Dr. Margaret Chan, director-general of the World Organization (WHO), issued the following statement on preparing for the long haul of Zika readiness:
"On Feb. 1, 2016, I declared that the Zika outbreak sweeping through the Americas was a public health emergency of international concern. That was not an easy call. But looking back, it was the right one. At that time, the disease itself, long dismissed as an obscure medical curiosity, could hardly be described as “extraordinary”, which is the principal requirement for declaring an international health emergency. In the decades between its discovery in Uganda in 1947 and its appearance in the Americas, only a few human cases of Zika virus were reported.
"The 18 international experts who advised me in the Zika emergency committee had additional, though inconclusive, evidence to draw on. In 2007, Zika left its ancestral home to cause its first outbreak, on Yap Island in the western Pacific Ocean. That outbreak was surprising, but ultimately reassuring. Although almost three-quarters of the population were infected with Zika virus, only about 1,000 people fell ill with sickness attributable to the virus. None of the cases required hospitalization, and the outbreak ended after just three months.
"The next surprise was more ominous. Having demonstrated its ability to spark an outbreak, Zika did so again in French Polynesia from 2013-2014, causing an estimated 30,000 cases. Though all cases were mild, doctors were puzzled by a disturbing uptick in cases of Guillain-Barré syndrome, a severe and usually rare neurological complication. Was this just a coincidence, or was something more sinister at work?
"By the start of 2016, nearly everyone had seen the heart-breaking images of babies born in Brazil with tiny heads. We all heard the tragic stories of their distraught mothers and the bleak outlook projected for their babies. The possibility that a mosquito bite during pregnancy could cause severe neurological damage in babies deeply alarmed the public, but also astonished scientists. They asked: Why only now, and why only in Brazil?
"At the time, Brazil was also experiencing large outbreaks of dengue and chikungunya. Could the three viruses somehow interact, in an amplifying way, to damage babies in the womb? Could something in the environment of northeastern Brazil, the epicenter of the outbreak, be partly responsible, perhaps a chemical or a natural toxin? No one had firm answers.
"Fortunately, experts on the emergency committee could draw on some brand new evidence. In an elegant piece of detective work, a retrospective investigation of the outbreak in French Polynesia unearthed findings strongly suggesting a link between Zika infection during pregnancy and microcephaly in newborns. Now it wasn’t “only Brazil” anymore.
"A year ago, when I declared an international health emergency, it was this suspected link between Zika infection and microcephaly and other neurological complications that, according to my advisers, turned the outbreak into an “extraordinary” event.
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