The full text of the commentary of Dr. Margaret Chan:
February 1, 2016, I stated that outbreak of virus disease of Zika which was spreading along the Americas constituted a public health emergency of international importance. It was not an easy decision, but, looking back, it was the right decision.
At that time, actual disease, which long had been minimized to consider a mysterious medical curiosity, could hardly have been described as something "extraordinary", which is the essential requirement to declare an international health emergency. In the decades after its discovery in Uganda, in 1947, and his appearance in the Americas, a few human cases of disease only had been reported by the Zika virus.
18 international experts who advised me on the Emergency Committee about the Zika virus had some additional data but were not conclusive. In 2007, Zika virus came out of its original territory and caused the first outbreak on the island of Yap, in the Western Pacific Ocean. The outbreak was surprised, but ultimately it was reassuring. While nearly three-quarters of the population were infected by the Zika virus, only about 1000 people showed symptoms of illness attributable to the virus. There was not to be admitted to any patient and the outbreak became extinct after only three months.
The next surprise was even more disturbing. The capacity of virus Zika to trigger outbreaks came again demonstrated 2013 to 2014 in French Polynesia, where it is estimated that it caused a 30 000 cases of the disease. Even though all of them were mild, it surprised the doctors increased worrying cases of Guillain-Barré Syndrome, a neurological complication generally uncommon and serious. It was just a coincidence or was something more worrying?
In early 2016, almost everyone had seen the heartbreaking images of the newly born Brazilians, tiny little heads and had been able to hear the tragic stories of the capsizing of the grim prospects that were foreseen for the babies and their mothers. The possibility that the bite of a mosquito during pregnancy could cause such serious neurological damage in infants greatly opened to the public, and surprised scientists, who wondered: why precisely now and only in the Brazil?
At the time also were registered in Brazil major outbreaks of dengue and chikungunya. Perhaps the virus interacted in some way, by amplifying the effects, and damaging to the fetus? Was in part an agent of the environment of the North-East of the Brazil, the epicenter of the outbreak, for example, a chemical or a toxin responsible for? Nobody had a conclusive answer.
Fortunately, experts of the Emergency Committee had at its disposal new data. In an elegant example of detective work, a retrospective of the outbreak in French Polynesia investigation brought to light some findings that strongly suggested the existence of a link between infection by the Zika virus during pregnancy and the birth of children with microcephaly. Already it was not something exclusively characteristic of the Brazil.
A year ago, when I declared the international health emergency, it was this alleged link between infection by Zika virus and microcephaly and other neurological complications that, according to my advisers, made the outbreak an "extraordinary" event.
The Zika was also serving other two criteria of interest to declare a public health emergency of international importance. As few people were immunized against polio before uncommon, the virus could spread rapidly and without control, aided by the abundance of international flights. Any area that could accommodate the transmitting mosquito species (Aedes aegypti) were considered exposed, covering almost half of the world's population. Given the number of people at risk and the few control tools available, the outbreak required clearly a coordinated international response.
As it is the case whenever an explosive outbreak is declared, on the Zika emphasized collective preparation failures worldwide. One was the lack of access to family planning services. Another, the dismantling of national mosquito control programs.
A year later, what is the situation? The international spread has persisted, although it has improved surveillance.
Some 70 countries and territories of the Americas, Africa, Asia and the Western Pacific have reported cases from 2015.
The documented consequences for the newborn already include a long list called "congenital syndrome by Zika virus". We know that the virus can be transmitted STDs, a reason more to recommend that women at reproductive age adopt precautions.
In regards to the prevention, may not take much to have a weapon. In line with the recommendations of who, in several countries, pilot testing of innovative mosquito control approaches are being conducted, and the results are encouraging.
Some 40 candidate vaccines are in the study. While some are already in the testing phase, you can that 2020 is not available a vaccine that is considered safe enough for use in reproductive-age women by, and that has obtained all authorizations.
In November 2016, I revoqué the Declaration of a public health emergency of international concern regarding the Zika virus, again on the advice of the Committee of experts. Also, it was a correct decision. At that time the research had already elucidated many aspects making nine months before disease something "extraordinary". Remained some uncertainties, but many key issues already had the response.
The virus is now firmly stationed in many parts of the world. WHO and the countries concerned should not handle the infection by Zika virus as if it were an emergency, but sustained, the same way that we respond to other pathogenic epidemiogenos firmly in place, as the dengue and chikungunya, which come and go in periodic waves of infection.
That is why who has established a mechanism for the whole of the Organization to provide advice on interventions and support to families, communities, and countries affected by the Zika virus. For the research community, who specified the priority areas in which are urgently needed knowledge.
The journey is long, and we have to do it together. The strategic planning of the who and its commitment to collaborate with partners in the realization of sustained research and interventions will contribute greatly to prepare the world for this difficult and even painful effort.
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