Zika’s Forgotten

Infants with shrunken heads. An unknown pathogen. Potential global epidemic. In late 2014, reports of an unidentified  disease, characterized by rashes occasionally accompanied by fever, surged in the state of Pernambuco in northeast Brazil. By March of 2015, similar cases had emerged in surrounding states. Prompted to act, Brazil’s Ministry of Health began to investigate the disease’s origin by testing for chikungunya, dengue fever, and rubella. However, none of these diseases were determined to be the causative agent for the string of outbreaks. Amidst the spread of the epidemic, the agency continued to be baffled.

Finally, in May of 2015, the Ministry of Health determined the cause: the Zika virus.

Although experiencing massive economic growth in recent years, Brazil still retains a high degree of income inequality, with over 9 million citizens living under the poverty line (Phillips, 2017). During the recent Zika epidemic, and the correlated spike in microcephaly(a medical condition associated with incomplete brain development leading to an abnormally small head), affected parents had to contend with this economic disparity, along with conservative attitudes towards abortion, sex education, and mental health. Furthermore, due to government inefficiencies and infrastructure issues, many of those eligible for government assistance did not receive benefits they qualified for. As a result, many of Brazil’s poorest women were left to care for severely disabled children with no income and minimal assistance, constituting a violation of their human rights.  

Brazil’s Zika outbreak was by far the largest Zika outbreak in history, with several million suspected cases in 2015-16 (Heukelbach et al., 2016; Pan American Health Organization, 2017). In September and October of 2015, there was a sharp increase in reports of microcephaly, a severe developmental disorder in which the brain does not develop properly, leading to small head size among infants (Heukelbach et al., 2016).  Symptoms of microcephaly differ in severity case by case and include seizures, developmental delay, vision loss, and hearing loss (CDC, 2016). Although the severity of the Zika epidemic in Brazil has been ameliorated (PAHO, 2017), its economic and social effects continue to reverberate throughout Brazil today. The epidemic has caused severe disabilities in thousands of children, while impoverished, under-resourced mothers have had to assume the responsibilities of care (Heukelbach et al., 2016).

Typical Head Size, Microcephaly and Severe Microcephaly Comparison (CDC, 2016).

Brazil’s lack of infrastructure, economic inequality, and inability to properly disseminate public health information positioned Brazil to become a prime location for a Zika outbreak. Despite its explosive economic growth in past decades, Brazil is one of the most economically unequal nations in the world. Twenty-five percent of Brazilians live below the poverty line of $5.50 per day, with 43.5% in the Northeast region living below this threshold (Forte, 2016). Many poor Brazilians, especially in the Northeast, lack access to clean running water. Additionally, Northeastern Brazil is prone to droughts, during which the government often shuts off the water supply (J. Alfaro-Murillo, personal communication, October 23, 2017). Water supply issues can cause many poor Brazilians to collect and store water in containers for extended periods of time. When left unprotected, these containers quickly become a breeding ground for mosquitoes (Cowie, 2016).

The lack of access to technology further compounds the problem. According to Jorge-Alfaro Murillo, an epidemiology researcher at the Yale School of Public Health, Brazilians living in poverty, especially in the Northeast “are not going to be able to afford AC wherever they live so they have to open the window, so the mosquitoes can come inside of the house  (J. Alfaro-Murillo, personal communication, October 23, 2017).” Because these mosquitoes inhabit people’s houses, attempts to spray insecticide and kill mosquitoes outside are largely ineffective in mitigating the problem. Dr. Alfaro-Murillo further states that, in order to effectively kill mosquitoes, people “have to actually go into the houses and spray the insecticide inside, and generally people don’t like that. When you’re spraying outside, what people do is that they close their windows as not to get the spray from the insecticide.” Even if people properly execute all possible prevention methods, poor design of many towns leads to puddles of standing water, allowing mosquitoes to breed and infect nearby populations.

The Brazilian government’s failure to sustain mosquito eradication efforts also contributed to the Zika virus’s rapid spread. Zika is caused by the Aedes aegypti mosquito, a species that is also responsible for dengue, a virus with flu-like symptoms (WHO). From the 1940s to the 1970s, widespread eradication efforts throughout the Americas led to the extermination of Aedes aegypti in 21 countries throughout the Americas. However, as the threat posed by the mosquito decreased in severity, efforts were not sustained, leading to a reinfestation and repopulation of Aedes aegypti (Dick et. al, 2012).

The Zika virus has disproportionately affected Brazil’s vulnerable population of pregnant mothers. According to Human Rights Watch, a quarter of Brazilian women who have given birth to babies with microcephaly are under the age of 20, and nearly half are single. A report by the New York Times stated that, “family relationships have been upended, precarious livelihoods shattered. Some parents have had to leave jobs to devote themselves to their child’s care. High rates of teenage pregnancy in Brazil add another layer of hardship, as adolescents with braces on their teeth and homework to finish find themselves the mothers of afflicted infants (Franco, 2017).” As such, the disastrous consequences of the Zika outbreak has reached beyond the domain of individual health to affect entire families and generations.

Sex education in Brazil is sparse and distinctly lacks knowledge about contraception and sexually transmitted diseases. Specifically, the Northeastern region disseminates a minimal amount of sex education material to young potential mothers. The combination of inadequate education and lack of access to contraception has led to the majority of pregnancies in Brazil to be unplanned. Although it is possible to test for microcephaly during pregnancy, oftentimes women are unable to obtain these tests when requested (Wurth et al., 2017). Even for women who were able to screen for microcephaly before childbirth, abortion was not an option. Abortion is illegal throughout Brazil, except in cases of rape, risk to the mother’s life, and anencephaly, a fatal developmental disorder. As a result, women seeking an abortion are forced to have illegal abortions, which are unsafe and sometimes fatal. With the rise of Zika-related microcephaly, the demand for illegal abortions in Brazil increased, exacerbating this public health crisis (Cowie, 2016).

Since its peak in 2015, the threat of the Zika virus in Brazil has largely subsided. However, people who have been affected by the outbreak of microcephaly, especially low-income single mothers, still face permanent struggles. In extreme cases, microcephaly renders children unable to walk, talk, or survive independently. These children need constant, lifelong care (Phillips, 2016). Due to the severity of symptoms, nurturing babies with microcephaly often becomes a full-time job for mothers, forcing many already impoverished women to stop working or going to school (Wurth et al., 2017). Former director of the CDC, Dr. Brenda Fitzgerald, described it as “heartbreaking” saying, “we would expect that these children are going to require enormous amounts of work and require enormous amounts of care” (Belluck, 2017).

While microcephaly cannot be cured, through treatment and therapy, the quality of life for children with microcephaly can be improved (Bailey, 2016). The Brazilian government has taken on initiatives to provide the necessary care for children affected by microcephaly. Still, this care is concentrated in urban centers, meaning women living in rural areas have to spend exorbitant amounts of time traveling to appointments. Although the government provides transportation to many people living in the countryside, it is often unreliable and bureaucratically inefficient, creating an extra struggle for rural women (Wurth et al., 2017).

With a nationwide crisis on its hands, the Brazilian government’s resources are stretched thin, and numerous children with microcephaly are waitlisted for government assistance (Franco, 2017). Additionally, Brazil’s government is currently mired in economic depression and governmental scandals, leaving little room to devote resources to public welfare. In 2016, then-president Dilma Rousseff was impeached, and her replacement, Michel Temer, is under criminal investigation for numerous corruption charges, with an approval rating of 3% (Phillips, 2017).

Under Brazilian law, families with a disabled person and a total family income less than ¼ of the minimum wage per person are eligible for a disability benefit of $297 per-month. Families who meet this criteria and have children with Zika-induced microcephaly are eligible to receive this benefit for three years. Unfortunately, this money is often not enough to even cover the cost of providing medicine and other care for a child with microcephaly, let alone the lost productivity due to the time spent caring for microcephalic children. Additionally, in order to earn the benefit, it must be established that the child actually has microcephaly, a process that often takes months of bureaucratic wrangling (Wurth et al., 2017).

Aside from their struggles with the government, poor single mothers in Brazil often face stigma and abandonment from their communities. The constant pressure placed on families caring for microcephalic children leads to a strain on relationships, and high stress relating to the constant struggle for everyone involved in child-rearing. This, in combination with strict gender roles, causes many Brazilian men to leave families (Eisenhammer, 2016). In much of Brazil, especially the poorest regions, there is also a significant stigma around mental illness, leading to the ostracization of mothers with mentally disabled microcephalic babies. According to the Los Angeles Times, “even mothers who have a partner have found themselves suddenly abandoned as their relationships crumble under the emotional strain, economic burden and social stigma that come with raising a child who may require almost constant attention (Zavis, 2016).” Branded by such prejudices, these mothers must face the judgmental eyes of neighbors in addition to the heartbreaking reality of raising an ill child.

Fortunately, Brazil is not at risk of another outbreak of Zika for a few decades  (J. Alfaro-Murillo, personal communication, October 23, 2017). However, the Brazilian government still needs to take major steps to improve the infrastructure of poor communities. It is also imperative that Brazil improves its stance on women’s reproductive rights and sex education to prevent similar public health crises from arising in the future.

For many though, these efforts will come too late. For the people whose lives have already been irreversibly impacted by Zika, the Brazilian government and the international community must do all it can to help them. Financially neglected and socially stigmatized, the Zika mothers have been barred from access to some of the most fundamental rights of a person. The present lack of a coherent, systematic effort to compensate for their myriad troubles demands urgent attention from anyone with a genuine interest in fostering human rights.

References

Bailey, M. (2016, September 01). The unrelenting struggle of raising Brazil’s Zika babies.

Retrieved from https://www.statnews.com/2016/08/12/zika-babies-brazil/

Belluck, P. (2017, December 14). ‘As Zika babies become toddlers, some can’t see, walk or talk’.

Retrieved February 4, 2017, from https://www.nytimes.com/2017/12/14/health/zika-babies-brazil.html

Birth Defects. (2016, December 07). Retrieved November 25, 2017, from

        https://www.cdc.gov/ncbddd/birthdefects/microcephaly.html

Cragan, J. (2016, February 18). Surveillance for Microcephaly. Retrieved from

https://www.cdc.gov/ncbddd/birthdefects/documents/surveillance-microcephaly-webinar.pdf  

Cowie, S. (2016, February 12). In Brazil, are the poor more likely to contract zika?

Retrieved from http://www.aljazeera.com/indepth/features/2016/02/brazil-poor-contract-zika-160210072338596.html

Dengue and severe dengue. (2017, April). Retrieved from

        http://www.who.int/mediacentre/factsheets/fs117/en/

Dick, O. B., Martín, J. L., Montoya, R. H., Diego, J. D., Zambrano, B., & Dayan, G. H. (2012,

October 03). The History of Dengue Outbreaks in the Americas. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3516305/

Eisenhammer, S. (2016, March 11). Brazil’s mothers left to raise microcephaly babies alone.

Retrieved from https://www.reuters.com/article/us-health-zika-women/brazils-mothers-left-to-raise-microcephaly-babies-alone-idUSKCN0WD21D

Franco, P. B. (2017, March 11). For Brazil’s Zika Families, a Life of Struggle and Scares.

Retrieved from https://www.nytimes.com/2017/03/11/health/zika-virus-brazil-birth-defects.html

Forte, Jay. “More Than 50 Million Brazilians Living Below Poverty Line | The Rio Times |

Brazil News.” The Rio Times, 16 Dec. 2017, riotimesonline.com/brazil-news/rio-politics/more-than-25-million-brazilians-living-below-poverty-line/.

Guillain-Barré Syndrome Fact Sheet. (2011, July).Retrieved from

https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barr%C3%A9-Syndrome-Fact-Sheet

Heukelbach, J., Alencar, C. H., Kelvin, A., De Oliveira, W., & Cavalcanti, L. (2016,

February16). Zika Virus Outbreak in Brazil. Retrieved November 24, 2017, from https://jidc.org/index.php/journal/article/view/26927450/1450

Kindhauser, M., Allen, T., Frank, V., Santhana, R., & Dye, C. (2016, February 7). Zika: the

origin and spread of a mosquito-borne virus. Retrieved from http://www.who.int/bulletin/online_first/16-171082/en/

Pan American Health Organization. (2017, September). Zika-Epidemiological Report Brazil.

Retrieved from http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=35221&&Itemid=270&lang=en       

Petersen, L. R., Jamieson, D. J., Powers, A. M., & Honein, M. A. (2016). Zika Virus.

Retrieved from New England Journal of Medicine, 374(16), 1552-1563. doi:10.1056/nejmra1602113

Phillips, D. (2016, March 09). Poor Brazilian mothers join hands, turn to social media amid

microcephaly crisis. Retrieved November 25, 2017, from https://www.washingtonpost.com/news/world/wp/2016/03/09/brazilmothers/?utm_term=.ebe1cba4600a

Phillips, D. (2017, July 19). ‘People are getting poorer’: hunger and handouts as Brazil crisis

deepens. Retrieved November 25, 2017, from https://www.theguardian.com/global-development/2017/jul/19/people-getting-poorer-hunger-homelessness-brazil-crisis

Phillips, D. (2017, October 17). Accused of corruption, popularity near zero – why is Temer still

Brazil’s president? Retrieved from https://www.theguardian.com/world/2017/oct/17/accused-of-graft-popularity-near-zero-so-why-is-brazils-president-still-in-office

Wurth, M., Bieber, J., & Klasing, A. (2017, July 13). Neglected and Unprotected | The Impact of

the Zika Outbreak on Women and Girls in Northeastern Brazil. Retrieved from

https://www.hrw.org/report/2017/07/12/neglected-and-unprotected/impact-zika-outbreak

women-and-girls-northeastern-brazil

Zavis, A. (2016, July 21). When it comes to raising a child disabled by Zika, Brazilian women

often do it alone. Retrieved from http://www.latimes.com/projects/la-fg-brazil-zika-mothers/