Abstract
AbstractThe Zika virus is vectored by mosquito species of the genus Aedes, particularly the yellow fever mosquito, Aedes aegypti and, very likely, the Asian tiger mosquito, Ae. albopictus. These species also vector a host of other viral diseases including dengue and chikungunya all of which are “neglected tropical diseases” (NTDs) because of the lack of attention given to them. NTDs are diseases of poverty: They have lacked due attention because they typically affect the poorest populations of the world and at the same time they are not common enough to be profitably exploited by the pharmaceutical industry. We argue that the depth of the current Zika crisis is because of the extent of neglect for NTDs: First, in spite of yellow fever, dengue, chikungunya and other diseases vectored by Aedes mosquitoes, insufficient efforts have been directed towards their population control. Second, specific drugs for combating yellow fever, dengue, or chikungunya do not exist. For the last two, vaccines are yet to be developed (though some trials are finally taking place for one for dengue). Thus the pharmaceutical knowledge base for tackling related viral diseases is lacking. Third, thanks to the neglect even the epidemiological, sociopolitical and economic data required to make credible and timely risk assessments are not available. For instance, in the case of Zika, it would be useful to have a global risk map based on projected travel to and from Brazil for the 2016 Summer Olympics in Rio de Janeiro. Yet, projected travel volumes for chartered flights for the summer of 2016 are not publicly accessible, preventing the creation of credible risk maps. In addition, there is a severe lack of publicly available case data, especially in countries of the South where NTDs have the largest impact. Without reliable and comprehensive outbreak data, risk models necessary for outbreak prediction cannot be validated. Zika has only drawn attention to these problems because of the likelihood of its spread into the affluent North. It is high time that all NTDs are rescued from their dangerous oblivion.
Highlights
During the last few months of 2015 and 2016, Zika virus disease has emerged as a global public health emergency that has evoked multiple responses from individual and institutional actors across scientific, medical and political establishments
What used to be regarded as a generally mild viral disease is viewed as a crisis because the newest outbreaks have shown Zika to be linked, probably causally, to a debilitating and once rare foetal condition, microcephaly (Besnard et al, 2014; Besnard et al, 2016; Driggers et al, 2016; Nowakowski et al, 2016; Oliveira Melo et al, 2016; PAHO, 2016a; Schuler-Faccini et al, 2016; Qian et al, 2016; WHO, 2016), besides Guillain–Barré syndrome (GBS), a neurological disorder with immunological origins (Pan American Health Organization/World Health Organization (PAHO), 2016a)
Do we have no tools for the effective treatment and management of Zika virus disease, we have no credible preventive strategies that will significantly reduce the risk of its occurrence
Summary
During the last few months of 2015 and 2016, Zika virus disease has emerged as a global public health emergency that has evoked multiple responses from individual and institutional actors across scientific, medical and political establishments. Dengue and chikungunya are caused by flaviviruses that are so closely related that they are believed to have switched names during the last century (Halstead, 2015) This neglect comes in different forms and is due to three factors (Hotez, 2008): (1) each of these diseases affects a relatively small subpopulation even though the total population affected is comparable to the major tropical diseases mentioned above; (2) as indicated earlier, the subpopulations affected are often the most marginalized ones even in their own national contexts; and (3) by and large, these diseases have low mortality even though they have high morbity. All three diseases are propagated by mosquito vectors from the genus Aedes with a single species Ae. aegypti being the dominant vector in each case This means that if the spread of dengue or chikungunya had been curtailed by the control of these vectors and exposure to their bites, we probably would not have faced a Zika crisis close to the level at which it is occurring today. If the presently suggested timeline of vaccine development within a year or so is credible, there should have been a vaccine available
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