Zika has entered the American consciousness in much the same way Ebola did: with a melodramatic flourish and a twinge of impish paranoia. It is something to be feared and something very deadly. And, so goes the narrative, it will be here soon.
This is, of course, a delightful oversimplification of Zika the disease and Zika the media sensation. But it still points to the fundamental flaw of discourse surrounding infectious disease. These conversations seem to be silently and powerfully tinted by the assessed immediacy, measured by physical proximity or the familiarity of current victims of the illness at hand. Nonetheless, the disease is a problem—it has been linked to the birth of thousands of children with microcephaly in Brazil and it is marching its way up the Americas. Though a case caused by a local mosquito has yet to be recorded in the United States, it is likely just a matter of time.
But it is hard to look at this issue, with its mild symptoms in non-pregnant adults and non-fatal prognosis, and understand the need for a promised 1.8 billion dollars in US funding, or a hastily proclaimed World Health Organization public health emergency. It is difficult to see how the facts at hand spell out epidemic. Or, at the very least, it is hard to conclude that our national concern is not born from uniquely self-interested fear. This fear belies a shortsightedness that diminishes our security, as it leaves us far behind the curve in the face of emerging infectious diseases like Zika. Our shortsightedness, in turn, underlines the flaws in the decision-making process for community health policy, where our isolationist tendencies buttress our economic objections to infectious disease research.
This is not to suggest that Zika is a disease of cataclysmic proportions. It is unlikely that an increase in governmental funding for infectious disease research would have produced concrete solutions for the Zika problem, as it is a disease that has historically been considered non-threatening. However, Zika stands as a salient and powerful example of the endemic flaws in American thinking regarding infectious disease. Zika, the newest soon-to-be epidemic, illustrates that we ought to reconsider how we interact with public health concerns. Ultimately, by shifting how we value medical research we can better prepare ourselves for future infectious diseases.
Societal views on scientific research spending could be the key change engendered by this shift in thought processes. Ideally, it would cast research as prophylactic and not luxurious or inessential, and might remove economic concerns that hinder current research efforts. Traditionally, developing vaccines has been seen as a largely unprofitable affair with highly complex approval procedures, production issues, and licensing concerns. Many of these realities are not unique to vaccine production. For instance, it is estimated that it may take up to 350 million dollars to bring a drug to market. But, vaccines are categorically different than other types of pharmaceuticals. First, a vaccine is inherently a single-dosage solution to the disease in question; it stands as a one-shot cure and not a weekly — or daily — means of managing symptoms. Second, because vaccine development is difficult and does not promise the same sort of long-term profits that other drug development ventures might, rational decision makers might choose to either combat other afflictions or create non-vaccine based treatments. Simply put, vaccines are cures, not treatment, and can be less profitable for the firms that produce them.
Nevertheless, there have been recent positive trends regarding private interest in vaccine development, which reflect idiosyncrasies in the patent law that governs vaccines. Ultimately, the direct licensing of vaccine production to given companies on the part of regulatory bodies has become a barrier to entry for start-up firms looking to join the vaccine manufacturing industry, even after a firm’s initial patent has run out. These barriers, though worrying in their own right, have redirected private interests towards the production of novel vaccines, as pharmaceutical companies are now promised more enduring returns on their initial investment. Recent data in the scientific literature corroborates this reality, as eight of the world’s ten largest pharmaceutical companies have pursued significant research and development interests in the field of vaccine production.
In light of concerns about governmental funding for vaccine development, President Obama’s stated intent to petition Congress for 1.8 billion dollars to combat Zika is particularly heartening. Still, even the most optimistic scientists believe that a Zika vaccine is years away, even with ongoing research that addresses West Nile Virus, a relative of Zika. The President’s declaration comes as too little too late; the fickle nature of vaccine development and deployment necessitates consistent, proactive dedication of funding and support. But in our current policy-making environment, spending on preventative measures is categorically undervalued, perhaps a function of the simple idea that in removing a scourge it becomes easy to forget it ever existed. This comfortable logic makes it too easy for policy makers to forego preventative spending as it lacks immediate returns, ensuring that funding increases stand as means of cleaning up the mess rather than stopping it in the first place.
It is also important to note that only 200 million dollars of the $1.8 billion President Obama is asking for will go directly to vaccine research and development. The rest of the sum is split between prevention efforts in Zika-stricken Puerto Rico, efforts to fight the disease in other nations, general Zika research on the part of the Center for Disease Control, and the establishment of an emergency fund should the disease hit the US with particular virulence. Additionally, the vast majority of prevention efforts are centered on reducing the mosquito population via the elimination of mosquito breeding grounds and the deployment of larvicide. These methods allow authorities to combat mosquito-born diseases where vaccines have failed or simply don’t exist, but they lack the preventative capacity promised by vaccines.
Though technological progress is still being made in this field, it is stunted by the same funding issues as vaccine development. Oxitec, an English biotechnology firm, has developed genetically modified mosquitoes that can curb mosquito populations by breeding with members of the native population and producing infertile offspring. Field studies in the Brazilian city of Piracicaba demonstrated an 82% decrease in the total population of Aedes aegypti, the mosquito species responsible for Zika. However, given stringent regulations regarding genetically modified organisms Oxitec is unable to officially sell its product to those in need, like the city of Piracicaba. As such, the company bears the brunt of the financial burden for developing and deploying this solution, limiting prospects for technological advancement. Like vaccine research before it, the development of novel methods to control mosquito populations could be improved if the political will existed to ensure that innovators received consistent public funding.
Ultimately, Zika is a case study for how and when American political agents choose to act in the face of public health issues. And this example paints a picture that is far from flattering. Valid solutions stand mired in political handwringing and our politics of fear appears ineffectual and overwrought with myopia. Further, our collective shortsightedness acts directly in the face of our interests, as it does little, or nothing, to combat and prevent infectious disease. Worst of all, the current policy-making paradigm problematically stations American lives at the core of our concern and ensures that issues like Zika only attain political and cultural relevance insofar as they impinge upon our national interests. In rejecting the notion that out of sight is out of mind, we can save lives and work to further the interests of both ourselves and others. To best serve our national interests, we ought to broaden our concern beyond our borders and proactively pursue technological advancements that allow us to better fight infectious disease. Such measures would also allay ethical issues with our current decision-making process, as we would be better equipped to fight diseases like Zika no matter where they appeared.