The first documented cases of local transmission of Zika infection in Florida illustrate the need for a coordinated and fully funded plan to deal with the public health threat Zika brings with it. But that doesn’t seem to be happening.
It’s one thing for the International Olympic Committee to ignore the danger of staging the Summer Games in Rio. But it is quite another for elected public officials in this country to walk away from their jobs with no real plan for funding what to do when — not if, but when — there is a Zika outbreak among pregnant women, threatening to deform their babies.
We already know enough about Zika to demand more action. We know it can be spread by mosquitoes and transmitted sexually by people who show no signs of illness or disease. We know it can get into the blood supply. We know there is no vaccine or cure, that mosquito-control programs will help, and that safe sex is a good idea. We know that all of us should take precautions while working or playing outdoors in areas where Zika-carrying mosquitoes can breed.
And we also know this: We need a sizable infusion of federal and state dollars to put what we know into action. Unfortunately, when Washington and the states can’t agree on what to do about a potential epidemic, history shows that that the burden of dealing with it falls heavily on public hospitals, public health departments, and local safety-net providers. That’s what happened 30 years ago with HIV/AIDS. Many of these providers are already overwhelmed dealing with poor and uninsured people with chronic conditions, like cancer, heart disease, and diabetes. Will the funding for programs these people depend on be set aside to deal with the more imminent threat of Zika? Should it be?
Florida officials have now confirmed more than a dozen cases of local transmission just north of downtown Miami. But weeks before that, public health departments in South Florida had to scramble teams of epidemiologists to investigate hundreds of potential cases, to set up testing protocols to make sure no one is missed, and to step up efforts at mosquito control in the region’s wetland-rich breeding grounds. Those efforts will be more important than ever — and more costly — now that Zika-carrying mosquitoes have made their way into Florida’s tropical climate. If a locally widespread outbreak happens, it will be South Florida’s largest public hospital, financially stressed Jackson Memorial in Miami, which will once again have to muster the expertise and financing to deal with a major public health threat.
Lest we calm our fears by wishful thinking that perhaps the transmissions will be contained to a small section of Miami, remember how wrong we were to think in the early 1980s that the first widespread cases of HIV among Haitian immigrants was mostly a South Florida problem. Keep in mind, too, that Miami is one of the biggest ports of entry into the US from South and Central American countries where Zika is widely circulating. This includes returning visitors from Rio de Janeiro, which is expecting a half million tourists for the Summer Games. Brazilian health authorities have acknowledged more than 30,000 cases of Zika in the region around Rio.
The International Olympic Committee ignored pleas by scientists and public health experts to postpone or move the games with what amounted to a claim that the event was too big to fail. But Congress lacks even that flimsy excuse for its failure to take timely action in this country. Despite President Barack Obama’s request for $1.9 billion in funding for Zika prevention and detection programs, Congress adjourned in July for seven weeks with no plan for how much the federal government is willing to spend.
Republicans in Congress once again balked at more public funding for a public health emergency, asking that the total appropriation be much less than what Obama was seeking. They insisted that any funding for Zika be offset by reductions elsewhere in the budget. This line of reasoning about zero-sum budgeting has gained popularity in recent years among the most zealous conservatives in Congress, even extending to special disaster assistance money going the Federal Emergency Management Agency after natural disasters. This crowd wants to hold the public health response from the Centers for Disease Control and Prevention and other federal health agencies to that same standard, despite the fact that in outbreaks like Zika and Ebola, speed matters and delays cost lives.
Even worse, when it appeared that a compromise on the funding level might be reached, conservative House Republicans attached deal-breakers to the measure — such as inserting language abolishing public funds for Planned Parenthood and some Obamacare programs — which Democrats correctly would not tolerate.
Holding funding hostage for important public health initiatives like prevention of Zika has become a standard tactic in a Congress that places a higher priority on ideological obstruction and zero-sum budgeting for anything but military spending.
Zika does not care about politics. Your children and grandchildren will pay the price for inaction.
Arthur L. Caplan is director of the division of medical ethics at the NYU Langone Medical Center. Mike King is a journalist and author of the recently released book, “A Spirit of Charity: Restoring the Bond between America and Its Public Hospitals.”
