H

ealth officials trying to raise money to respond to the Zika outbreak say that their appeals are largely falling flat — and that the effort is shaping up as one of the most challenging hat-passing exercises they have ever seen.

Congress, which has been in a protracted partisan fight over Zika funding, seems certain to give the Obama administration far less than it requested. The World Health Organization has received a measly 13 percent of the nearly $18 million it requested from donors.

And other United Nations agencies — seeking money to help with mosquito control or promote access to condoms in affected countries — aren’t seeing fat checks ripping out of checkbooks.

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Dr. Bruce Aylward, the WHO’s assistant director general responsible for outbreaks and health emergencies, pointed to what he called a Bermuda Triangle-like confluence of issues hampering the fundraising efforts.

Although the Zika virus causes devastating birth defects for some newborns, the vast majority of those infected experience either no symptoms or mild illness. There are only limited ways to respond to the outbreak. And it is occurring mainly in Latin America, where some countries are not eligible for development financing.

“This is not West Africa,” Aylward said.

“Everything about the financing is difficult,” the 24-year veteran of the WHO told STAT. “This is not a short-term, humanitarian life-saving response. This is something very different.”

During West Africa’s horrific Ebola outbreak, money set aside for humanitarian crises could be drawn to fund the response. But Aylward said those funds are generally not used for the kind of efforts that could be most effective in preventing Zika-related birth defects  — mosquito control and condom access, for instance.

Others looking at the faltering fundraising efforts raise the specter of donor fatigue. Donors’ pockets have been picked at over the past few years with the Ebola crisis, Syria’s civil war, and the displacement of millions of refugees, as well as the ongoing and expensive effort to try to eradicate polio, which has cost $14 billion so far.

Some countries may be uncertain about how seriously to take the Zika outbreak, said Preben Aavitsland, Norway’s former chief epidemiologist and a professor of medicine at the University of Oslo.

There remain many unanswered questions about Zika, he noted, including what percentage of women infected during pregnancy will give birth to an affected child and whether previous circulation of a different strain of the virus in Africa and Asia means the outbreak won’t take off there.

“The paradox is that we can overcome these uncertainties only by good surveillance and rapid, high-quality research. And that requires donor support. It’s almost a catch-22,” Aavitsland said in an email.

“There is the public perception of this epidemic,” he added. “It’s not like Ebola, where people are dying in the streets of the poorest countries of the world. No one is dying from Zika.”

Dr. Tom Frieden, director of the Centers for Disease Control and Prevention, agreed that in some quarters, Zika may not be seen as the urgent situation public health leaders believe it to be.

“I do think the nature of the emergency is not so clear to people,” he acknowledged. “This is an emergency for pregnant women.’’

Frieden, who has been pushing Congress to fund the Zika response, said he believes politicians on both sides of the aisle in Washington understand the threat, however.

“I do think they get that it’s an emergency,” he told STAT. “I just think Congress doesn’t always have the ready means to deal with emergencies.”

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The fact that there are no easy solutions and no obvious quick fixes to the threat Zika poses may also be slowing the influx of funds, Aylward said. In addition to formulating an immediate response, countries will have to deal with the long-term care of the children who have been born with microcephaly, or the range of other birth defects that are coming to be associated with Zika infection during pregnancy.

“I have to say: When you meet legislators and donors and the rest, people are super concerned. And I think part of the concern is ‘God, how do we tackle this?’” Aylward said.

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