What a difference a month makes. At the start of 2016, its likely that Zika virus was on very few of our radars, yet as we reach the close of January, we find ourselves in the midst of an emerging epidemic, where facts about the virus and associated birth defects have combined with larger questions about the politics of public health responses in the wake of a crisis, both on an individual and governmental level. The emergence of yet another widespread epidemic so soon after Ebola leads again to questions how responses are formulated, and who gets priority access to medications and hospital beds in the face of a shortage of resources or available vaccines, not that there is any vaccine available at the moment.
Some have suggested that the arrival of Zika virus is foreshadowing dystopian climate future, where the realm of science fiction is slowly becoming a reality as a result of “pushing the limits of our planets ecology”. This article in the Guardian proposes that the emergence of viruses such as Zika affect society on a much broader scale beyond the immediate health implications, most notably in the increased likelihood that residents of wealthy developed world will travel less frequently to places just starting to emerge from poverty for fear of contagion, leaving the poor and vulnerable bear the brunt.
An article in The Lancet looks at the history of moral panic and pandemics, highlighting the importance of choice of language in shaping how people respond. It brings up interesting ideas regarding how pandemics or epidemics are perceived, something that seems especially relevant as we watch yet another virus emerge hot on the heels of the recent Ebola epidemic. This concern with how early information is disseminated is also referenced in the New York Times where the article highlights the delicate task public health officials have in having to communicate to both the general public and policy makers alike the seriousness of the outbreak so as to mobilize resources, but without causing panic. Everything involved in rolling out an official response needs to be considered, right down to the language used, with the difference between ‘concern’ and ‘alarm’ or ‘association’ and ‘causation’ having the potential to shape public response.
What are the psychological effects of infectious diseases? And how some devolve into moral panics? This is something we may be seeing more of as the debates over how best to tackle Zika move into conversations about abortion and government declarations advising women to refrain from becoming pregnant for several years -recommendations leading to questions over how far states should go in response to health panics. Recent guidelines established by the Centers for Disease Control and Prevention get pretty close to recommending abortion for women who have been diagnosed with Zika, however the language leaves that idea on the table noting that “Referral to a maternal-fetal medicine or infectious disease specialist with expertise in pregnancy management is recommended”. It is this link between the Zika virus and birth defects that has opened up avenues for discussion about abortion, with several articles mentioning how the virus is changing Latin America’s relationship with abortion. The idea of lifting a ban on abortion is the focus for an article in Wired as well, with doctors at a loss for how to protect their patients given that no vaccine exists on the horizon. For clinicians there is the ever-present question of how best to respond and advise in the face of uncertainty. Zika makes the confusion even worse as the virus doesn’t make everyone ill, so not having any symptoms is no guarantee of safety. Are those who choose to get pregnant signing up for a future where they are somehow destined to be blamed? Somehow held responsible for choosing to get pregnant? Once we get into the territory of choice, the virus stops becoming just a public health issue and moves into a more politically driven moral domain. So as we watch what happens in the development and response to Zika virus, there is no shortage of food for thought…
In the meantime, for another look at ethical considerations in public health responses to epidemics and pandemics, this report focuses on ethical considerations in public health response to influenza. And finally, for a look at some ideas proposing 5 myths about pandemics and how they are refuted, have a look here .