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Public Policy|Southampton

Who's afraid of the Big Bad Zika Virus?

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Well, go on – are you? Yes? No? Probably no? Although mainly because you’ve never heard of it. Or you’ve vaguely heard of it but know nothing about it. For those of us in the global public health community, Zika (pronounced ‘zee-kuh’) disease is an emerging threat about which we will quickly need to assemble knowledge and action plans.

At time of writing, 2016 is not even one month old, yet The Lancet has already this year described Zika as ‘a new global threat for 2016’. It is a mosquito-driven infection, and is of particular immediate concern in Latin America though national and international surveillance agencies are all paying close attention. Symptoms are typically mild, causing fever, rash and muscle pain. However, emerging epidemiology suggests more serious health outcomes, for example congenital abnormalities such as microcephaly (quite literally meaning ‘smallness of the head’) in newborns.

As one example of the paucity of our knowledge base, Public Library of Science has issued a call for submissions to its journals for contributions about Zika. To request submissions on a particular topic of health interest is of course a common enough occurrence; however, in this case, the call is not seeking that blockbuster paper (such as the Ebola vaccine publication), but has an undercurrent of ‘please send in something, anything about Zika…’. A quick look at pubmed, using the search term ‘Zika virus’, brings up 135 results, of which 67 are dated since the start of 2013. There was a small flurry of papers published in the 1950s, and then very little until the recent emerging interests. We really don’t know very much about it.

The virus may be added to the WHO list of neglected tropical diseases, as efforts on surveillance are scaled up. And therein lies the problem. Typically there is little research carried out on emerging infectious diseases before they become the problem some feared they might. Ebola is an excellent example here – from some unpublished work of ours, there was minimal research investment worldwide on Ebola studies (bar some pre-clinical work mostly funded by the US National Institute for Health), and then in 2014, the west Africa outbreak explodes in catastrophic style and vast amounts of money are thrown in its general direction. The funding was and is very much necessary, but so much more could have been done in the years prior to the outbreak by way of knowledge gained from research.

This is a point we have made previously in our analyses through the Research Investments in Global Health study (ResIn), covering infectious diseases, and more specifically respiratory infections, that investment is reactive, not proactive. There is little in the way of horizon-scanning and that needs to change. The complexities of the modes of transmission of different infectious diseases suggest that Zika won’t become the new Ebola in terms of the rapid spread and immediately-frightening impact; however, it may cause significant disease burdens in countries that are poorly equipped to deal with the fallout (perhaps think more along the lines of dengue).

This is not pointing the finger at global health funders, since they can only invest in proposals that come through their doors, and it’s fair to assume they don’t have locked drawers full of Zika-related proposals. This is a problem that, like Ebola, can only be effectively tackled by the Royal ‘we’, across the global health community, including policymakers, funders and research institutions (and numerous other organisations). If we are to learn lessons from Ebola, and potentially here from Zika in mitigating these threats when they arise, it’s that we need to be far more proactive in providing research investment resource beforehand, not afterwards.

 

Dr Micheal Head, Southampton

Michael Head is a Senior Research Fellow in Infectious Diseases and Research Investment Analyses in the Faculty of Medicine at the University of Southampton. He has received an award from the Public Policy|Southampton to disseminate the findings of the Research Investments in Global Health study direct to high-level policymakers.

 

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