What Do You Do with a Problem Like Zika?

28 November 2016, 0156 EST

Two years ago, more people probably knew that Stephen Breyer is on the Supreme Court (hint: it’s a really low number) than had even heard of the Zika virus. I certainly hadn’t, and I make my living studying global health politics. The entirety of published research on Zika could fit in a shoebox. Since the first reports of the virus appeared in Brazil, though, Zika has grabbed international attention, leading to travel warnings and even causing some athletes to pull out of the 2016 Summer Olympics in Rio.

Zika’s emergence changed the dialogue on global health and forced states and organizations to get involved. On 1 February 2016, the World Health Organization (WHO) declared Zika-related microcephaly to be a Public Health Emergency of International Concern (PHEIC). Nine months later, WHO ended the PHEIC for Zika, arguing that the organization should shift to a “robust longer-term technical mechanism.” Is WHO’s decision a reflection of the changing strategy necessary to tackle Zika, or is it evidence that the organization is waving the white flag and admitting defeat?

WHO’s decision to end the PHEIC (an acronym which, it must be said, doesn’t exactly roll off the tongue) has not been popular. Lawrence Gostin of Georgetown University and one of the leading experts on global health law called the move premature and worried that it would lead governments to reduce their funding and research. He also called international society’s response so far lethargic and unlikely to get better without a PHEIC. Laurie Garrett of the Council on Foreign Relations described it as “not good news” and a reflection of defeat. UNSW Australia’s Catherine Bateman Steel shared Gostin and Garrett’s sentiments, and highlighted how WHO’s decision reinforced the organization’s inability to address the gender dimensions of global health.

Bateman Steel, Garrett, and Gostin raise really important concerns, and WHO’s track record on addressing recent disease outbreaks may not exactly inspire confidence. That said, WHO’s decision makes sense—if it is part of a larger strategy. PHEICs can be useful for generating attention, but they aren’t designed for sustaining the sort of long-term engagement that Zika-related microcephaly will require. So long as ending the emergency declaration is not also the end of attention, WHO’s decision is probably the best one to make at this point.

I can’t talk about global health politics without talking about the International Health Regulations (it’s why I’m so much fun at dinner parties), and this case is no different. The entire concept of PHEICs comes out of the IHR.

Think of a PHEIC as WHO telling international society that we need to go to DEFCON 1 on a global health issue. When states detect a disease outbreak that has potential international consequences, governments are obligated to report that to WHO, and WHO keeps an eye on the disease. In the most extreme cases, the IHR’s Emergency Committee may decide that an outbreak is an “extraordinary event” because of the risk it poses and the need for a coordinated international response. In that case, it declares a PHEIC—essentially telling the rest of the world that this is a top priority and needs immediate attention and resources. Since the current version of the IHR came into effect in 2007, WHO has only declared four PHEICs: H1N1 influenza in 2009, polio in 2014, Ebola in 2014, and Zika-related microcephaly in 2016.

It is precisely the emergency element of a PHEIC declaration that is both useful in the short-term and potentially counterproductive in the longer-term. A PHEIC is a way to reach through the clutter and clarify where international society should be focusing its attention. It is designed as a shock to the system and make coordination among global health organizations a bit easier than its standard cat-herding nature. WHO doesn’t have the resources or personnel that it can shift around on its own when emergencies arise. Declaring a PHEIC is a tool WHO can use to get those states that do have money and personnel to deploy them. This is exactly what happened when WHO declared Zika-related microcephaly a PHEIC. It was not perfect, by any means, but it got governments that knew nothing of Zika to start thinking seriously about it.

You can only keep an emergency going for so long, though. There is so much that we still do not know about the connections between Zika and microcephaly, and that sort of research will take patient, long-term strategies. That doesn’t mean that international society should sit on its hands until it has all the answers, but it does mean that the sorts of strategies that it will need to pursue will change. Zika research needs long-term, dedicated funding. It’s part of the new microbial normal that we will face. Creating a vaccine against Zika, which Garrett advocated in a story for Foreign Policy in January, won’t happen overnight. Zika’s PHEIC has obvious gender dimensions since it focuses solely on the virus’ effects on the foetuses being carried by pregnant women, but addressing these gender-based inequities in health needs to happen more broadly. Zika should encourage larger changes around sexual health, reproductive freedom, and access to contraception in a broader, horizontal sense—the sorts of changes that don’t happen overnight. These are vital changes, but framing them as an emergency doesn’t foster creating these sorts of long-term, patient strategies.

Rather than decrying the end of the PHEIC, we need to put pressure on WHO, national governments, and groups like the Gates Foundation to maintain their commitments. Let’s make sure those longer-term mechanisms that WHO mentioned actually happen and encourage donor states to keep funding Zika research. Zika may not be the top story in the newspaper, but that doesn’t mean that that problem has gone away.