A Case for Common Sense in Combating the Zika Virus

A Case for Common Sense in Combating the Zika Virus

So soon after the global community has begun to recover from the most recent Ebola outbreak in West Africa, another international epidemic is on the rise, this time in the Americas. The Zika virus, heretofore relatively unknown, has begun to spread throughout South and Central America, prompting the World Health Organization (WHO) to declare the outbreak a public health emergency of international concern. Given the speed of infection, Zika is becoming a rapid-growing concern for public health officials across the Western hemisphere.

As the international community begins to develop strategies for dealing with the virus, certain officials are already calling for sweeping measures to combat the spread of the pathogen. In the United States, Governor Chris Christie (R-NJ) announced during a Republican Presidential Primary Debate that he would support the quarantine of potentially exposed individuals who return to the US from Brazil and other places where the Zika virus has spread [1]. More extremely, the El Salvadorian, Colombian, and Ecuadorian governments have urged women to stop having children until such a time as the epidemic passes [2]. Such hyperbolic statements warrant an examination of the ethical concerns that arise in handling such public health crises as the current one.

 An important distinction must be made between quarantine and isolation, the difference between the two being that the latter refers to the sequestering of a symptomatic individual whereas in the former the individual is asymptomatic but has potentially been exposed to a pathogen. On this topic, the question arises as to which, if either, of the measures are warranted by the risk of Zika. Only twenty percent of those who contract the virus are symptomatic, and those symptoms are usually mild at worst [3]. Compare this to the harmful nature of Ebola, which results in hemorrhagic fever and death in more than fifty percent of cases [4]. Yet even in dealing with Ebola, a case has been made that individuals exposed to the virus are not contagious until they become symptomatic, delegitimizing the quarantine of potentially exposed individuals imposed by certain state governors during the crisis [5]. That being said, isolation is clearly warranted with a harmful virus such as Ebola, but it is dubious if the same holds true for Zika given the mildness with which the virus presents.

Additionally, Ross Upshur states in his framework for the justification of quarantine that such a measure must be proportional to the risk posed by a pathogen [6]. Zika has been suggested to be a potential cause of microcephaly, but a clear link has not been determined [7]. At least until such a time as a definitive link has been demonstrated, it is unjustified to restrict the autonomy of individuals by quarantining or even isolating them. Even if such a link is proven, however, another criterion for quarantine is that the measure must be effective [8]. Because Zika is carried by mosquito vectors, and is not spread by casual contact between individuals, Tom Talbot, chief epidemiologist at Vanderbilt University Medical Center argues that quarantine and isolation serve no function in preventing the spread of the virus [9]. Therefore, quarantine and isolation cannot be justified no matter the potential risks of the disease.

In many ways, the call by the El Salvadorian and South American governments to halt reproduction until the epidemic passes mimics the American call for quarantine of individuals—proactively restricting individual autonomy in an attempt to protect public health. Such a proposed restriction on reproduction certainly entails the use of contraception such as birth control and condoms. Enacting said method of disease prevention appears infeasible due to the fact that over fifty-seven percent of the Salvadorian population, ninety percent of the Colombian population, and seventy-four percent of the Ecuadorian population is Roman Catholic, a religion strictly against the use of artificial birth control [10] [11] [12] [13]. To further this point, another one of Upshur’s guidelines for ethical quarantine is the principle of reciprocity, asserting that, “if society asks individuals to curtail their liberties for the good of others, society has a reciprocal obligation to assist them in the discharge of their obligations [14].” If the government chooses to not provide free or readily available contraception, it is not fulfilling its obligation in the social contract, and the imposed quarantine-like measure places an undue burden on individuals, and is thus unethical.

What actions, then, can governments take to combat the spread of the Zika virus while refraining from crossing ethical boundaries? I argue that vaccination is likely to be the greatest method of defense against the pathogen. The species of mosquito that carries Zika, Aedes aegypti, is found throughout the American tropics and subtropics, as well as the southern United States and other tropical to temperate areas [15]. Therefore, Zika is likely to become an endemic disease in these regions. Though vaccination raises the issue of conscientious objection, there is evidence to suggest that a large proportion of people in affected areas are concerned about the virus [16]. Though no studies have been conducted on such, this concern would likely translate to procurement of an available vaccine, even across a distrustful Latin America, where measles vaccination rates are similar to those in America [17][18]. It is very possible that enough people would receive vaccination so as to confer upon unvaccinated individuals herd immunity, the phenomenon by which unvaccinated people are protected from a viral outbreak due to the immune status of other individuals [19].

Already, efforts have been initiated within the US to fund vaccination development and basic research, considered by a panel of expert witnesses who testified before the US Congressional Energy and Commerce committee to be the most effective measures for responding to the epidemic [20]. In light of the suggestion that vaccination is the preferred method of Zika containment, it is clear that wholly ineffective, sweeping methods of disease prevention such as those proposed by Governor Christie and several Latin American governments are both unwarranted and unethical in combating the spread of Zika. The propositions are fearful, knee-jerk responses to the epidemic, and such behavior easily leads to infringement upon autonomy and other moral principles. Though vaccine development will take time, short-term blanket solutions involving quarantine and similar measures will do nothing but propagate the stigma surrounding the disease, instead of combating it.

References:

[1] "Christie In Support Of Zika Quarantine For Summer Olympics Travelers,” CBS New York, February 07, 2016, accessed March 01, 2016, http://newyork.cbslocal.com/2016/02/07/christie-summer-olympics-zika-quarantine/

[2] Ahmed, Azam, “El Salvador’s Advice on Zika Virus: Don’t Have Babies,” The New York Times, January 25, 2016, accessed March 01, 2016, http://www.nytimes.com/2016/01/26/world/americas/el-salvadors-advice-on-zika-dont-have-babies.html

[3] “Symptom, Diagnosis, & Treatment,” The Centers for Disease Control and Prevention, last modified March 03, 2016, accessed March 06, 2016, http://www.cdc.gov/zika/symptoms/index.html

[4] “Ebola virus disease,” World Health Organization, last modified January 2016, accessed March 02, 2016, http://www.who.int/mediacentre/factsheets/fs103/en/

[5] Jeffrey M. Drazen, et al., “Ebola and Quarantine,” The New England Journal of Medicine 371 (November 2014): 2029-2030, accessed March 02, 2016, http://dx.doi.org/10.1056/NEJMe1413139

[6] Ross Upshur, “The Ethics of Quarantine,” AMA Journal of Ethics 5, no. 11 (November 2013), accessed March 02, 2016, http://journalofethics.ama-assn.org/2003/11/msoc1-0311.html

[7] Erika Check Hayden, “Proving Zika link to birth defects poses huge challenge,” Nature 530, no. 7589 (February 11, 2016): 142-143, accessed March 07, 2016, http://dx.doi.org/10.1038/530142a

[8] Ross Upshur, “The Ethics of Quarantine”

[9] Dina Fine Maron, “Why We Shouldn’t Quarantine Travelers Because of Zika,” Scientific American, February 07, 2016, accessed March 03, 2016, http://www.scientificamerican.com/article/why-we-shouldn-t-quarantine-travelers-because-of-zika/

[10] “El Salvador,” The CIA World Factbook, last modified February 25, 2016, accessed March 02, 2016, https://www.cia.gov/library/publications/resources/the-world-factbook/geos/es.html

[11] “Colombia,” The CIA World Factbook, last modified February 25, 2016, accessed March 02, 2016, https://www.cia.gov/library/publications/resources/the-world-factbook/geos/co.html

[12] “Ecuador,” The CIA World Factbook, last modified February 25, 2016, accessed March 02, 2016, https://www.cia.gov/library/publications/resources/the-world-factbook/geos/ec.html

[13] Pope Paul VI, “Encyclical Humanae Vitae,” July 25, 1968, accessed March 03, 2016,

http://w2.vatican.va/content/paul-vi/en/encyclicals/documents/hf_p-vi_enc_25071968_humanae-vitae.html

[14] Ross Upshur, “The Ethics of Quarantine”

[15] “Surveillance and Control of Aedes aegypti and Aedes albopictus in the United States,” The Centers for Disease Control and Prevention, last updated February 26, 2016, accessed March 03, 2016, http://www.cdc.gov/chikungunya/resources/vector-control.html

[16] Jeffrey Dastin, “Exclusive: Zika virus discourages many Americans from Latin America travel,” Reuters, February 08, 2016, accessed March 01, 2016, http://mobile.reuters.com/article/idUSKCN0VG0L8

[17] Jessica Glenza, “Zika virus: survey shows many Latin Americans lack faith in handling of crisis,” The Guardian, February 09, 2016, accessed March 02, 2016, http://www.theguardian.com/world/2016/feb/09/zika-virus-survey-many-latin-americans-lack-faith-handling-crisis

[18] “Measles containing vaccine 1st dose (MCV1) immunization coverage,” World Health Organization, accessed March 03, 2016, http://www.who.int/gho/immunization/measles/en/

[19] “Community Immunity (“Herd Immunity”),” Vaccines.gov, last updated March 03, 2016, accessed March 03, 2016, http://www.vaccines.gov/basics/protection/

[20] Anthony S. Fauci, “Research Conducted and Supported by the National Institues of Health (NIH) in Addressing Zika Virus Disease” (Testimony presented before US House Committee on Energy and Commerce, March 02, 2016), http://docs.house.gov/meetings/IF/IF02/20160302/104594/HHRG-114-IF02-Wstate-FauciA-20160302.pdf

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