Global Threat Assessment

Debora Diniz’s historical and ethnographic study Zika: From the Brazilian Backlands to Global Threat illuminates the emergence of the disease and how global health organizations have dealt -- and not dealt -- with it, writes Scott McLemee.

September 13, 2017

For the moment, anyway, the subtitle of Debora Diniz’s Zika: From the Brazilian Backlands to Global Threat (Zed, distributed by University of Chicago Press) looks like the warning sign, glimpsed in a rearview mirror, for a danger no longer on the road ahead.

At least the Biomedical Advanced Research and Development Authority (part of the U.S. Department of Health and Human Services) seems to think the menace is behind us. On Sept. 1, the French pharmaceutical manufacturer Sanofi’s website announced that BARDA’s latest “assessment of all Zika-related projects they are funding” had downgraded the priority of creating a vaccine. Work would continue, Sanofi said, “to a point where development would be indefinitely paused but could be restarted if the epidemic re-emerges.”

Decision making at that level is stratospherically removed from the world that Diniz, a professor of bioethics at the University of Brasilia, set out to document in her historical and ethnographic study. Much of the fieldwork was done in “the Northeast” part of Brazil -- an area much less urbanized than the southern half of the country, which is, she notes, “site of the top universities and research centers.” When Zika was reported in the Americas for the first time in 2015, it was in the Northeast, in a virulent strain that proved to be especially dangerous to pregnant women. The number of infants born with microcephaly increased a staggering 2,023 percent over the previous year.

Both the arrival of the virus itself and its role in the birth defect were first announced “in the lilting accent of the Northeast,” as Diniz puts it, by “clinicians and practitioners of bedside medicine -- where the focus is on the doctor-patient relationship -- many of whom were unknown to the public at large or the academic community.” But by the time the World Health Organization declared a public health emergency of international concern in February 2016, an official narrative had taken shape that stressed the contributions of established medical authorities, rather than the front-line health-care providers.

Funny how that works. More is at issue than regional pride. The initial study showing the Zika virus in the amniotic fluid of women whose babies had congenital malformations was done by a doctor who -- in part because of her bedside rapport -- was able to persuade the mothers to donate the bodies for research. The overwhelming majority of such mothers “were also poor Northeasterners, many of them farmworkers, many black and brown, women whose faces and biographies are usually all but invisible in Brazil’s socially stratified world.”

Nor did that change when the Ministry of Health issued its press release announcing confirmation of the link between the virus and microcephaly. It managed to erase both the doctor’s role and the generosity of the anguished mothers. The medical institute that confirmed the doctor’s findings -- as goes almost without saying -- was credited by name.

“This immediate replication of the reigning social stratification within Brazilian science should come as no surprise,” Diniz writes, “because a single event cannot in itself be expected to undermine unequal patterns of resource distribution.” Social and intellectual capital takes care of its own.

Diniz’s book was first published in Brazil last year, with the dates in her citations suggesting the manuscript was done about three months before the director-general of the World Health Organization declared an end to the state of emergency last November. A second outbreak of Zika in Brazil had been less catastrophic in its impact; the country was on the warpath against the mosquito that had been the virus’s major vector. And in early 2017, WHO affirmed the “need to manage Zika not on an emergency footing, but in the same sustained way we respond to other established epidemic-prone pathogens.”

An inhabitant of one of the highly industrialized or metropolitan regions of the world is apt to take this narrative arc as bending toward progress. But the most recent Situation Report issued by WHO states that the disease “continues to spread geographically to areas where competent vectors are present,” and it lists 61 countries showing “new introduction or reintroduction [of Zika] with ongoing transmission.”

And a recent New Yorker article points out that “the geographic distribution of Aedes aegypti, the mosquito species that transmits Zika, continues to spread into “unexpected parts of North America and Europe.” Among them is Washington, where it “appears to have survived four consecutive winters.” So hardy a virus and so competent a vector will probably be menacing us for a while yet.

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