Making the Zika threat worse

February 4, 2016

Rebekah Ward and Nicole Colson report on the outbreak of the Zika virus--and explain that the solutions being offered will force women to make impossible choices.

IMAGES OF Black and Brown people suffering an epidemic viral disease are flooding television screens yet again. This time, however, it isn't Ebola but the Zika virus that is the culprit.

The current outbreak of the Zika virus evokes similar racist fears to those surrounding the 2014 Ebola epidemic--but more than that, the explosion in Zika cases has a special impact on reproductive freedoms and speaks to the rotten core of a system that puts profit above human needs.

The Zika virus, first reported in humans in 1952 in Africa, is related to the West Nile, Yellow Fever and Dengue viruses, and is carried in mosquitos from host to host. Since it was first reported, it has spread across Southeast Asia and the Pacific Islands, mutating and therefore changing its potential interaction with human hosts along the way. While most people are never aware that they have contracted the virus, the estimated 20 percent of those infected who experience symptoms report joint pain, fever, rash and conjunctivitis (red eyes).

A mother holds her infant born with microcephaly
A mother holds her infant born with microcephaly

In April 2015, Zika was reported in Brazil, possibly transmitted by someone visiting the country during the World Cup tournament. Although it's unclear exactly how many cases there are, Brazil's Health Minister Marcelo Castro told Reuters this week that the outbreak is worse than initially believed because of the fact that most of those infected never show symptoms.

It is estimated that 1.5 million Brazilians have now caught Zika. According to the Pan American Health Organization, since the Brazilian outbreak, the virus has spread to 24 countries and territories in the hemisphere.

But while the health impact of the virus on adults is relatively minor, Zika appears to be responsible for a drastic spike in a major complication in fetal development. Along with the initial outbreak, the Brazilian Ministry of Health (Sistema Unico de Saulde, or SUS) noticed an almost 20-fold increase of cases of microcephaly in infants--babies born with abnormally small brains and heads, sometimes resulting in developmental problems or even death.

Brazilian officials estimate that there have been some 4,000 cases of microcephaly in infants as a result of Zika transmission since October; almost one in 1,000 new births in the country appears to be affected. Some 90 percent of children born with microcephaly will have later problems with mental and/or physical development, according to experts.

Scientists are not sure how the virus causes microcephaly, but it may be related to the way that centrosomes, a small part of a human cell, act during neuronal development. This week, the World Health Organization declared the Zika outbreak to be a global emergency, fast-tracking research into a potential vaccine.

There have been outbreaks of Zika before. Many of the Pacific Islands have seen a rapid increase in cases. These usually involved no deaths and few apparent long-lasting effects.

But the virus has now spread to a region with many of the identified factors that make infection more likely--including poverty, crowding and deforestation. Some scientists think that it is the increase in cases that may have revealed the link to microcephaly, while other think the virus may have mutated in a way that is linked to the new incidence. Regardless, the drastic and devastating impact on human lives is undeniable.

BEYOND BIOLOGY, the "host specificity" of the virus--that is, who is likely to become infected with it--is largely a result of social factors.

For example, there are few predictions of a widespread outbreak happening in the U.S. because of the prevalence of air conditioning. The mosquitoes that carry the virus can, unlike those that carry malaria, aggressively seek out humans during the day--but daytime during the hot months in the Global North is profoundly different from that in the Global South. Although the range of the two main mosquitoes that carry the virus (Aedes aegypti and Aedes albopictus) extend into the U.S., there is little alarm, outside of the media, that the epidemic will significantly impact the U.S.

Another social factor impacting virus transmission is human-driven (anthropogenic) climate change. One of the mosquitoes that carries the disease is rapidly expanding the areas in which it can thrive. Some scientists suggest that Dengue, Chikungunya and Zika are all risks for occasional infections in the U.S. because Aedes albopictus is headed north due to climate change.

Another ecological component that has been identified is deforestation which leaves soil open to erosion and can increase pools of stagnant water, fertile spaces for breeding for the common Aedes aegypti.

The most outrageous aspect of this epidemic is the response of government health officials in countries like Brazil, Colombia and El Salvador in advising women in how to avoid Zika transmission during pregnancy: Don't get pregnant.

In December, Brazilian officials announced that were recommending that women postpone pregnancy. Jamaica and Ecuador also followed suit. Columbia has advised women not to get pregnant for six to eight months, and El Salvador recently urged that all women should avoid pregnancy for two years, until 2018.

Such advice is virtually impossible for women to follow, however, when abortion is tightly controlled and virtually banned--as it is across much of Latin America.

In Brazil, where abortion is legal only if pregnancy puts the life of the woman in danger or if the pregnancy is the result of a rape, the right wing has recently been attempting to pass a bill to restrict abortion access even further for rape victims "by requiring them to undergo a police report and forensic medical exam," the New York Times reported. "Another part of the bill seeks to make it a crime for people to assist in an abortion or encourage a pregnant woman to have one."

Additionally, the limited abortion services that do exist in countries like Brazil and Colombia are primarily available in urban areas--while Zika transmission is disproportionately affecting poor, and often Black, women in rural areas. Likewise, access to and use of contraception is limited in some of the countries hit by Zika outbreaks, including El Salvador.

Researchers reported this week the first confirmed case of sexual transmission of the virus in the U.S. Although thought to be rare, the possibility of infection through sexual transmission makes the need for easy access to abortion and birth control--particularly condoms--even more urgent.

AS JESSICA Valenti noted in the Guardian, these recommendations "are not just unrealistic, they're dangerous. Because if there's one thing that public health experts know, it's this: women who don't want to be pregnant will find some way not to be, including illegal and unsafe abortions."

Complicating the picture is that severe microcephaly cases can be detected by ultrasound during pregnancy, but often not until the end of a woman's second trimester, delaying the time in which an abortion can be performed if a woman wants to wait until fetal abnormalities are detected. This will leave many women weighing whether to try to get an abortion in an agonizing limbo. As Valenti noted:

The concern from international women's health organizations is not only that women lack reproductive care options, but that the lack of options could lead to an increase of illegal and unsafe abortions. As it stands, 95 percent of abortions that happen in Latin America, where laws restricting the procedure are quite strict, are performed in unsafe conditions.

"Unsafe abortion is the number one maternal mortality cause in the region," Paula Ávila-Guillen, programs specialist at the Center for Reproductive Rights and an expert on reproductive policy in Latin America, tells me. "When women decide to terminate their pregnancies, they are going to do so – it's just a matter of how."...

In El Salvador--where abortion is illegal under all circumstances and women are thrown in jail if they can't prove their miscarriage or stillbirth is the result of natural causes--the landscape is even bleaker. Ávila-Guillen tells me that those working to make abortion legal in the country have to be incredibly careful, because "if you talk too much about abortion, you can be prosecuted." A law punishes those seen as instigating or pushing abortion.

"Pregnant women across Brazil are now in a panic," Silvia Camurça, a director of SOS Corpo, a feminist group in Recife, Brazil, told the New York Times. "The fears over the Zika virus are giving us a rare opening to challenge the religious fundamentalists who put the lives of thousands of women at risk in Brazil each year to maintain laws belonging in the dark ages."

In Brazil, some 150,000 women seek medical treatment each year for complications from illegal abortions. Estimates suggest that as many as 850,000 illegal abortions are performed in the country each year. That number is likely to rise--as will the deaths of women from these unsafe procedures--as fears of Zika transmission grow without any added access to legal abortion services.

The suggestion by various governments that women avoid pregnancy in order to avoid the possibility of having a child with birth defects suggests as well that women's bodies and their reproductive choices belong to the state.

From the point of view of the state, the "burden" of children who could need additional medical attention will be borne by the state health system in these countries. But the question arises: Would the response be the same if it were mostly light-skinned and wealthy women with private means for health care who were affected? Race, class and gender are combining to produce a perfect storm over women's right to control their own bodies--whether that means choosing to become pregnant or choosing not to have a child.

LAST, BUT sadly not least, is the role that Brazil's hosting the 2016 Olympics is likely to play in how the unfolding epidemic plays out. A severe recession is hitting Brazil and an estimated 1 million jobs were lost in 2015. Brazil's economy, which is dependent on oil and basic commodities production, has tanked oil prices have plummeted--leading, among other things, to cuts at state-funded hospitals.

Brazil also is in the midst of a protracted political crisis. In December, impeachment proceedings were opened against Brazilian President Dilma Rousseff over allegations that she illegally used funds from state banks to cover shortfalls in the budget.

With Rousseff's political life on the line and the economy in a shambles, Brazilian officials are desperate to present the perception that they are capable of stopping the spread of the Zika virus and ensuring the health of athletes and tourists in order to ensure that preparations for the Olympic Games--which are privately funded, but require the Brazilian government to cover any shortfalls--continue moving forward.

Already over budget, Olympic organizers ordered 30 percent cuts to spending in October. As NPR recently reported:

One woman recently gave birth on a sidewalk in Rio because a hospital wasn't admitting patients owing to funding shortages. The main doctors union said this week that the health system in Rio isn't capable of dealing with the influx of tourists for the games.

"The crisis has completely impacted the Olympic Games," says Roberto Maltchik, the Olympics editor at Rio's biggest daily, O Globo.

"They have no money. They can't incur any last-minute costs," he says. Budgets have been slashed across the board.

Officials are now scrambling to present the image that they are getting the Zika outbreak under control, even as they warn pregnant women not to travel to Brazil during the Games. Over 9 million house visits have been made in Rio De Janiero to ensure that mosquitos breeding grounds are eliminated and officials are monitoring some 400 pregnant women who may have Zika infections. These women, the families and communities of which they are a part, are paying the price for the Olympics.

In both its history and its current trajectory, this small virus shows all the twisted priorities of a system that puts profit over human lives. Those who have less get less. Women and people of color are deemed to "deserve less." And the chance to make money is always seen are more important than the lives that will be ruined as a result.

Biology and society are inseparable--and the Zika outbreak is only the latest proof.

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