We have been asking colleagues to write posts on our blog giving different perspectives on the zika virus response. This post comes courtesy Dr Mishal Khan. Mishal is a Lecturer at the London School of Hygiene & Tropical Medicine, and an Assistant Professor at the Saw Swee Hock School of Public Health. Her research focuses on gender inequalities in health, health systems strengthening and tuberculosis control.
Learning from the strong criticism received over the slow response to the Ebola crisis in 2014-5, the global health community appears to have acted much faster for Zika – the new bug on the block. We have been told about the scale of the threat to human health, how little we know about the biology of the virus and the need to act urgently.
So of course we need new knowledge to develop a targeted, innovative solution, right?
Indeed much attention is being focused on finding out more about the biology or epidemiology of the virus and on developing a vaccine, and new diagnostic tests For example, the UK Medical Research Council’s recently-launched Zika Rapid Response Initiative has identified some key research areas, including:
- Epidemiological characteristics,
- Development of more specific rapid diagnostic tests for Zika virus
- Viral pathogenicity, association with links to neurodevelopment / microcephaly
- Mechanisms of infection and host immune responses and potential therapeutics/ vaccines
There is little mention of studies to identify and build upon lessons from other epidemics, or to understand health systems and policy barriers to effective responses in affected countries.
I would argue that we may, in fact, need to focus on known, generalisable, boring solutions.
Because new vaccines, diagnostics and drugs cannot reach the people that need them most without well functioning health systems and effective policies.
The human papillomavirus (HPV) vaccine illustrates this well. In 2006, after decades of research and investment a vaccine against HPV – a virus that is the second most important cause of cancer-related death in women globally – was available. However, by 2012, of the 51 countries implementing national HPV vaccination programmes, only six were low or middle-income countries. Reasons for low uptake in settings where the vaccine will be most useful include:
- Sociocultural barriers (lack of knowledge amongst parents, cultural traditions and rumours)
- Health systems barriers (not enough human resources, lack of cold storage, challenges with transport of vaccines)
- Lack of political support in country
We already know that these barriers need to be addressed in the majority of low and middle-income countries, not just to enable an effective response to Zika but also to other infectious disease threats waiting to pounce on us.