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WHO removes Zika 'emergency of international concern' designation, stresses crisis is not over

The World Health Organization (WHO) on Friday declared that Zika is no longer an international public health emergency, but the organization highlighted a need for a long-term response to the virus, the New York Times reports (McNeil, New York Times, 11/18).

Background

The Zika virus is not easily diagnosed, and it does not have a cure or vaccine. The virus is most commonly transmitted by a bite from an infected mosquito, but it can also be spread through sexual activity (Women's Health Policy Report, 11/16).

WHO classified Zika as a "Public Health Emergency of International Concern" in February after an "extraordinary clustering" of cases of microcephaly and other neurological disorders linked to the Zika virus were reported in Brazil. David Heymann, chair of the WHO panel that made the recommendation, said the classification was issued largely to better understand the cause of microcephaly cases in Brazil (Sun, "To Your Health," Washington Post, 11/18).

Researchers have since linked Zika infection during pregnancy to congenital Zika syndrome, which includes microcephaly, a sometimes fatal anomaly in which a fetus develops an abnormally small head and brain; decreased brain tissue with a distinct pattern of calcium deposits that suggest brain damage; damage to the back of the eye; limited range of motion in the joints; and excessive muscle tone that restricts movement shortly after delivery (Women's Health Policy Report, 11/16).

Zika has been found in 60 counties since the outbreak was identified last year in Brazil.

WHO's update

Heymann said WHO decided to remove the emergency classification because the researchers achieved the goal of determining whether Zika was linked to the reports of fetal anomalies in Brazil.

According to Reuters, WHO's decision moves Zika into a class with other diseases that present serious risks and require ongoing research (Nebehay/Steenhuysen, Reuters, 11/18).

Peter Salama, executive director of WHO's health emergencies program, said Zika is seasonal and could return repeatedly to countries with the mosquitos that carry the disease. "We are not downgrading the importance of Zika," Salama said, adding, "We are sending the message that Zika is here to stay and the WHO response is here to stay" (New York Times, 11/18).

Heymann said individual countries may still declare local emergencies. However, he said going forward, the most effective way to address Zika and its complications is for WHO to manage "this significant and enduring public health challenge" within the organization. He said such efforts would allow for a more sustained focus, with more dedicated resources and expertise. Heymann said, "This represents an escalation into a major activity within WHO ... If anything, it's escalated in importance" ("To Your Health," Washington Post, 11/18).

Discussion of WHO's actions

Some public health experts have voiced concerns that the removal of the "international emergency" designation could slow Zika research, Reuters reports.

Lawrence Gostin, a global health law expert at Georgetown University, called WHO's decision "unwise." He said, "Although Zika's spread has waned, it still holds the potential for an explosive epidemic. If it were to reemerge in the Americas or jump to another part of the world, it would significantly threaten a new generation of children born with disabilities such as microcephaly" (Reuters, 11/18).

Separately, Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases (NIAID), suggested WHO's move was premature, noting that summer is just starting in the Southern hemisphere. Fauci added that NIAID would not slow its vaccine efforts.

Albert Ko, a Yale epidemiologist who has worked in Brazil, said he understood the reasoning behind WHO's decision but also said that he thought the agency had acted too soon. He said that the extent of damage in Latin America is unknown, noting that many cases of Zika contracted during pregnancy have not yet reached term. In addition, Ko said Asian governments are just starting to realize that they face a crisis and may now reduce their efforts.

The Centers for Diseases Control and Prevention (CDC) did not voice an opinion on WHO's decision but said the move "did not change the urgent need to continue our work." CDC repeated a travel warning from January for pregnant women (New York Times, 11/18). According to CDC, it "remains crucially important that pregnant women avoid traveling to areas with local transmission of Zika, because of the devastating complications that can occur in fetuses that become infected during pregnancy" (Reuters, 11/18).