Zika Virus: A Reflection on Health Security
On February 1, the World Health Organization (WHO) declared increasing cases of neonatal disorders amid the growing Zika Virus outbreak a Public Health Emergency of International Concern (PHEIC). The potential scope of the Zika outbreak prompts the question: when does a health threat in one region transition to a global health emergency? Global health security academics correlate the timing of a PHEIC declaration with the increased likeliness of an outbreak reaching Western nations. When outbreaks are contained in the Global South, international responses tend to be slower. The timing of WHO declarations during past health emergencies demonstrate this trend.
For example, in November 2002, the initial cases of SARS (Severe Acute Respiratory Syndrome) broke out in South China. The next six months resulted in a total of 8,096 infected people worldwide and 774 deaths. From November to March, there were cases throughout China, Vietnam, and Hong Kong. On March 15, 2003, the WHO issued an emergency travel advisory after cases were identified in Singapore and Canada.
The H1N1 swine flu outbreak of 2009 also falls into the pattern of western-centric WHO declarations. The first case occurred in Mexico on March 18. By April 21, two cases were confirmed in California. On April 25, WHO Director-General Margaret Chan declared swine flu a PHEIC, and by April 29, it was confirmed as pandemic-level.
More recently, the 2014 Ebola outbreak consisting of 28,639 cases and 11,316 deaths seriously questioned the international community’s commitments. Ebola was first identified in 1976, with reports of less than 500 outbreaks per year; from 1976-1994 there were no reports. However, a sudden outbreak in March 2014 killed 50 people in Guinea. On August 2nd, a U.S. health missionary official was infected in Liberia and flown to the U.S. for treatment. By August 8, the WHO declared Ebola as a PHEIC. Between March 22 and August 2, outbreaks were confirmed in Liberia, Guinea, Sierra Leone, and Nigeria, many of which resulted in fatalities.
The first case of Zika was located in Uganda in 1952. At first, it was contained within the equatorial parts of Africa and Asia, but in the past ten years it has spread to the Pacific islands. On March 25th, 2015, Zika was detected in Brazil, where it has since spread exponentially; more than 13 countries in the Americas reported sporadic infections. Just two days after the PHEIC declaration on on February 3, Texas confirmed the first case of Zika in the U.S.
The International Health Regulations defines a PHEIC as “an extraordinary event which is determined to constitute a public health risk to other States through the international spread of disease and to potentially require a coordinated international response.” While Zika does not cause illnesses and deaths as severe as previous global health emergencies, the prenatal disorders of babies born from Zika infections raise serious debates about abortion, as well as the effects of climate change and El Niño. Moreover, the “coordinated international response” builds a stronger, prioritized message to national leaders, which typically brings in increased funding for research, the development of vaccines, and virus containment resources, which are key to stemming the spread. As scholars Richard Has and Pamela Dos reflect, SARS served as a reminder that border controls could not stop the international spread of diseases.
Global health leaders must remember that a PHEIC declaration does not only pertain to when a risk threatens Western states who possess able healthcare systems, but also “other States.” International organizations should be cognizant the power of rhetoric and plan their role in advance to contain outbreaks to specific regions. The WHO seems to have made progress in this regard by showing a more proactive response in the fight against Zika. To achieve justice in terms of health security, WHO should focus on eliminating regional-centric responses.