To fight Zika, fight poverty and inequality
Marta and João live in a small town in the state of Paraiba, Brazil. Pregnant with their fifth child, Marta showed symptoms of Zika. Her pregnancy was otherwise uneventful, but an ultrasound at eight months picked up symptoms of microcephaly. Marta remembers: “The nurse and the doctor told me not to worry, that he would be normal. But I was worried.”
When Luiz was born, their fear was realized. “We did not expect that this could happen from the bite of a mosquito. The shock is still huge”. At seven months, Luiz requires constant attention. Unsure if he will walk or talk in the future, Marta and João’s worries are compounded by financial woes. “I hope I can work again soon”, Marta laments. “We want to buy a stroller to put the baby in, because he can’t sit. That way I would have a little bit more freedom. But we don’t know how much it costs.”
The couple is unable to make short-term plans to resume paid work, creating uncertainty about their financial stability despite the assistance they receive from the Government. Unfortunately, the struggles of Marta and João are not unique. Poor households, like Marta and Joao’s, are both more likely to be exposed to the virus and least equipped to deal with its impacts.
A Socio-economic Impact Assessment of the Zika Virus in Latin America and the Caribbean: with a focus on Brazil, Colombia and Suriname, a report by the UN Development Programme and the International Federation of Red Cross and Red Crescent Societies, shows that Zika is a disease of poverty and inequality. While no longer considered a Public Health Emergency of International Concern, Zika is still an unfolding crisis. There is no vaccine ready, and the number of babies born with congenital defects, now termed ‘congenital Zika syndrome’ continues to grow. The impacts are life-long.
Governments across Latin America and Caribbean are responding to the epidemic in the context of a region-wide economic downturn, just when renewed emphasis and commitment are needed to ensure that hard won development gains are not reversed. The report argues that inaction is not an option.
Three different scenarios with varying infection rates of the virus were used to model impacts, drawing on macroeconomic estimates to define the short and long-term costs of the Zika epidemic – that include diagnostic and healthcare costs, loss of tourism revenue, lost productivity due to caregivers missing work, and the long-term costs of disabilities. In the best-case scenario, the cost of the current Zika epidemic is estimated at US$7 billion over three years, but could climb to $18 billion in the worst-case scenario. There is approximately $1 billion in extra costs for every 5 percent rise in numbers of people infected.
Beyond economic costs, the Zika virus has the potential to widen gender and health inequities. Evidence indicates that women in the region are increasingly attempting to terminate pregnancies, regardless of restrictive laws; they risk their lives and health in the process. Women already earn less and are over-represented among the poor and unemployed. This inequality could grow, in part, because of the disproportionate demand on women and girls to stop working and serve as caregivers for affected family members.
The report calls for a range of inter-related responses to the social and economic impacts of Zika. It urges wide-reaching action to combat mosquito-borne diseases, as the factors that shape vulnerability lie largely beyond the health sector: housing, sanitation, gender inequality, socio-economic status and urban infrastructure all influence the risk of infection. Some of the poorest and the weakest social protection systems are bearing the highest costs, and women are carrying the largest portion of that burden. Yet adaptation and strengthening of these social protection systems are essential for affected women and their families not to be left further behind.
The report also recommends that ministries of health increase engagement with other line ministries, national institutions and stakeholders, including civil society, international organizations, affected communities and the private sector. Such multi-sector responses have proved effective in responding to malaria epidemics in Africa. Similarly, community participation in combatting dengue has been shown to reduce both mosquito density and transmission of the virus.
The Zika epidemic provides a valuable insight: to prepare for and respond to emerging infectious diseases, health and other development goals must be addressed together. If we fall short of improving daily conditions for families in poverty, do not address gender inequality, and fail to recognize the impact that poor urban environments have on the spread of disease, then public health will increasingly be at risk and social and economic progress for all will remain precarious.
For Marta and João, the daily struggles will continue. Zika reminds us that all countries and peoples remain vulnerable to emerging infectious diseases, and that a disease that primarily affects poorer populations has wide-ranging social and economic implications for entire communities, regions and nations.
This article originally was published in the Huffington Post.