How did Zika rise so quickly to the top of the global health policy agenda?

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Tessa Vellek

Tessa Vellek

Tessa Vellek is a senior at Duke University with a major in Public Policy and Global Health, and a certificate in Policy Journalism and Media Studies. She conducted research on media coverage of recent Ebola outbreaks for her honors thesis, "Media Framing of the Ebola Crisis." Her health policy experiences include interning with the research and advocacy teams at Janaagraha Centre for Citizenship and Democracy in Bengaluru, India, reporting for The Cancer Letter in Washington, D.C. about news in cancer policy and research, and working as a research assistant for a food policy lab studying SNAP benefits at Duke's Sanford School of Public Policy. While at Duke, she acted as editor-in-chief for Encompass Magazine, a magazine dedicated to investigating ethical issues related to Duke students and faculty, and wrote for The Chronicle, the student newspaper.

The World Health Organization reported the first local transmission of Zika virus in the Western Hemisphere in May 2015. Since then, transmission was identified in 18 countries and further spread is likely. In Brazil, there have been 400,000-1.4 million Zika cases. With the disease’s arrival in Puerto Rico and imported cases in the U.S., the global community faces a pandemic. The U.S. Centers for Disease Control and Prevention issued a level-2 travel alert. The Pan-American Health Organization and WHO convened a joint conference this month to prepare countries for Zika’s arrival. Since 2016, the media has published 380 articles about Zika, showing how the disease is at the forefront, according to LexisNexis. How can we explain the sudden rise of Zika to the top of the global health policy agenda? One way to understand the rise is to apply a framework developed by Jeremy Shiffman and Stephanie Smith that can be used to understand how certain health issues receive attention. Their framework has four categories: the strength of the actors involved in the initiative, the power of the ideas they use to portray the issue, the nature of the political contexts in which they operate, and characteristics of the issue itself.

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The priorities of the policy community converged with the Zika outbreak.

Actor Power

Policy Community Cohesion. The priorities of the policy community converged with the Zika outbreak. International health organizations have standards to address emerging infectious diseases, such as the CDC’s alert levels. WHO, U.N. Food and Agriculture Organization, and U.N. Children’s Emergency Fund’s toolkit for Communication for Behavioral Impact designed communication interventions that support outbreak prevention and control. Over 2,000 experts met in January in the Dominican Republic to brief health officials and providers on diagnosis, treatment, mosquito control, and reporting.

Leadership. Director of PAHO/WHO’s Department of Communicable Diseases, Marcos Espina, led the health officials who met in the Dominican Republic. He, with WHO Director-General Margaret Chan, articulated the need to address this virus and identify its impacts, including its possible link with microcephaly. The 2016 Brazil Olympic spokesperson, Phil Wilkinson, brought Zika to the agenda, dispelling panic about the upcoming games.

Institutions. Global and national health institutions worked to coordinate mechanisms with a mandate to lead the initiative, as exemplified by the PAHO/WHO meeting and the CDC’s travel alert.

Civil Society. Because of Zika’s recent emergence, grassroots organizations have not been at the forefront of agenda setting. However, the American Congress of Obstetricians and Gynecologists as discouraged pregnant women from traveling to regions with Zika due to microcephaly risk. Additionally, the Bill & Melinda Gates Foundation funded studies to determine the potential spread of Zika.

Ideas

Internal Frame. Researchers classify Zika as an “arbovirus”, but there is not a consensus on its complications. Data from French Polynesia and Brazil suggest a connection to neurological disorders, notably Guillain–Barré syndrome. Likewise, the 20-fold increase in microcephaly in Brazil caused concern, although without proven linkage. This lack of consensus represents a problem with the framing of Zika as an illness. Accurate diagnosis is difficult because dengue and chikungunya produce similar symptoms; commercial tests for Zika are not yet available. Health experts agree that mosquito control is an effective policy. The policy community agreed to discourage travelers from visiting infected regions.

External Framing. Public portrayals of Zika virus mimicked those of previous infectious diseases. Media reporting often reveals broader anxieties about the inability of technology to contain epidemics and about the economic threats of globalization. Additionally, Zika’s uniqueness and timing created new frames. The correlation between microcephaly and Zika allowed policymakers and the media to portray Zika as a threat to infants.

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Zika’s timing represented a moment when global conditions aligned favorably for drawing attention to the virus.

Political Context

Policy Windows. Zika’s timing represented a moment when global conditions aligned favorably for drawing attention to the virus. With Ebola’s decline, a slot opened on the agenda for another emerging disease. Furtherm
ore, the possible congenital abnormality complications classified Zika as relevant to infant and maternal health priorities. Another policy window opened with the upcoming Olympics in Brazil, meaning many were looking to this region.

Global Governance. Because Zika is an emerging infectious disease, the international public health organizations have standards for catalyzing collective action.

Issue Characteristics

Indicators. Zika virus’ presence in 18 countries represents a fast-growing pandemic. PAHO recommended surveillance systems in member countries to determine if Zika was introduced, monitor the spread of infection, and monitor neurological syndromes and congenital abnormalities.

Severity. Statistics identifying the total number of Zika cases are not available. Only 1 in 5 people infected with the virus become ill and present with mild fever, skin rash, and conjunctivitis. Zika virus may also have possible neurological complications and congenital abnormalities.

Interventions. PAHO recommended countries prepare health facilities to respond to a rise in neurological syndromes, strengthen prenatal care, and continue efforts to control mosquito vectors. Supportive care measures are the only known treatment.

Conclusion

With support from WHO/PAHO and other important actors, such as stakeholders from the Olympics, Zika has garnered worldwide attention from the policy community and the media. The sudden outbreak of Zika and its potential for spreading, as well as the possible related neurological complications and congenital abnormalities, make it an issue warranting consideration. The combination of actor power, ideas, political context, and issue characteristics have made Zika reach the top of the global health policy agenda.