Volume 27 / November 2016

The Power of Partnerships

The spread of Zika virus is the latest in a long history of disease outbreaks that elicit a great sense of urgency among the Public Health community. In the past 17 months since Zika virus was first confirmed in the Western Hemisphere in Brazil in May 2015, it has rapidly spread within the range of its key mosquito vector Aedes aegypti to the Southeastern U.S. And in today’s age of non-stop and instantaneous communication, awash with images of mothers and nurses coddling Zika-affected children, the outbreak becomes even more visceral to the community at large.

Who remains unaffected when pregnant mothers and unborn children are at risk? We all feel compelled to do something, but how can we come together in a meaningful and impactful way?

Public and Private Partnerships (PPPs) may likely hold the answer. There is considerable evidence that much can be accomplished when people of differing viewpoints, disciplines, backgrounds, geographies and experiences come together for a common cause. We all know about the dramatic effect that PPPs have had on the fight against malaria. It’s estimated that since the year 2000, more than six million lives have been saved through scaled-up malaria interventions – many of them funded through PPPs. What wisdom have we gained from those efforts that can benefit us in the fight against Zika?

With that question in mind, the State Department organized a Zika roundtable event in Washington D.C. in July. I attended along with representatives from 60 other public and private entities to discuss this very topic. First and foremost, we all agreed that PPPs work. But we also discussed our approach with malaria can’t be cloned and dropped into a Zika protocol.

While Zika has many things in common with other vector-borne diseases, there are major differences that stand out. First and foremost is the disease cycle itself. Malaria is spread by nocturnally feeding mosquitoes that rest within human dwellings. That makes interventions such as bed nets that protect people as they sleep and indoor residual sprays (IRS) that kill mosquitoes as they rest on indoor walls effective against the disease.

Not so with Zika. Zika is spread by day-time feeding mosquitoes, primarily by the aggressive day-time biters Aedes aegypti and Aedes albopictus when humans are active and out-of-doors rendering bed nets and IRS far less effective. Another important difference is that Zika can also be spread by human-to-human contact. That’s a whole different ball game.

On the plus side, as work to more fully develop long-term strategies such as a vaccine continues, current tools applied within Integrated Vector Management (IVM) programs have seen significant reductions in Aedes transmission of related diseases such as dengue fever. Because both Zika and dengue are transmitted by the same mosquitoes, our experience reducing dengue vector populations and disease transmission have immediate applicability to the Zika crisis. Our successes today are building on the adaptation of current tools – such as GPS guidance technology for precision application of insecticides, biorational insecticide formulations designed for large-scale and long-term Aedes container-breeder mosquito control, and targeted public education campaigns offer proven benefits for a container mosquito control program.

Having effective tools is only one part of the solution. Just as we have adapted our technologies, effective PPPs require that we’re willing to adapt ourselves. There are many chartered Public Health organizations assigned to protect the well-being of particular groups, neighborhoods, or individuals just as there are private institutions that bring unique technologies or philanthropic wherewithal to the table. If PPPs are to be successful, people within these establishments must be willing to set aside their formal job descriptions and temporarily cross over occupational or traditional lines. Based on what we observe and what we learn, we must be willing to stand up and say “THIS is the best intervention for this particular situation,” and work hard to make it happen. We can’t try to conform solutions to what we do in our own individual silos, but rather, must adapt our behaviors to meet the demands of the crisis at hand. This will be the key to our success to slow the spread of Zika virus and eliminate transmission where possible.

Despite suggestions to the contrary, complacency is really the biggest challenge we have to face. Zika represents a risk at all levels of society. Zika doesn’t care if you are rich or you are poor, if you are living in a shelter or in an air-conditioned, two bedroom condo overlooking the bay. Zika has no prejudice.

And thus, we all have to fight Zika. Together. We have to be vigilant and use the most effective tools available today while we wait for the tools of tomorrow.