Chasing our tail: The Zika ‘emergency’ and stalled U.S. Congressional appropriations

23 April 2016, 1500 EDT

On April 13th, the Centers for Disease Control reported 358 travel-associated Zika virus disease cases in the U.S. spanning 40 states and the District of Colombia. The U.S. territories of American Samoa, the U.S. Virgin Islands and Puerto Rico reported 471 locally acquired cases and 4 travel-associated cases. Since Zika is primarily transmitted by the Aedes species mosquito, the numbers of Zika virus disease cases are anticipated to rise once mosquito season is in full swing in the U.S. Yet, Congress has thus far refused to approve the $1.8 billion in emergency funding President Barack Obama requested in February. The House Appropriations Committee has instead asked the President to redirect funds previously designated for the fight against Ebola to the Zika outbreak.

It is puzzling why Zika has not garnered the same policy attention from Congress as the Ebola outbreak. Viewed through a security lens, the Zika outbreak more readily meets the attributes of a “threat” in its proximity to the U.S., in its pervasiveness, and in the fact that it poses a high risk for global transmission. Moreover, mobilization in response to humanitarian crises is generally more likely to occur when it strikes communities in close proximity to us (i.e. South America) or with whom we can identify (i.e. Americans).

Partisan politics might explain some of the Congressional stall tactics, though this would be a high stakes game to play.  So, what’s going on? I think the “emergency imaginary” has both enabled and constrained policy responses. First, because the Zika outbreak does not conform to conventional understandings of an “emergency,” policy action has been slow despite the demonstrated threats to the U.S. population. Second, because the Zika crisis is nonetheless viewed as an emergency, policymakers feel justified in diverting resources from other emergencies, even though it might produce mediocre results in both cases.

An emergency occurs when unexpected events demand immediate attention; emergencies are temporary, abnormal, unpredictable and they have what Rubenstein calls “event-like” features, which she equates with natural disasters and conflicts (in contrast to protracted crises). Importantly, humanitarian emergencies create the ethical obligation to save lives and reduce human suffering, which Calhoun argues are key features that distinguish humanitarian actions from human rights and development.

I submit that the more “emergency” features a crisis has, the more policy attention it will receive. While the Zika outbreak is abnormal and unpredictable, it has a low mortality rate. Scientists have recently confirmed a causal link between exposure to the virus and development of microcephaly, a condition that causes babies to be born with abnormally small heads and Guillain-Barré, which causes paralysis in adults. While both diseases cause human suffering, they strike some people and not others and in the case of microcephaly, the effects are not immediate. Therefore, the Zika outbreak does not follow the typical “emergency script,” which requires urgent action to save lives.

This lack of urgency slows down responses. To illustrate, the World Health Organization (WHO) Director-General Margaret Chan declared the Zika virus outbreak a Public Health Emergency of International Concern (PHEIC) in February, but Congress has yet to appropriate requested funding.

While the Zika outbreak might be perceived as a low-grade emergency, it still has more emergency features than the intermittent flare ups of Ebola that continue to occur in West Africa. Rubenstein argues


The primary effect of event-like features is not to divert resources from development aid to emergency aid, but rather to distort resource distribution among emergencies (that is, among situations of urgent need) from chronic emergencies to event-like emergencies.

This zero-sum logic produces suboptimal policy  that diverts resources from proactive solutions and prevention (stabilizing the situation in West Africa, or getting ahead of Zika in the U.S. by investing in health care systems and infrastructure) to reactive activities designed to put out fires. This week, the Obama administration redirected $510 million funds previously designated for the Ebola intervention to the Zika response efforts. Shifting emergency appropriations from one “emergency” to another undermines efforts to invest in health infrastructure, research, and development programs that might stymie future health crises. As I argue elsewhere, rapid responses to infectious disease threats often fail to address the root causes of the outbreaks.