The Zika virus has taken a heavy toll on South America since the start of the epidemic in 2015. We spoke to four scientists working internationally to tackle the social impact of the disease and combat the virus itself across Brazil.
Hannah Kuper and Luciana Sepúlveda Köptcke are two researchers studying the social impact of the Zika virus on communities. Read their answers:
What is the current status of Zika in Brazil?
The world first became widely aware of the Zika virus in late 2015, when global media reported hundreds of cases of microcephaly (abnormally small heads) and other congenital disabilities in newborn babies. After much research, the epidemic was linked to the infection of women with Zika virus during pregnancy, and declared a public health emergency by both the Brazilian government and the World Health Organisation.
Several vaccine candidates entered Phase I trials last year, but no medicine or vaccine solution exists yet. New Zika cases are far less prevalent in 2018 compared to a few years ago, but the virus has not gone away. Thousands of children and their families are still at risk, and need support to deal with the long-term effects of the disease.
What has the government healthcare response been so far?
Zika has exposed gaps in the Brazilian healthcare system. Local care services are the cornerstone of the health service here, but often lack the experience to deal with the complex needs of children with disabilities. Specialised rehabilitation services are frequently sparse, fragmented and poorly linked; they are not well connected to social and educational services needed by these children.
How have families and communities dealt with the impact of the Zika virus?
Our research shows that parents play a more important role as carers for children affected by Zika than the health service. Unfortunately, many Brazilian parents lack the necessary information and skills to best care for their child, as well as being under a high level of pressure, anxiety, and poverty.
The virus disproportionately affected poor families in the Northeastern states of Brazil, who were already vulnerable through a combination of poor housing, lack of education, restricted sexual and reproductive rights information, and inadequate healthcare access. With the birth of affected babies, families are driven further into poverty. Mothers stop work to concentrate on childcare, families incur high costs in looking after a severely disabled child, and weekly clinic visits add further strain on both time and money. The risk of fathers abandoning the family is statistically high for children with disabilities, making a challenging situation even harder for those left behind.
Support programmes have sprung up to help parents. They range from informal Whatsapp groups, to advocacy groups and formal support programmes. One option that is currently being pilot-tested by the London School of Hygiene and Tropical Medicine is the provision of parent-support groups to strengthen parents' childcare skills, and provide peer psychological and social support. This approach has been popular and appreciated by the community so far.
What are the secondary repercussions of Zika?
The virus has exposed other systemic unresolved health issues in Brazil. Children with the Zika virus have attracted a lot of media interest, but similar care challenges exist for children with other less-publicised disabilities such as Down’s syndrome and cerebral palsy. One silver lining of the virus outbreak is that it brings attention to these neglected and excluded groups.
The Zika virus has also started conversations about sexual and reproduction rights. One message from the government during the epidemic was to avoid pregnancy – not an easy task as many women in Brazil have irregular access to contraception and many unwanted pregnancies occur. Abortion is illegal here in almost all instances, and even the few exceptions that do exist are now under scrutiny. Sexual health resources (or rather, the lack of them) are significant for controlling Zika, but are also important more broadly in Brazilian society.
Professor Susanne Charlesworth and Dr Debora Cynamon Kligerman are two scientists studying the relationship between Zika virus spread and water supply. Read their answers:
What does water have to do with Zika?
The virus is transmitted by the Aedes (Stegomyia) mosquito, which is also responsible for yellow fever, dengue, and chikungunya. This mosquito breeds in aquatic environments, from holes in river banks, to the roof gutters of houses. We propose that there is a relationship between incidences of microcephaly caused by Zika, and people who do not have sufficient access to drinking water, and where drainage and sanitation are inadequate.
Who is affected most?
Of 3,000 reported cases of microcephaly, 85 per cent were located in northeast Brazil and were mainly found in low-income families. These families are mostly living in slums, and often store water in open containers at times of shortage, which provides the mosquito with places to lay their eggs.
We saw the problem with drainage ourselves on a visit to the Rosalinda favela in northeast Brazil, where we observed street water containing hundreds of mosquito larvae. Whilst the community in Rosalinda was prepared to arrange to collect its own waste, there was still a lot in the street. This can block what drainage infrastructure there was, making it even more inefficient. The lack of reliable drinking water supplies and the lack of surface water management means that everyone is at risk of the diseases that vector insects carry.
How can the risk be reduced?
With no Zika virus vaccine, a first line of defence must be to reduce, or eliminate mosquito breeding sites. In the short term, water containers need to be covered, thus denying access to the insects. Insecticide spray can also reduce mosquito populations, but this is not a long-term solution.
In the long term, these people need a reliable source of drinking water, so that they do not need to store water in their homes.
Drainage is also extremely important. Provision of suitable management of stormwater and greywater (water from food preparation, personal bathing and washing of clothes, but not including human waste or 'black water') is lacking in some areas. As a result, greywater is often disposed of in the street, resulting in puddles of standing water outside of people’s homes in which mosquitoes can breed.
Hannah Kuper is Director of the International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, and receives joint funding from Wellcome and DFID. Her project partner Luciana Sepúlveda Köptcke is Executive Director of Fiocruz Government Graduate School, Fiocruz Brasília
Dr Kligerman also researches at Fiocruz. Professor Charlesworth is a researcher at Coventry University in the Centre for Agroecology, Water and Resilience.
Both projects are financed by the Newton Fund and delivered by the British Council as part of internationally collaborative efforts to combat the Zika virus.
International Women's Day is on 8 March. The United Nations' theme for 2018 is 'Time is Now: Rural and urban activists transforming women’s lives'.