There are few things more terrifying than an epidemic unfolding in real time, when the true cause of a disease is still unknown, and before effective public health interventions can be implemented. And it is all the more vexing when a disease seems to ravish innocent and sympathetic victims, like newborn babies, or has such a devastating impact that it could change the human rights of the people affected.
The current outbreak in Latin America of zika—a flavivirus mainly spread by mosquitos that is related to dengue and yellow fever—has summoned all these anxieties, primarily because it has been linked with the increase in cases of microcephaly, a birth defect in which an infant’s skull and brain are significantly smaller than average.
Fears continue to grow as reports of the first case in Cuba and a sexually transmitted case in France reach the world’s media. The World Health Organization reports that four million people could be infected by the end of 2016, and the virus is expected to spread to Gulf States of the US, such as Florida and Texas, by the summer.
Despite the lack of evidence to establish a causal relationship between zika and microcephaly, international attention still focuses primarily on the link between the two, and its impact on the human rights of the people affected. So why are we so keen to connect zika with birth defects? How can great thinkers like Thomas Piketty explain our panic? And could the sexually transmitted cases contribute to a human rights violation?
Why are we so keen to find a connection between zika and birth defects?
Certainly, desperation for an explanation and an effective and efficient remedy for both zika and microcephaly clouds rational explanation of this potential syndemic (when two or more epidemics occur in concert with one another), and such a tragic birth defect warrants extreme precaution.
But the enduring link between zika and microcephaly in the public mind may have much to do with the paradigms in which we understand disease causation and cure. Let’s explore some of these paradigms in more detail.
Could the zika epidemic contribute to a human rights violation?
Recent reports have documented that zika is being spread through sexual intercourse, indicating that contraceptive and prophylactic measures may protect women from infection. As microcephaly becomes more prevalent—even without conclusive proof that it is caused by zika—women in countries that legally prohibit access to contraception or abortion may seek drastic alternatives, such as unsafe, illegal abortions to terminate pregnancies they fear may result in birth defects. In El Salvador, where abortion is completely illegal, nearly a third of all women of childbearing age have opted for sterilization as a drastic recourse.
Many Latin American countries have issued warnings to women that they should avoid getting pregnant for the next two years. These policies presume that women have full control over their reproductive choices, which belies the fact that many of the very same countries prohibit or limit women’s access to birth control by criminalizing abortion and making condoms and birth control pills prohibitively expensive to the poor women who are most susceptible to zika.
As University of Toronto professor of law and women’s health rights expert Rebecca J. Cook argues, the legal deprivation of contraception not only contributes to gender inequity in healthcare, but constitutes a human rights violation that warrants the exercise of international treaties. The zika epidemic reveals that the deprivation of contraception leaves women and their children vulnerable to dangerous diseases.
Does poverty make you sick?
While tuberculosis, diphtheria, and other contagious diseases are equally infectious to all despite social status—what Historian Nancy Tomes has described as “the socialism of the microbe”—they have historically been heavily distributed among people that live and work in unventilated and/or dirty environments where germs can be easily spread.
In situations where social conditions encourage the spread of disease, social interventions may best reduce their prevalence. English physician John Snow established this during the cholera epidemic in Soho, London, in 1854. Despite the fact that the cause of cholera (the cholera vibrio) was unknown at the time—and miasma theorists still contended that it was spread by vapors—Snow found that vast majority of the cases of cholera centered around the Broad Street pump, and that when residents were forced to use a non-infected water source, the epidemic abated.
Is capitalism to blame for the spread of infection?
“The growing gap between rich and poor make many technical advances irrelevant to most of the world’s people,” says Harvard ecologist and biomathematician Richard Levins, suggesting that capitalism itself should be recognized as a social determinant of health.
We see this in the current outbreak of zika, where the vast majority of cases affect impoverished communities where the aedis mosquitos that carry zika breed enthusiastically, and where few residents have access to insecticides to protect themselves.
The unequal burden of disease has been exacerbated by neoliberal forces. French economist Thomas Pikettyhas provocatively argued that the natural trajectory of capitalism is to increase inequality, and if left unchecked by governmental intervention, it will only increase over time and in proportion to increased global trade. Piketty’s warning urges caution to take socioeconomic factors very seriously in determining public health interventions.
How neoliberalism creates possibilities for infection
Low-income communities in places like Recife, Pernambuco—the fifth largest metropolitan areas in Brazil—are suffering from high rates of zika due to ecological factors that have been hastened by neoliberal development. Urban sprawl has brought Recife residents in close contact with the forest-dwelling breed of the aedis mosquito, which carries zika. At the same time, the concrete urban environment that protects residents during the tropical monsoon season also harbors mosquitos, and the poorly managed public sanitation services exacerbate these conditions.
Evolutionary biologist Rob Wallace argues that environmental factors have been overlooked in the zika outbreak. In addition to the impact of urbanization, deforestation to support the expansion of commercial farming and metropolitan development has displaced mosquitos, driving them into urban areas. And global warming has increased temperatures and humidity, creating more environments in which mosquitoes can thrive.
The ecological determinants of zika signal a warning to other Latin American countries with tropical climates. And as zika prevalence increases in Central American countries, like Puerto Rico, the fear increases that the epidemic is moving northward, and into the United States.
But, Wallace urges that while mosquitoes are the primary means of zika contagion, the real threat to public health seen in the zika outbreak are the unrestrained neoliberal forces that destroy local ecology and exacerbate inequality. To that extent, he contends that determining the causal relationship between zika and microcephaly is less important than addressing the structural problems that victimize low-income and marginal populations.
Lessons from zika and microcephaly
The urgency and danger of the unfolding crises with zika and microcephaly in Latin American demand answers. But, as the US National Institute of Child Health and Human Development warns, it may yet be years before we can conclusively establish a causal relation between zika and microcephaly.
In the meantime, we must take action to try to combat both diseases and this might require a complex of social, environmental, structural, and legal interventions that address the root causes of these epidemics, not simply restrictions limiting human and animal contact.