This post comes from Dr Neisha Sundaram. Neisha is a cultural epidemiologist and Research Fellow at the Saw Swee Hock School of Public Health. Her research focuses on use of mixed methods to study vaccine acceptance.
This Flavivirus is a current infectious disease and media favourite, with a lot being said about Zika in the recent past. Although there is growing evidence, there is insufficient clarity as yet on whether Zika infection in pregnant women is a responsible for a rare birth defect called microcephaly. We also don’t know whether Zika is associated with neurological and autoimmune problems, including Guillain-Barré syndrome (but this has received lesser media attention).
While the jury is out, Brazil has undertaken a nation-wide public action plan to reduce proliferation of mosquitoes on a war footing (literally). Control of Aedes aegypti mosquitoes—which in addition to being the principal mosquito vectors for both Zika and dengue viruses, are also responsible for spreading chikungunya and yellow fever viruses—has been woefully inadequate in many countries. India, and to be more specific, my own hometown Bangalore in southern India, is a notable example. Notwithstanding high morbidity from dengue fever in Bangalore, basic and seemingly easily implementable measures such as tackling mosquito breeding sites, regular garbage collection, surveillance and public education are often altogether missing. It would be an excellent outcome if the current attention given to Zika virus resulted in long-term national commitments and action to control Aedes aegypti mosquito populations.
Unfortunately, several governments and conversations have focused on human rather than mosquito breeding. National recommendations urging women to delay pregnancy have been issued by Colombia, Ecuador, El Salvador, Panama and Jamaica. This is a poor response when governments could instead be concentrating on reducing mosquito populations. Criticism of these recommendations by women’s rights groups and others include the fact that in many of these regions contraception is hard to come by, sex education is low and these recommendations do not take into account that a majority of pregnancies are unplanned. Apart from being impractical, such a recommendation that shifts onus away from governments to individuals, raises two other relevant questions:
- Shouldn’t a national recommendation be evidence-based? Despite spatio-temporal associations of microcephaly with the Zika outbreak in Brazil, it is yet to be conclusively established whether Zika virus does indeed cause microcephaly. If research dismisses this link in the future, Zika fever with its relatively mild symptoms would perhaps be a lower cause for worry than, say, dengue hemorrhagic fever.
- What ripple effects could this recommendation have on individual acceptance of other control measures such as Zika virus vaccines when they become available? A discussion of any aspect of fertility in conjunction with any disease should be carried out with great responsibility, care and caution. We ought to have learned this lesson by now. Mere rumours of infertility associated with life-saving polio and tetanus vaccines have led to mass boycott of vaccine campaigns and disastrous consequences for national and international disease control efforts. A callous recommendation that has not been fully thought through could have consequences far beyond what may be imagined.