Zika virus is making headlines all around the world. In Latin America, Zika caused little less than a turmoil. In less than a year, perception veered from one more dengue-like discomfort to that of a devilish threat, particularly so since its possible association with microcephaly. Not unsurprisingly in times when health is increasingly seen as a security issue – and certainly not after the Ebola debacle – national and international actors react hard and fast. Existing chemical vector control measures are boosted, women (no, not men) are asked to delay pregnancies and – not everything is bad news – airfare to Latin America all of a sudden is becoming affordable.
What receives far too little attention is the fact that the Zika crisis – and the response to it – generates fear, confusion and uncertainty for the poor actually living through it, especially women. Little justice is done to gender, sexual and reproductive health issues, major inequities in the living and sanitary conditions of the poorest and criticism towards mainstream control strategies.
Delaying pregnancies is one containment measure. Several Latin American countries have asked women to delay pregnancies until there is a better understanding of Zika and its relation to microcephaly, and the transmission of the virus in utero. It is good to realise that Latin America is the same region that saw abortion banned in Chile, Surinam, El Salvador, Haiti, Nicaragua and the Dominican Republic, where access to contraceptive methods is generally inadequate, and which already has the highest proportion of unintended pregnancies (56%) in the world. It’s also the region where ‘Christian’ beliefs are most influential in policymaking, and pope Francis’ comment that in times of Zika “avoiding pregnancy is not an absolute evil” caused panic among local church officials .
With Zika being the latest addition to Aedes-spread infections in Latin America (yellow fever, dengue, chikungunya), vector control is key to the public health response. Ever since the construction of the Panamá Canal, chemicals have occupied a central role, either through spatial fumigation or adding them to drinking and non-drinking water storage containers. Most commonly used in the region were organophosphates like Temefos and Malathion, and they keep being used despite well-known harmful effects on humans and ecosystems, and increasing resistance of the mischievous Aedes. A pesticide of more recent use in chemical vector control is pyriproxyfen. In Brazil, where pyriproxyfen was introduced in drinking water in 2014, Abrasco (Associação Brasileira de Saúde Coletiva) made a case for paying more attention to the association between poverty, intensity of chemical disease control and incidence of microcephaly (in a February 2016 Technical Note ). Abrasco’s thoughtful questioning of mainstream disease control was dismissed as a complot theory, the suggestion that pyriproxyfen could be part of the problem debunked as a myth. While indeed the case for a causal link between the Zika virus and microcephaly is getting stronger, defenders of pyriproxyfen have weak arguments. The WHO, in its emergency update ‘No evidence that pyriproxyfen insecticide causes microcephaly’ , bases its claim on 2008 ‘Guidelines for Drinking Water Quality’ . Those guidelines however extrapolated the safety of pyriproxyfen from tests in rats and rabbits only, and clearly state that “this guideline value is not intended to be used when considering the use of pyriproxyfen as a vector control agent”. From a scientific point of view, it is a pity that the mounting evidence against culprit Zika eclipses critical attention for the impact of pesticides. From an ethical point of view, it is a shame.
What is common to most Zika control measures so far – vector control and others – is a total neglect of the people involved. Women are told to postpone childbearing, but denied family planning. Favela shacks are sprayed without consent, while their inhabitants are denied a life worthwhile living. This is of course nothing new in disease control; it is rather a déjà vu. Nearly 100 years ago, Juan Bautista Justo was one of the first to criticize Rockefeller public health in Latin America for turning a blind eye to the people. What was needed, Justo argued with strong political arguments, was social change for improved health. He was laughed away.
We should be wiser today. On top of the arguments Justo already had, we have a century of failed disease control, including old and new emergencies, and know much more of social and environmental impact than was the case then. For public health to be effective, it should be with the people, not against them.