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–Barré 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–Barré 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.
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-à-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. 4 Stringent accountability mechanisms should be put in place by both national governments and aid donors to minimise mismanagement and corruption. In addition, countries need to make their own long-term investments to generate and use surveillance data rather than use ad hoc funds that are prone to mismanagement.
The threat of Zika in Africa is also an opportunity to evaluate the continent’s positions on issues related to climate change. According to the World Health Organization (WHO), a 3.6°F–5.4°F rise in temperature can increase the number of people at risk of malaria by more than 100 million. Similarly, warmer weather can speed up the mosquito breeding cycle from about 2 weeks at 77°F to 7–8 days at 82.4°F. 5 There is a need for progressive climate change policy and legislation to mitigate its health effect on the continent.
The recent increase in Field Epidemiology Training Programmes in various African countries is a welcome development. Through the technical support of organisations like the US CDC, the programme has the potential to improve local talents and human resource capacity needed to respond timely to emergencies. Similarly, the emergence of Zika is an opportunity to strengthen research capacity of scientists to investigate the link between the Zika virus and microcephaly on the African continent.
Additionally, globalisation, urbanisation and cheap international travel may worsen the spread of Zika between African countries through sexual transmission. African countries must embark on effective public health awareness and educational campaigns, as well as risk communication, to their citizens.
While there is no Zika virus vaccine at the moment, there is sufficient information on the natural history of its vectors. 6 Some of the prevention and control strategies that are used to target malaria-causing mosquitoes are also effective against Zika-carrying mosquitoes. African countries need to intensify their mosquito control efforts using an integrated vector management approach as recommended by WHO. These include personal protection and prevention strategies that combine the use of environmental management tools and physical barriers with chemical tools such as insecticide-treated nets in every home; environmental management strategies that can reduce or eliminate mosquito breeding grounds, as well as the use of biological controls such as larvivorous fish that target and kill mosquito larvae without generating the ecological impacts of chemical use.
The most emerging realisation from the ongoing Zika virus debate is that the African governments cannot afford to go to sleep thinking that Zika is a disease of the Americas. The time to take proactive steps against the Zika virus is now.
Responding to the Zika virus with ad hoc solutions is not sustainable and as Ebola showed, there is no substitute to developing national health system capacities.