Zika virus in Africa: revitalising the discourse of health systems.

Abstract

The Zika virus in Africa has the potential to create another source of morbidity for a continent affected by poverty. Oluwatosin Omole of the Department of Community and Family Medicine, Howard University Hospital, and Temitope Folaranmi of the OGEES Institute, Afe Babalola University, discuss the level of preparedness needed from African public health systems to respond to this epidemic .Although the current Zika virus outbreak was largely thought of as restricted to the Americas, the virus has spread to the islands of Cape Verde, off the coast of Africa,[1] and may eventually make landfall on continental Africa. The strain of the virus detected on Cape Verde is the same as the one responsible for the cases in the Americas, and over 7,500 suspected Zika cases and 3 cases of microcephaly have been reported.[2]Scientists and public health experts from many African countries have opined that the continent is ready to face the Zika virus but many hard questions remain about the level of preparedness and response when it finally makes landfall. Very much unlike the Ebola epidemic, which was extremely devastating and exposed the vulnerability of the health systems of Guinea, Liberia and Sierra Leone, the challenges of the Zika virus in Africa are different but equally serious. Most importantly, the effects of the Zika virus on pregnant women and women in the reproductive age group and its link to infant microcephaly and Guillain-Barre syndrome are a cause for concern.[3]As various epidemics in the past have shown, the African continent may suffer disproportionately if Zika eventually makes a landfall on the continent. The reasons for this are multiple. First, Africa's climate is conducive to Zika-carrying Aedes mosquitoes. Second, unlike Ebola in which public fear and high mortality rates jolted the governments of many African countries into action with the support of international development partners, the low mortality rate associated with the Zika virus may not have the same effect on the government's desire to take action. Third, the traditional culture in some African communities that permits polygamous family structures may amplify the sexual transmission of the virus and complicate the prevention and control strategies. Fourth, most surveillance systems are not advanced enough to detect changes in the epidemiology of health outcomes associated with Zika such as infant microcephaly and Guillain-Barre syndrome. Fifth, there are various other high-priority endemic diseases with high morbidity and mortality rates on the continent; hence, African countries may not have an incentive to channel funds to Zika given limited resources until it is too late. So, what should African countries, provinces and cities do with regard to the Zika virus?The most critical element needed in addressing the threat of emerging infectious disease such as Zika in Africa is the availability of infrastructure, and this can only be achieved through financing and long-term investments in public health systems. In contrast to the United States and other countries in the Americas, there have been limited reports of funds specifically earmarked by any African country towards activities focused on Zika. At the continental level, the African Union and other regional bodies are yet to start conversations regarding funding Zika preparedness activities, although the African Union recently approved the establishment of the African Centers for Disease Control and Prevention (CDC), modelled after the US CDC.[Image omitted: See PDF.]While the threat of Zika virus causing significant public health emergencies in Africa remains minimal, we would argue that the emergence of the Zika virus on the continent provides an important opportunity for health policy makers to re-evaluate the health system debate in Africa vis-a-vis improved accountability among public health leaders. There were allegations of the wastage and mismanagement of Ebola funds in some of the countries affected during the last Ebola epidemic. …