Co-authored with Christopher Spera
Prevention is an investment. Investments in local, state and federal public health infrastructure are necessary to stop the spread of Zika and other infectious diseases in the United States, as well as address the health outcomes for those who are infected. As is true of most public health challenges, there is no one "silver bullet" solution. Instead, we need a systemic, multi-faceted approach to contain and stop the disease.
In the case of the current Zika crisis, public health agencies and others in the United States require resources for a range of activities that can occur simultaneously such as:
• Educating the public about the disease and what can be done to prevent one from
getting the disease;
• Monitoring the spread of the disease and its impact;
• Developing a vaccine and testing its effectiveness;
• Performing laboratory tests to confirm the diagnosis of the disease;
• Training healthcare providers about how to identify and treat Zika:
• Implementing measures to prevent the spread of Zika though spraying and other strategies (e.g., cleaning up pools of water, etc.) and;
• Providing health care and other social services to the children and adults with disabilities that result from the Zika infections.
Congress recently made $1.1 billion available to address the Zika outbreak. This amount was a little more than half of what was requested ($1.9 billion). These dollars are a good "down payment" to address the Zika outbreak; local and state health departments need federal funds to augment their efforts with state and local dollars. And sustained public health efforts require a partnership of federal, state and local entities working together with other public and private organizations in their jurisdictions.
What if We Focused on Prevention First?
If we had used the guiding principle of focusing on prevention first, we may have averted the current Zika caseload (as of October 12, 2016) of 3,936 within the United States and 25,871 in the U.S. territory of Puerto Rico, as well as prevented microcephaly in the 23 infants born in the US to date to infected mothers. The number of children with birth defects will most certainly rise as pregnant women with Zika (878 in the United States and 1806 in Puerto Rico) deliver their babies. The Centers for Disease Control & Prevention (CDC) estimates that 1 percent to 13 percent of Zika babies could have microcephaly that results in serious developmental disabilities. Using these estimates we can expect between 27 and 349 more babies with microcephaly in the United States and Puerto Rico in the future.
The long-term costs of supporting a child with microcephaly during their lifetime range from $1 to $10 million dollars per child. The burden for this cost and care will fall on the families, medical care system, educational systems, and the states with overburdened budgets. In addition to these costs, the states and territories with cases of Zika also suffer from large losses in their economies due to a drop in tourism. The World Bank estimates Zika will cost the world $3.5 billion dollars in 2016.
It is especially important that we allocate resources to the poorest communities that are disproportionately impacted by Zika and other health diseases. For example, major ways of preventing Zika include putting screens on windows, eliminating garbage and puddles of stagnant water, using mosquito netting and insect repellant. Unfortunately, many who are poor cannot afford insect repellent, and they might not live in buildings with screens or in neighborhoods with good sanitation and environmental practices. We need to make special efforts in these neighborhoods to assure that their residents have the same preventive measures that those living in more affluent neighborhoods have. Like other health outcomes, one's zip code is associated with the population's health status as well as their ability to address a public health crisis.
Resources Needed for Next Steps in Preparation
As we make investments in developing a vaccine to combat Zika, it is extremely important for people to take actions to limit exposure to the virus. According to the Kaiser Health Tracking Poll in September 2016, 90 percent of Americans have heard something about Zika, but fewer are taking precautions to reduce Zika - e.g., 50 percent use mosquito repellant, 46 percent removed standing water around their home, and 42 percent avoided travel to another country where people are being infected. Although a larger percentage of people in the South (57 percent) are taking measures to reduce mosquitoes around their home, the percentage should be much higher to combat Zika. We must provide education and support for these measures to reduce mosquitoes until everyone in the affected communities are safe from all sources of the Zika virus.
How do we ensure we can respond to the current and future crises without a commitment to a public health emergency infrastructure? Just like our roads and bridges, we need to be prepared for the next public health crisis that confronts us in the future. We must embrace lessons learned from our experiences with major public health crises of the past decade (e.g., SARS, Ebola, H1N1 and Zika).
We must be prepared before the crisis confronts us. Resources should be allocated at all levels of government to continue to address the Zika crisis and prepare for the next one "around the corner." Waiting for the crisis costs more money and usually results in more disease and misery that could have been prevented with preparation. As the economic leader in the world, the United States can do better in preparing for public health crises and set the direction for other countries.
Deborah Klein Walker is a Vice President and Senior Fellow at Abt Associates. She is the current president of the Global Alliance for Behavioral Health and Social Justice (formerly the American Orthopsychiatric Association) and a former president of the American Public Health Association.
Christopher Spera is Division Vice President for US Health at Abt Associates.
The opinions expressed are those of the authors and do not reflect those of their affiliations.
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