Zika Virus and the Grinch of WHOville

You’ve heard of How the Grinch Stole Christmas at least a hundred times at this point, yes?   Ever since its conception in 1957, it’s a Christmas classic almost as consistent as Peyton Manning’s appearances in a SuperBowl, or a Clinton’s ability to stir up a D.C. press core.

For the antiquated, this green monster known as the Grinch, goes out of his way to terrorize a seemingly innocent town known as Who-ville during Christmas out of spite of not receiving the newest Xbox.

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I can comment on how he’s creepy, but his jaw anatomy?  You’re on your own

Or something like that.

Today, I’m utilizing this non-sequitur as a tie-in for a very different kind of Grinch, and an astoundingly different type of WHO-ville.

Because it was only about an hour ago, upon my drafting this article that the WHO announced that the recent Zika Virus outbreak should be considered a ‘public health emergency of international concern’.

This is great, because the prevalence of babies born with microcephaly ought to be on the forefront of international attention and a preventable pandemic should be on the mind of every nation with capacities to provide aid.

But quite frankly there’s one thing that really bothers me.

What the heck does the World Health Organization even do when they announce this public health emergency, besides … well… announcing that it’s an emergency?

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and…why male models?  refer to Zoolander if you don’t get this

To examine this, we’ll use the recent Zika outbreak as a vehicle to look at what conditions lead to a declaration of international concern, and then look at bits of the Ebola outbreak to predict what could be transpiring within the next couple of months.

As a reminder, take what I say with a grain of salt. I’m no clairvoyant and my predictions on the Lakers playoff chances have already been flushed so far down the toilet that it is currently being remediated at a water treatment facility…

Let’s begin.

Zika-Zika-rah-rah

The Zika virus, is something fairly recent with the first reports of its existence being the coincidental product of the WHO’s efforts to screen for yellow fever in 1947.  It is a flavivirus, which doesn’t really mean anything practical other than the crucial fact that it is in the same camp as dengue fever, yellow fever, and West Nile, as they are all flaviviruses.

Transmission of the disease occurs through a mosquito vector – basically it happens when an infected person’s blood is passed unto another.  Given that the symptoms of Zika virus mirrors those of the flu in healthy people, and that it is not directly fatal, for the most part, Zika isn’t on the same level as that of Ebola.

That is, however, precisely why it’s so dangerous to the vulnerable population of pregnant mothers.  Think of it as the strong, silent type.  The one you’d skip when trying to pick a bar fight and opting for a much louder Polio instead.

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An Austrian depiction of Zika

Zika fits this description in the sense that it is also ‘silent’ when one tries to diagnose it, as it requires a blood sample and often can get confused with its other similar looking flavivirus cousins.

Now, clinics around the world, especially in areas with many known cases of Zika infections, have reported a large number of newborns suffering from microcephaly, or an underdeveloped cranial region.  What makes this worse is that in some cases in Brazil, even children with regular looking skulls and heads seem to concurrently suffer the same type of brain damage as those with the underdeveloped skulls.

WHO, What, Why

What concerns the scientific community at large isn’t necessarily what we know about the virus,  it’s the astounding amount of information we don’t know.

First and foremost we do not know for sure if Zika even causes microcephaly. The Scientific American even went out of its merry way to throw a quick op-ed describing the studies needed to prove this link.   A classic case-control studies.  Take pregnant women without the virus, compare them with pregnant women with the virus, and see if their babies have the approximate brain morphology of Donald Trump.

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Not like we wanted a president with a fully matured frontal cortex anyway

 

Oh, wait, we have ethics in place that don’t let us do that. So we’ll have to use epidemiology to provide the linkage right?   Good thing we have 6000 reported cases in French Polynesia back in 2013!    Oh wait, we weren’t really looking for the connection then and it was dismissed as just another add-on to a set of case reports.

Bummer.

Worst off, Dr. Fauci, director of the National Institute of Allergy and Infectious Diseases at the NIH, admitted that we are still years away from a vaccine.

With a proven record of disease transmission à la 2013 French Polynesia, little known information of how it causes a fetal development disorder, no known cure, and no easy signs of diagnosis aside from a blood test, the Zika Virus essentially spelled out a clear-cut no-brainer as a public health threat.

Hence, the announcement.  But now that the WHO just pulled off its best impression of “The British are Coming!”, what follows?

WHO am I?

I can’t promise that this will be the last time I utilize the extremely pun-able acronym the World Health Organization uses as its name.  But I can promise you that after this point… there really isn’t much else WHO can do outside of providing information to healthcare providers on site.

What I mean to say is that where the UN has ‘Peacekeepers‘, the WHO has… not much of anything. Sure they have physicians on staff, but they’re mostly busy keeping vulnerable populations healthy.  There does not exist a WHO task force to deploy.

But let’s not fret all too much.  I assure you this has been a deliberate part of the organization’s design.

In the WHO’s constitution, ratified in 1948, there are a set of 22 actions that the organization can do.  Nearly half of them are simply to ‘promote’ welfare or cooperation.  The others?   ‘Assist’, ‘Furnish’, and ‘Establish’.

steve-nash_1803040
Pictured: a guy who knows a thing or two about assists

WHO’s role is essentially relegated to an agency built for one real thing in public health, monitoring and reporting.  Something it does magnanimously.

In a little over 50 years, it has been one of the most comprehensive networks of any known federal health agencies, and public health bodies.   It tracks diseases, vectors, and keeps tabs on some of the most inaccessible regions such as South-East Asia, and Africa, relying heavily on closely monitoring case reports & clinical literature.

In the case of Ebola, even after its declaration, WHO produced literature detailing recommended surveillance strategies to keep tabs on the outpour of cases and weeding out ones that haven’t been reported.

It then compiled all the known data, facts, and research into dense situation reports, which is essentially the press’ wet dream when it comes to random tidbits and quotable statistics.

I would know.  How do you think these articles get drafted?

Moving along, the WHO essentially delivered all of the information and strategy it could… with absolutely none of the authority to see that any of it was used.

In fact, it has such little power in actually moving resources that even when the 1.6 billion dollars promised for Ebola aid hasn’t been accounted for, all it can do is shake its figurative head and wag a finger at its member states.

Sure, there was backlash.   How could there not be?   How can we realistically expect good to come of a body that in 2015, in the midst of multiple pandemics, had basically the spending power of Health Canada.   Let that sink in,  two public healthcare providers, same budget (3.9 billion USD WHO vs 3.6 in Health Canada).

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NO! You’ll only spend it on frugal things like social welfare!

One deals with 30 million people, another essentially is the lifeline of the continent of Africa.  You do the math.

It doesn’t help that in it’s recent 2016 budget proposal, they increased the asked amount to 4.4 billion USD.   Now its understandable that member states fall short of providing this.  After all, the global market is volatile and healthcare spending overall is on the rise.

But a closer look at the budget proposal (Page 105 if you’re curious) makes one thing very clear: WHO is the first responder to public health crisis and there is no existing in-country emergency response team as of yet.

Heck they basically made it their 2017 target to have member states compose a response team.  Just imagine that if an individual was a country and you had no neutrophils (your immune system first responders) to contain a viral outbreak.

The virus spreads a lot faster, doesn’t it?   It’s why Ebola and Zika have clinicians holding their breath.  Our first responder, WHO, is basically an alarm clock that can’t even force any member state to take action.

An alarm clock with a hair trigger snooze button.

Which begs the questions, what would the WHO look like if it had legal authority?   What if it had the weight of something similar to a list of human rights set by the Geneva Convention?   That defying WHO recommendations would affect your ability to choose where your money goes as a country in the IMF and World Bank?

We have pandemics come through the news cycle back to back like Drake’s diss tracks.  Shouldn’t our first line ought to have a bit more ‘oomph’ so that countries have some leeway in preparing a more permanent response to pandemics?

If health truly is a human right, isn’t it time the global community puts its money where its mouth is?

We could contain outbreaks before CNN has a chance to report it.

So Like I was Saying…

In summation, the WHO is in many ways, infallible like the residents of the fictional Who-ville.

It’s done all it could with what it has been given and can only curse its rotten fate when its lack of medical might and legal authority (it’s Grinch) comes to nip at its heels.

At this point, one of two things must improve for the sake of quicker, better responses to international disease epidemics.  A country’s ability to survey and recognize the potential for an outbreak, or WHO’s ability to respond.

Given its track record, established network, and distance from Sarah Palin, I would argue the latter seems more deserving.

Now if you’ll excuse me, I’m off to cast a Broadway musical remake of this article, using the Grinch as my medium.

Anyone seen Jim Carrey?  They say he still thinks he’s on set for Liar Liar.

Or is he just lying?

jim-carrey-meconnaissable-dans-the-grinch_101066_w620
context: Jim Carrey starred as the Grinch.  Now you get the joke.

 

 

 

 

 

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