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The World Health Organization has warned that Zika virus and associated microcephaly clusters pose a public health emergency of international concern.
Prof. Peter Horby, Professor of Emerging Infectious Diseases and Global Health, Centre of Tropical Medicine and Global Health, University of Oxford, said:
“In my view the decision by WHO to declare a global public health emergency is right. The rapid spread of Zika and the alarming number of babies with microcephaly puts us in uncharted territory. It’s an extraordinary situation that demands an extraordinary response.
“The declaration by WHO of a public health emergency will inject some much needed urgency and funding. There will be no quick-fix for a problem like this but the WHO declaration puts us on the right footing.”
Dr Gail Carson, Head of the ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) Coordinating Centre and Consultant in Infectious Diseases, University of Oxford, said:
“Ebola and Zika are very different yet both merit a coordinated, global response led by the WHO.
“The Zika-associated microcephaly declaration of a PHEIC was expected and I suspect is welcomed by many, as it should help the global scientific community answer the key questions about this infection quickly.
“Collaborations already working together on Zika will continue and we will see many more form as we try to control and understand this virus.”
Prof. Luis Cuevas, Professor of International Health and Epidemiology, Liverpool School of Tropical Medicine, and visiting Professor of Epidemiology, University of Sergipe in northeast Brazil, said:
“WHO Director General has accepted the recommendation to declare the outbreak of microcephaly as a public health emergency of international concern. The declaration highlights the urgency to confirm the link between Zika infections during pregnancy and microcephaly. This measured reaction is a reflection of the limited evidence available to date and recognises we still have major knowledge gaps in this outbreak. To date only a minority of the nearly 4000 children affected have been shown to be infected with the virus and, although studies are progressing, only 270 have been confirmed to have neurological problems. We are still a long way in establishing the magnitude of the association and if there are other factors that worsen the effect of an infection.
“Declaring that the increase in cases of microcephaly is a concern, and not the spread of the Zika virus, recognises that the cluster of children with microcephaly is very unusual and that the priority is to confirm and explore the magnitude of this association. What is urgent is to deal with the uncertainty and to rapidly generate information of the consequences of infection in pregnancy.
“The declaration will trigger increased surveillance of cases, promote and intensify research, including case control studies comparing children with and without microcephaly to see how they differ, and highlighted the need to speed up the development of diagnostics and vaccines.
“Also very importantly, there are to date no travel restrictions and thus avoiding mosquito bites and vector control continue to be priority to reduce the spread of infection.”
Dr Nathalie MacDermott, Clinical Research Fellow, Imperial College London, said:
“It is welcome news that the WHO International Health Regulations Emergency Committee has recommended the situation in relation to Zika virus and possible association with microcephaly be declared a public health emergency of international concern and that the WHO has accepted this advice. While the link between Zika virus and microcephaly has not yet been proven, the circumstances of the association make it highly plausible and the impact of the association has significant implications for pregnant women and women desiring to become pregnant in the affected countries.
“It is essential that further research is now rapidly undertaken to determine if Zika virus does have a direct association with congenital malformations such as microcephaly. This research must take the form of assessing the currently reported suspect cases of microcephaly, now amounting to over 4000 in Brazil alone, to establish if these infants definitively meet the definition of microcephaly, what neurodevelopment impairments they may have and whether they are suffering from any other malformations. This will provide information on the true increased incidence of microcephaly in Brazil in the last year. Further prospective research must then occur using animal models to determine if Zika causes damage to an unborn infant when infection occurs in pregnancy and at what stage, as well as studies of pregnant women who have unfortunately been infected with Zika virus to determine the outcomes of their pregnancies. Women who have been unfortunate to become infected during their pregnancy should be counselled regarding the possible implications and will require close antenatal monitoring of their infant to enable early identification of any problems.
“It is important pregnant women take measures to try and prevent being bitten by mosquitoes in affected countries by wearing long sleeves and trousers as well as mosquito repellent. Vector control measures, as many South American countries are already undertaking, are essential to try and reduce the mosquito population and so reduce the number of cases of disease. A robust strategy to intensify and maintain these measures needs to be in place for all affected countries. Similarly an internationally coordinated strategy needs to be in place to rapidly advance potential vaccine candidates once they are developed.”
Prof. Peter Piot, Director of the London School of Hygiene & Tropical Medicine, said:
“The WHO’s announcement is welcome news. It will draw worldwide attention to Zika, encourage international collaboration and allow holidaymakers and travellers to make informed decisions. It will also release funds to intensify research efforts. This is crucial as there is no vaccine, no known cure or good diagnostic test for Zika.
“We need to be clear – Zika is not Ebola and the risk to the general population is low. Only about one in five cases show any symptoms at all, which are normally very mild – malaise, rash, low fever, itching and red eyes. However, this outbreak in South and Central America is unprecedented and, coupled with this potential link with microcephaly, it is right that a public health emergency was declared.
“There is a danger of Zika spreading to countries with less developed healthcare systems, including in Africa. This could have serious financial and health implications in some of the poorest parts of the world. The WHO’s decision could help prevent this happening. When it comes to Zika, we need to be ahead of the game.”
* Prof. Piot’s comment was amended at the request of LSHTM to state that a public health emergency was declared, rather than that the outbreak of Zika virus itself had been declared an emergency (16:00 02/02/2016)
Dr Ed Wright, Senior lecturer in Medical Microbiology, University of Westminster, said:
“With 23 countries in the Americas now reporting human cases of Zika virus infection, a prediction of 3-4 million cases in the next 12 months and the WHO’s announcement that it considers this outbreak a “public health emergency of international concern” due to the possible link to microscopy in newborns, this gives some indication of the potential devastating impact this virus could have. This is especially alarming with the outbreak of Ebola in West Africa so fresh in our minds. However, it is important to note some key points.
“Towards the end of 2014 it was predicted that the number of Ebola cases could rise to over one million by 2015 but the true number was only a tiny fraction of that. Hopefully the prediction regarding the number of Zika virus cases will be an over estimation too.
“Further to this, the scientific evidence to-date suggest that the virus is only being transmitted by one type of mosquito. This not only naturally limits where the virus can circulate but for people living in these areas, simple strategies such as repellents, clothing that covers all exposed skin and sleeping under bed nets can greatly reduce their chances of becoming infected.
“Finally, the link between Zika virus infection of pregnant women and neurological and physiological development in a small proportion of their babies, is serious but so far unproven. The announcement by the WHO today will enable more funding and resources to be used to answer this vital question.
“The fast reaction of global public health organisations to this outbreak and observation that pregnant women could be at greater risk of complications, and therefore given additional advice and support, should minimise the burden Zika virus has on populations where it has been found.”
Prof. Michael Bonsall, Professor of Mathematical Biology, University of Oxford, said:
“Now that microcephaly associated with Zika has been declared as a PHEIC by the WHO it warrants immediate and swift action. I agree with all the points raised by the WHO.
“Unlike Ebola this disease is spread by a mosquito vector, not direct contact between infected people. This is requires different public health intervention.
“Human populations remain highly susceptible (there is limited immunity) and the effective initial line of defence to suppress this infectious disease will only be achieved through vector control.
“Developing globally coherent and joined up interventions that use all available tools and technologies to suppress Aedes mosquitos should be considered. It is vital and swift and effective cost-benefit analysis of these approaches are considered and implemented.
“The WHO, PAHO and all countries now have a major role to play in developing the coordinated vector control responses.”
Prof. Jonathan Ball, Professor of Molecular Virology, University of Nottingham, said:
“Whilst a direct link between Zika virus infection in pregnancy and babies born with microcephaly needs to be established, the severity of the disease and the strong association with recent and ongoing Zika outbreaks is clearly sufficient cause for concern to declare an international health emergency.
“This makes sense as it will help mobilise international effort and collaboration.
“Regarding the reluctance to impose travel or trade bans, the real difficulty is balancing the risk of further international spread with the needs of the those countries experiencing the worst of the current outbreak. A kneejerk response would be to ban travel and trade with countries affected, but the truth is that the potential problem is much wider. It wouldn’t really be feasible to lock down the affected countries to try to stop the spread of a virus that is carried by the Aedes mosquito, especially when affected and unaffected countries border one another.
“Until populations can build up sufficient immunity, either through natural infection or through vaccination then the risk to pregnant women is real and therefore this group need to take extra care to avoid becoming exposed.”
Prof. Trudie Lang, Director of the Global Health Network, University of Oxford, said:
“It is excellent news that the WHO have taken this step to make this announcement today. There are many key research questions that must now be addressed in order to understand, manage and ultimately treat and prevent this apparent effect that the Zika virus is having on fetal development during pregnancy. This essential research needs to be coordinated, supported and prioritised and this will require rapid international collaboration and strong leadership from a neutral organisation, and this surely must be the WHO rather than any one country?
“We made all these points after the Ebola outbreak and we now need to ensure that we are now applying the lessons we learned. Making the step from standard clinical observations about individual cases to gathering samples and patient data for research is a difficult step and a major undertaking that typically takes many months and requires skills and experience in conducting clinical research. Fortunately there are many highly experienced research organisations in these regions, such as FioCruz in Brazil. Yet in other affected countries the research capacity is not so strong and here more support and guidance will be needed. There needs to be international collaboration and sharing of research methods and skills to help these studies begin as quickly as possible. Data collected by any one group should be taking the same measurements and making the same assessments in the same so that it can be pooled together with other results to give strong evidence and generate answers more quickly. This needs coordination and open access to research tools and documents.
“Unless we now put mechanisms in place to lead and coordinate this effort and make funds available to those conducting the research in the regions and those who are providing platforms, capacity development and expert support than this process will be too slow, and yet again we will fail to gain crucial evidence in this very difficult situation of an emerging crisis in an infectious disease outbreak.”
Dr Jeremy Farrar, Director of the Wellcome Trust, said:
“The WHO faced heavy criticism for waiting too long to declare the Ebola outbreak a public health emergency and they should be congratulated for being far more proactive this time. Today’s declaration will give the WHO the authority and resources it needs to lead the international response to Zika.
“Research efforts should focus immediately on trying to resolve the many unanswered questions about the infection, including the suspected link with microcephaly as well as determining the true incidence and geographical spread. Armed with this information, the world will be much better placed to develop preventative strategies and control measures to contain the spread of infection within the Americas and beyond.
“There is a long road ahead. As with Ebola, Zika has once again exposed the world’s vulnerability to emerging infectious diseases and the devastation they can unleash. Alongside the emergency response that Zika necessitates, we must put in place the permanent reforms, health systems strengthening and proactive research agenda that are needed to make the global health system more resilient to the threat of future pandemics.”
Dr Derek Gatherer, Lecturer in the Division of Biomedical and Life Sciences, Lancaster University, said:
“A PHEIC is like a declaration of war, in this case on Zika virus. As in real wars, a formal declaration is not necessary for hostilities to begin, and conversely formal declarations of war can be followed by periods of “phoney war” where nothing happens. The war against Zika has already begun, at street level across Latin America and in many research labs across the world. This is unlikely to be a “phoney war” from WHO’s point of view either.
“Sensitivity to the criticism of their Ebola response, where the PHEIC only came 9 months into the outbreak, means that we can expect to see some vigorous activity in the coming months. Several issues demand urgent answers:
“1. What is the true level of Zika infection in Latin America? Case numbers have inflated vaguely upwards to “possibly around 2 million” but a country-by-country and region-by-region breakdown of suspected cases is needed if we are to track Zika accurately.
“2. What proportion of suspected cases can be confirmed at the molecular level? In the Ebola outbreak, differences in reporting and testing standards between the three countries left us guessing about true incidence and distribution.
“3. Genome data needs to be released promptly. Questions about how Zika may or may not have mutated can only be answered in the light of virus sequences.
“4. What are the vectors? We are still working on the assumption that Aedes aegypti is the main vector but we know that in Africa there are various Aedes vectors of Zika. Stories of potential Culex transmission, or Aedes albopictus transmission, have circulated without substantiation. This is one of the most urgent questions, as without an answer we are left largely guessing at the final extent of the outbreak.
“5. The microcephaly association must be rapidly confirmed. Conspiracy theories are already appearing and these can only be quashed with accurate data and robust statistics, backed up by molecular evidence of the virus’ action on the fetus.
“6. Vaccine research and production must be given the same priority that it was with Ebola. Zika may not kill many, and the outbreak may peak and recede as the dry season begins, but its legacy of microcephaly may be with us for years in a generation of affected children who will need lifelong care.”
* http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/
http://www.who.int/mediacentre/news/statements/2016/emergency-committee-zika-microcephaly/en/
Declared interests
Prof. Peter Horby: “I’ve no interests to declare.”
Dr Gail Carson: “I am on the GloPID-R Secretariat, which is a consortium of funders, but I speak solely with my ISARIC hat on. As ISARIC we may receive grant money.”
Prof. Luis Cuevas: “I declare I don’t have conflicts of interest.”
Dr Nathalie MacDermott: “I am undertaking a PhD in Ebola virus disease at Imperial College London funded by the Wellcome Trust. I was employed by Samaritan’s Purse International Relief, working in Liberia as part of their Ebola response team, in July 2014 and from October 2014 to March 2015.”
Prof. Peter Piot: “Chair of MRC Global Health Group, board member of Biocartis”.
Dr Ed Wright: No conflicts of interest.
Prof. Michael Bonsall: “I was the Specialist Adviser to the inquiry on Genetically Modified Insects by the House of Lords Science and Technology Committee, and am a member of ACRE (Defra’s committee on releases into the environment). The Advisory Committee on Releases to the Environment is independent scientific committee that through EU derivatives and national UK legislation is mandated to provide the UK government/ministers with advice on the environmental risks (to wider receiving environments/human health) of non-native and GM releases. I have been a member of this committee since December 2007. I have carried out occasional consultancy work for WHO, NIH, and EFSA, including work on GM-based control methods for mosquitoes. I have received research funding from BBSRC (including working with Oxitec on GM insects), Oxford Martin School, NERC, the Royal Statistical Society, and the Royal Entomological Society. For full details off all my interests, please see: http://www.parliament.uk/documents/lords-committees/science-technology/GMInsects/michael-bonsall-specialist-adviser-interests.pdf.”
Prof. Jonathan Ball: “No conflicts of interest”.
Prof. Trudie Lang: “Trudie is Professor of Global Health Research at the University of Oxford, is a member of the ISARIC (International Severe Acute Respiratory and Emerging Infection Consortium) network and director of the Global Health Network.”
Dr Jeremy Farrar: Dr Jeremy Farrar chairs the Scientific Advisory Group of the World Health Organisation’s research and development blueprint.
Dr Derek Gatherer: “No relevant conflicts of interest.”