What The Ebola Crisis Can Teach Us About Responding To The Zika Outbreak

Two public health experts explain what the world needs to do better this time.

31/01/2016 7:58 AM AEDT | Updated 01/02/2016 1:09 AM AEDT
Municipal workers spray insecticide to combat mosquitoes that spread the Zika virus in Recife, Brazil, on Tuesday. A large outbreak of the virus is taking place in Brazil.

Every week, The WorldPost asks an expert to shed light on a topic driving headlines around the world. Today, we speak with Georgetown University’s Daniel Lucey and Lawrence Gostin about the global response to the Zika virus.

The World Health Organization was widely criticized for delays and mismanagement in its response to the Ebola crisis that ravaged three West African countries in 2014. 

The Ebola virus has killed over 11,000 people, mostly in Liberia, Sierra Leone and Guinea, since 2013. Liberia and Guinea have recently been declared Ebola-free, although experts warn the virus can quickly re-emerge.

Now, a new public health crisis is emerging in the Americas. The Zika virus, first discovered in Uganda’s Zika forest over 60 years ago, spread in recent years to the South Pacific and the Americas. The virus, which is transmitted by mosquitoes and, like Ebola, has no vaccine or cure, was initially not thought to be very dangerous, mostly causing a mild rash or fever. But a large outbreak of the virus in Brazil last year was linked to an explosion in reported cases of microcephaly, a condition that causes babies to be born with abnormally small heads. The possible connection between the Zika virus and microcephaly, which has yet to be confirmed, led Brazil to declare a national emergency in November.

The virus has spread rapidly, with reported cases in 23 countries and territories in the Americas. Earlier this month, the U.S. Centers for Disease Control and Prevention issued an alert advising pregnant women to consider postponing travel to countries with the Zika virus. 

On Thursday, the WHO announced it will convene a special emergency committee on the Zika virus on Monday, the first step towards possibly declaring a public health emergency.  A few days earlier, Georgetown University’s Daniel Lucey and Lawrence Gostin had published a paper in the Journal of the American Medical Association urging the WHO not to delay its response to the Zika virus any further. The WorldPost spoke to Lucey, a senior scholar at the O'Neill Institute for National and Global Health Law at Georgetown, and Gostin, the institute's director, about the lessons of the Ebola crisis.

The virus was believed to be relatively benign until the outbreak in Brazil was linked to a sharp increase in cases of microcephaly, which can cause shrunken brain size in newborns. 

What lessons do you hope the WHO has taken from the Ebola crisis that can be applied to the emerging Zika pandemic?

Lucey: The WHO director general Margaret Chan delayed very, very long the convening of the special emergency committee with regard to the Ebola epidemic in West Africa. I was working with Ebola patients in Sierra Leone and Liberia during the outbreak in 2014, and it really made a searing impression on me as to the real world, on-the-ground and in this case catastrophic consequences of decisions that are made -- or not made -- in places like the WHO headquarters in Geneva.

That was a large part of what motivated me to write the article with my colleague, Professor Gostin, urging the WHO director general to convene a special emergency committee. She delayed doing it again with Zika, although hopefully not with such catastrophic consequences as with Ebola.

Fatih Erel/Anadolu Agency/Getty Images
The World Health Organization director general, Margaret Chan, announced on Thursday that the WHO would convene a special emergency committee on the Zika virus next week.

It was already evident several weeks ago that the Zika pandemic is worth paying attention to.  The question will arise as to how much earlier should the committee have been convened, particularly if there are waves of epidemics of microcephaly in other countries affected by Zika. I hope and pray that there won’t be. But if there are epidemics of microcephaly in other Latin American countries, it’s a tragedy, and there’ll be more lessons to learn from that.

When she said on Thursday she was going to convene the committee, honestly, I was overjoyed. The committee has very specific responsibilities -- it really galvanizes the international community under the leadership of the WHO headquarters, so the entire world can benefit from harmonized communications and guidance about the outbreak. But it’s only the beginning. It’s like the key that you have to turn to unlock the door, and now you have to go through the door.

If there are epidemics of microcephaly in other Latin American countries, it’s a tragedy, and there’ll be more lessons to learn from that. Daniel Lucey

Gostin: The critical lesson is not to wait until a crisis spins out of control. Act rapidly, decisively and with leadership. When the Emergency Committee on Zika meets, actions will speak louder than words. These actions are vast mobilization of funding and international support to drastically reduce the mosquito population in Zika-affected areas, intense surveillance, determining conclusively the link between Zika and infant malformations and accelerated research for a vaccine.

Are there other ways the WHO and the international community have applied some of the lessons of the Ebola crisis so far?

Lucey: I think so. For example, Brazil responded in a very timely manner to the growing epidemic of microcephaly, and the Pan American Health Organization (PAHO) has done an excellent job at issuing epidemiological alerts. I think the U.S. CDC issuing a level 2 travel alert was appropriate, balanced advice and a proactive step.

It’s about the speed of response, the resources put in, and making sure the resources are appropriate. You have to frequently reassess the situation. That’s very important lesson that should be learned from Ebola. After a sharp increase in patients in Liberia it was predictable [that it would spread further], but there just weren’t enough diagnostic laboratories or healthcare workers.

The virus has spread to 23 countries and territories in the Americas. Here the Dominican Air Force fumigates parts of Santo Domingo against Zika virus-spreading mosquitoes last week.

Zika is very different from Ebola. What new challenges does the Zika virus present to the international community?

Gostin: Zika’s challenges come from the mosquito vector. This mosquito is ubiquitous, found in every region of the world. If we are not proactive and attack the problem with overwhelming resolve, the hazard of Zika will spread worldwide. If we see a wave of fetal abnormalities nine months after Zika outbreaks, it will be an enormous ethical and public health failure.

Lucey: Brazil has a wonderful medical research tradition and healthcare providers. To my knowledge, there’s no shortage of hands-on patient care that there certainly was in West Africa. There is an urgent research issue and it is being addressed.

One challenge is the amount of travel to places where Zika is transmitted. There’s so many more travelers to the 21 or so countries or territories in the Americas with reports of the Zika virus than there was to the three very underdeveloped, impoverished countries impacted by Ebola.

The critical lesson is not to wait until a crisis spins out of control. Act rapidly, decisively and with leadership. Lawrence Gostin

What lessons should the public health community apply from the development of Ebola vaccines and treatment during the crisis in West Africa to the current response to the Zika virus?

Gostin:  What we have learned is you need two things to speed vaccine research. First, there is the need for enormous funding. Second is the need for public private partnerships to harness the best talent in government and industry.

Lucey: Even though there’s still no licensed Ebola vaccine, one of the good things the WHO did early during the Ebola crisis was to bring together experts who decided that it would be ethical to do investigational studies for treatments and vaccines in the middle of an outbreak, as long as it’s done in a transparent, ethical manner with the approval of institutional review boards and ethical oversight from within each of the countries.

It was really a phenomenal thing that so many partners came together to do a study in Guinea. The results of this research are still going through an approval process, but it’s a remarkable success story. I think if Brazil and other countries affected by Zika epidemic choose to work with international partners, then they can look back to the recent successful precedent with Ebola vaccines in West Africa.
The interview has been edited and condensed for clarity. Interviews were conducted separately with Daniel Lucey by phone, and with Lawrence O. Gostin via email on Friday.


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