JAMA Viewpoint: Emerging Zika pandemic requires more WHO action now

WASHINGTON - The World Health Organization's Director-General should convene "urgently" a meeting of International Health Regulations' Emergency Committee to advise on the emerging Zika pandemic and galvanize global action, say two Georgetown University professors.

In their JAMA Viewpoint published online Jan. 27, Daniel Lucey, MD, MPH, and Lawrence O. Gostin, JD, of the O'Neill Institute for National and Global Health Law at Georgetown, explain that the WHO's failure to act decisively early on in the Ebola crises likely cost thousands of lives, and they warn of potentially serious ramifications if more action isn't taken immediately with Zika.

Until recently, the Zika virus was regarded as a mild disease, but the emergence of a possible link to Guillain-Barré syndrome and neurologic birth defects (microcephaly), seen in some affected countries, has elevated concern. Recent modeling of the disease's spread "anticipates significant international spread by travelers from Brazil to the rest of the Americas, Europe, and Asia," Lucey and Gostin write.

"The critical lesson learned from the WHO's handling of the Ebola crises was the need for early and decisive action," says Gostin. "Yet WHO, and even advanced countries like the United States, were caught off guard. It would be unconscionable if a lack of preparedness resulted in hundreds of unnecessary cases of Zika and potential congenital abnormalities in newborns."

Lucey and Gostin write, "An Emergency Committee should be convened urgently to advise the Director-General about the conditions necessary to declare a Public Health Emergency of International Concern (PHEIC).The very process of convening the committee would catalyze international attention, funding, and research. While Brazil, [the Pan American Health Organization], and the [Centers for Disease Control and Prevention] have acted rapidly, WHO headquarters has thus far not been sufficiently proactive given potentially serious ramifications."

Convening the committee "does not mean that the Director-General should declare a PHEIC," and they point to the example of MERS where the WHO Emergency Committee met 10 times yet advised against declaring a PHEIC, while still offering guidance to Member states.

Additional recommendations outlined by Lucey and Gostin include mosquito control (removing water sources where breeding occurs, use of insecticide, etc.), health information campaigns, country-issued travel advisories, accelerated research and development of vaccines and declarations of public health.

"The international community cannot afford to wait for WHO to act," they conclude.

Lucey, is an infectious disease specialist and a Senior Scholar at the O'Neill Institute, and adjunct professor of medicine at Georgetown University School of Medicine.

Gostin is faculty director of the O'Neill Institute. He served on the National Academy of Medicine's Commission on a Global Health Risk Framework for the Future whose report earlier this month warned of health system deficiencies specifically in managing a pandemic disease crisis.

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Click here for a list of Georgetown subject matter experts who can provide comment and context on Zika in the areas of infectious disease (clinical and molecular biology), biology, global health, maternal health and Guillain-Barré syndrome.

The O'Neill Institute for National and Global Health Law at Georgetown University is the premier center for health law, scholarship, and policy. Its mission is to contribute to a more powerful and deeper understanding of the multiple ways in which law can be used to improve the public's health, using objective evidence as a measure. The O'Neill Institute seeks to advance scholarship, science, research, and teaching that will encourage key decision-makers in the public, private, and civil society to employ the law as a positive tool for enabling more people in the United States and throughout the world to lead healthier lives.

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