in the past couple of years by scientists, aid organizations, and public health experts for the slow way in which it initially reacted to the Ebola epidemic, as it spread across West Africa in 2014. And so far, the hesitant response to the Zika outbreak, which has created the worst global health scare since Ebola, says much about the difficulties that the WHO and other health authorities face in combating unexpected public health threats. On Dec. 1, the WHO cited the lab evidence linking Zika to microcephaly in an advisory to its member countries. It will consider on Monday whether to declare an international emergency.

Critics say that the WHO has been slow to act after the link between Zika and microcephaly was made, and should have declared an emergency as soon as that was determined.

WHO officials say the agency’s response to Zika is driven by science, and they point out that much remains unclear, including the precise nature of any link between Zika and microcephaly.

Since October, 4,180 cases of microcephaly have been reported in Brazil but only 270 have so far been confirmed, with just six so far linked by the government to Zika. Of the rest, 3,448 are still being investigated through a long process involving clinical research, laboratory testing and monitoring of the infants’ development, and 462 were dismissed as not being microcephaly.

Following the spread of the disease is difficult. Many of those who get Zika can recover quickly from only mild symptoms, and across the Americas, hospitals do not have the clinical testing materials to quickly and definitively determine whether a patient is infected.

On April 30, a laboratory at the Federal University of Bahia, also in Brazil’s northeast, said it had identified the presence of Zika in samples from one patient. On May 2, it notified PAHO. The notification put a Zika outbreak on record at the WHO. On May 7, PAHO issued an “epidemiological alert” saying “public health authorities of Brazil are investigating a possible transmission of the Zika virus.”

By September, the chat groups among doctors were abuzz over a spike in the number of babies born with microcephaly. Many mothers of affected babies recalled having Zika-type symptoms.

Starting Nov. 30, WHO deployed a small team of researchers from PAHO’s Washington headquarters to Brazil. On Dec. 1, PAHO issued a new advisory, warning countries in the region of the link between the virus and microcephaly. Two months later, the WHO is considering whether to declare an international emergency.

“You have to gather the data,” says Marcos Espinal, director of the department of communicable diseases at PAHO, dismissing criticism that the regional body or headquarters could have moved any sooner.

Disclaimer: Views expressed by writers in the Column section are their own and do not reflect RiyadhVision’s point-of-view.

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