Challenge 2: Emerging epidemics
Like dengue and yellow fever, Zika virus is primarily spread by the Aedes aegypti mosquito. In 2015, a sharp rise in the number of babies born with microcephaly was linked to the emergence of Zika virus in Brazil. In response, the World Health Organization promptly declared the epidemic a Public Health Emergency of International Concern.
Guidance was issued on how to minimise the risk of contracting the virus, such as wearing long-sleeved clothing and mosquito repellent. Around the home, it was recommended that standing water was treated with larvicides or regularly removed. Pregnant women were advised to avoid travel and stay indoors at times when mosquitos are most active. It was also recommended that non-pregnant women delay pregnancy and use contraceptives during the epidemic. However, despite a series of public health campaigns, Zika rapidly spread to over 87 countries, leading to a generation of children with a series of uniquely complex and devastating disabilities.
One way to understand the perspectives of Brazilian communities affected by Zika virus is through the Health Belief Model, a framework which maps the decision-making process that a new behaviour may entail. This is because each of these behaviours can be strongly informed by a personal assessment of their convenience and cost, as well as how the behaviour may be perceived by loved ones and the wider community.
In a study that I co-authored for the London School of Hygiene & Tropical Medicine, we found that communities affected by the Zika virus epidemic felt that many of these preventive measures were not sustainable in the long term. Additionally, there was a sense that the burden of controlling the epidemic lay too much on them as individuals – especially women. For these reasons, the worldwide epidemic-preparedness community has predicted we have a high risk of Zika virus returning – in addition to outbreaks of similar neglected tropical diseases.