Vaccines Are Not Enough to Stop the Zika Outbreak

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The biggest problem with the Zika virus isn’t that it hits hardest in places that harbor tropical environments perfect for breeding mosquitos, but also that many of these locations lack the basic infrastructure necessary to curb the outbreak.

This is particularly evident in Brazil’s Northeastern region, in the impoverished communities of states like Pernambuco and Paraíba. Together, they form the epicenter of Brazil’s outbreak, and yet many of the communities there still lack critical sanitation and economic resources. Clean, running water, proper sewage disposal, and seemingly simple amenities like air conditioning and screen doors are all necessary to suppress the virus.

Zika is spread predominantly through the Aedes aegypti mosquito, which is a difficult mosquito to control because it bites any time of the day or night, indoors or outdoors (though it prefers indoors, which is a problem for urban areas). Although they are more prevalent during the summer, they can still bite at any time of the year.

According to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, the most important factor in containing the existing epidemics is vector control. It’s critical that communities with high populations of the mosquito are able to implement all necessary protections. Unfortunately, Dr. Fauci fears that the potential for vector control in various forms is impeded by the economics of whatever region is in question.

“You’re dealing with some of the areas that are less economically well-off, where there’s poverty and a lack of resources,” Fauci tells BTRtoday. “Particularly now what we’re seeing in the Northeastern section of Brazil, which is the epicenter of this outbreak as well as Brazil’s microcephaly cases–it’s really difficult to protect yourself from mosquitos in those environments. We can try as best as we can but it isn’t always successful.”

There are three main aspects to vector control, all of which are challenging in economically disadvantaged regions.

The first is controlling the environment, which means staying in air-conditioned places and installing screens in doors and windows. Given that over 80 percent of America uses air-conditioning, this factor seems easy. It’s not.

Air-conditioning use more than tripled in Brazil between 2007 and 2012, but it only rose from about 11 percent to roughly 30 percent. One can be certain that this already low percentage does not fully extend to Brazil’s poorest Northeastern communities.

Screens on doors and windows are also a problem in impoverished communities where both the time and resources to install them are scarce. Nets exist but they are not enough. Mosquitos can slip in and people are often unwilling to use them because they can quickly become a hindrance to everyday life.

The second important factor in vector control is the use of larvicides and insecticides like permethrin to kill larvae and adult mosquitos, as well as insect repellants like DEET to deter them from biting.

Last May, and again several more times during the year, a number of Brazilian northeastern communities stopped receiving scheduled deliveries of insecticides and Zika-related medical supply kits from the government. Blame corruption, disorganization, a floundering economy, or the likely combination of all three, but regardless, the healthcare system failed the residents of these areas and the result was a sharp increase in reported cases.

The third part of vector control is eliminating the places where mosquitos “readily and easily breed.” Mosquitos thrive in unclean, stagnant water. This goes beyond ponds and lakes to include water in “pots and pans, flower pots, tires, and pools.” In short, it includes making sure the water in and around people’s homes is clean and running. It also means ensuring the areas around the water supply are clean to prevent contamination.

Cities like Recife, the capital of Pernambuco, face shortages of running water. According to the same Reuters report, just 10 percent of households in Recife have running water. This means most people only have access to stagnant water that is stored in containers in their homes–an ideal breeding environment for mosquitos like Aedes aegypt (which particularly thrive indoors). This is part of a larger drought that hit many regions of Brazil for the last few years, but always affected the poorer regions most.

To make matters worse, stored water is likely contaminated by sewage: According to a 2012 census made by the Brazilian Institute of Geography and Statistics, 26.3 percent of children in Brazil’s Northeastern region live in cities where sewage runs outdoors.

One woman in Recife, who gave birth to a child with microcephaly, told Reuters, “sometimes the city comes to collect the garbage, but mostly it just piles up.” She related seeing “swarms” of mosquitos around those trash piles.

The water and sewage crisis perfectly illustrates why the Zika outbreak is not simply a medical problem that can be cured with the arrival of a vaccine. Vaccines are not enough for impoverished communities without running water, proper sewage treatments, or acess to necessary medical aid. The problem is only further exemplified by failure on the part of the government to provide insecticide for ailing communities all of last year.

As Dr. Adriana Scavuzzi, an obstetrician at one of the largest hospitals in Recife, told PBS NewHour, “to try to solve the medical problem won’t be enough. You have to change the quality of people’s life. Otherwise, you will not solve this problem.”

As one solution, some local government officials chose to cancel this year’s February Carnival celebrations and divert funds to vector control and Zika treatment supply kits. It is heartening that city officials were, and hopefully continue to be, aware that this crisis requires significant money and resources.

The downside is that Carnival is a joyful celebration of community. Canceling it seems more like a bandage, and less like a realistic step toward economic equality.

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