A recent poll found that 77% of the US public is not seriously concerned about Zika virus. 1 Congress went on summer recess without authorising President Obama's US$1·8 billion emergency Zika appropriation request. By Aug 30, 2016, the US Centers for Disease Control and Prevention had spent $194 million of the $222 million allocated to respond to the Zika virus outbreak. 2 WHO's $122 million strategic plan for response, to be implemented until December, 2017, grossly under-estimates the resources required. Still worse, WHO has raised only $14·2 million in direct contributions for a worldwide response. 3 WHO's emergency contingency fund has a meagre balance of $31·5 million, spread thinly among ongoing health threats. 4 Consequences of fi scal apathy can be measured in lives lost and long-term disabilities. Therefore, prevention of Zika virus infection is a matter of global health security. A major epidemic of Zika virus infection is ongoing in Latin America and the Caribbean including Puerto Rico, a US territory. Thousands of cases of Zika virus infection in continental USA are an early warning. Local mosquito transmissions in multiple communities in Florida are just a few of many potential hot zones in a large swathe of the south and Gulf coasts. The epidemiological pattern in the USA will probably mirror inequalities seen in the region, with low-income pregnant women bearing disproportionate burdens, living without screens or air conditioning in trash-laden, humid neighbourhoods. Health authorities have advised young women to delay pregnancy. Impoverished women, however, do not have reliable access to con-traception, are subjected to acts of sexual violence, and cannot aff ord testing or basic health services. Many Latin American countries have highly restrictive abortion laws. Additionally, US jurisdictions often ban late-term abortion even if the fetus has substantial impairments. The unequal distribution of Zika virus infections could be exacerbated in the USA, with nearly half of the 5·75 million pregnancies a year unintended. Zika-aff ected states have among the highest rates of unintended pregnancy and poverty, coupled with miniscule resources for mosquito abatement. Health coverage for millions of undocumented immigrants is denied and many governors refuse to expand Medicaid (health insurance for the poor) under the Aff ordable Care Act. These policies make reproductive, maternal, and health services unaff ordable or inaccessible. Poor women often have long waits for Zika virus testing, maternal, and other health services. Up to 6% of Zika-virus-infected pregnant women will miscarry or have stillborn deliveries. 5 Actual rates might be even higher. Surviving infants have as much as a 13% chance of Zika-virus-related microcephaly and associated mental, ocular, and hearing impairments.
Gostin, L. O., & Hodge, J. G. (2016, October 1). Zika virus and global health security. The Lancet Infectious Diseases. Lancet Publishing Group. https://doi.org/10.1016/S1473-3099(16)30332-2