The World Health Organization did the right thing back in February when it declared the Zika outbreak to be a public health emergency of international concern. It did the wrong thing last week when it ended the emergency.
I say that for several reasons, not least of which is the signal given by the latest declaration: that Zika is no longer a pressing global concern.
A legal technicality. I understand why the WHO Emergency Committee terminated the emergency. It felt obliged to follow the International Health Regulations, a move likely to set a precedent for future outbreaks. Zika is now endemic, and has been for many years. The major spread of the disease in Latin America and the Caribbean was an important reason to declare an emergency. Another was that the clusters of children born with small heads and major cognitive problems (microcephaly) were extraordinary events that required urgent research. The Emergency Committee felt that once those extraordinary events were confirmed as being linked to Zika and that the Olympics, which required emergency recommendations, were over, the requirement for a public health emergency of international concern — an unusual or unexpected event of international concern — was no longer met.
As a matter of law, the WHO director-general has considerable discretion on how to interpret the international health regulations that define public health emergencies of international concern. Zika offered a perfect opportunity to use that discretion. Moreover, the WHO has never been consistent in its interpretation of these regulations, as I describe later about polio and MERS.
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Too early. The southern regions of the globe will soon enter the summer season, which is peak time for mosquito breeding and biting. So far, there are no indicators that Zika won’t re-emerge with a vengeance. And those regions — Latin America, southern Asia, and southern Africa — tend to have poor countries that are least prepared to fight a Zika epidemic.
No vaccine. Despite hard and sustained work by research teams around the world, a vaccine against Zika is not on the horizon. Calling off the emergency without the means to prevent an epidemic doesn’t make sense.
Harmful signal. Despite the potentially devastating effect of a Zika infection — babies born with microcephaly — the world has devoted scant political and economic resources to this disease. Declaring that the emergency is over will be a signal to the world that it is all right to pull resources back from fighting Zika, no matter what the WHO says. Canceling the emergency lets uninformed politicians say, “It’s no longer an emergency. Let’s devote the funds to other priorities.” That’s a likely scenario for the incoming Trump administration, which has shown its antipathy, if not hostility, to global and United Nations institutions.
Deciding that the outbreak of a disease is or is not a public health emergency of international concern should be squarely based on science. Yet all too often it has a political dimension as well. In May 2014, for example, WHO declared an emergency for polio, even though only a small number of cases had emerged. That emergency is still in effect. The Gates Foundation, Rotary International, and other politically powerful organizations have poured enormous resources into polio eradication. A year earlier, WHO did not call an emergency for Middle East respiratory syndrome (MERS), even though the virus that causes MERS fulfilled all the requirements for an emergency. Saudi Arabia is the epicenter of MERS and it is widely believed the Saudi government exerted political influence to prevent an emergency declaration.
Although understandable, it is disconcerting that the WHO terminated the Zika emergency so quickly. Zika, with its effect on mothers and babies, has an enormous political — not to mention economic, social, and moral — dimensions.
Calling off the Zika emergency means dismantling the Zika Emergency Committee. That in itself is a handicap to the global response because the committee, chaired by David Heymann, has been a strong, intelligent, and powerful voice that kept Zika on the front burner.
Ebola taught us that the world is woefully unprepared for epidemics and that, in addition to causing death and suffering, epidemics cause enormous economic and social upheaval.
Declaring an outbreak to be a public health emergency of international concern sounds the alarm to the world to be watchful and prepared to act with manpower, funding, and political support. Discontinuing the alarm too soon sends the opposite signal, and could be an excuse for political leaders to pull back on national and global preparedness and response. To his credit, Dr. Peter Salama, executive director of the WHO’s health emergencies program said, “Zika is here to stay, and the WHO’s response is here to stay.” That is the right sense of urgency, but sadly the WHO has given a subtle signal that the world can go on with business as usual.
Lawrence O. Gostin, JD, is University Professor at Georgetown University in Washington, D.C., where he directs the O’Neill Institute for National and Global Health Law.