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Integrated responses are key to combating Zika

March 24, 2016

Over the past year, the once-obscure Zika virus has emerged as a global threat to public health. Its rapid spread throughout the Americas presents unexpected challenges the development community is mobilizing to address. 

This is a digitally colorized transmission electron micrograph of the Zika virusIn more than 35 countries and territories, the Zika virus has been linked to an untreatable birth defect, microcephaly, as well as a debilitating disorder, Guillain-Barré syndrome. To contain the spread and mitigate its impact on maternal and child health, health officials are drawing on invaluable experience controlling other infectious diseases, such as Ebola, dengue and HIV. Their efforts must also be guided by lessons from broader health and development efforts in resource-strained settings.

”An effective response to Zika requires coordination among health and development experts across sectors,” says Dr. Timothy Mastro, Director of Global Health, Population and Nutrition at FHI 360. “Applying an integrated approach that addresses education; mosquito control; reproductive health; gender and social norms; and water, sanitation and hygiene will be vital to the impact of the response.”

Applying communication expertise

Information on the Zika virus is a moving target and many questions remain unanswered. In response to disease outbreaks, FHI 360 has helped governments and civil society organizations develop and deliver clear, consistent messages that are responsive and adaptable to specific contexts and populations. With the experience of working on communication initiatives during disease outbreaks such as H1N1 influenza and Ebola, FHI 360 experts have learned that educating communities and frontline health workers must go beyond just messages; we need to inspire behavior change with specific, concrete steps that empower people to do their part to prevent and control outbreaks. Our work in social and behavior change communication helps government spokespeople build their capacity in risk communication, assists ministries in monitoring and responding to misinformation, and supports call centers and the use of mobile technology to provide health information. We also work with journalists to ensure accurate media coverage of health and development issues in countries from Nicaragua to Kenya to Thailand.

“Capacity building of local communicators is essential, especially in a crisis situation,” says Chamberlain Diala, Technical Advisor for Global Health, Population and Nutrition at FHI 360. “The need for a rapid response cannot override the need for culturally relevant messages and spokespeople. People will act on information if it speaks to their own experiences and comes from sources they trust.”

Building capacity on the frontlines 

Frontline health care workers and vector control specialists in the Americas look to join forces with trusted partners as they confront the challenges posed by Zika. FHI 360's global experience includes developing the capacity of epidemiologists, clinicians, health workers, laboratory technicians and community volunteers to improve health and nutrition and prevent disease. Most recently, FHI 360 drew on lessons from the Ebola virus crisis and other disease outbreaks to design a training course on outbreak preparedness in Equatorial Guinea. FHI 360 staff members will train disease control specialists, hospital administrators, first responders and community leaders to prepare for possible outbreaks of Ebola and other infectious diseases. In response to dengue, which is transmitted by the same type of mosquito as Zika, FHI 360 staff have shown that training and engaging local community members as social agents can reduce the effects of mosquito-borne outbreaks.

Strengthening family planning services

Given the probable link between Zika infection and microcephaly, women in Zika-affected areas may want to delay or avoid pregnancy. However, pregnancy prevention can be difficult in a region where many women lack access to modern contraception and experience high rates of sexual violence.

As Ward Cates, FHI 360’s longtime Distinguished Scientist and President Emeritus, and colleagues wrote in Huffington Post, governments, nongovernmental organizations and donors should draw on the wealth of evidence about what works in family planning as they respond to Zika. Expanding access to the most effective methods of modern contraception and involving men in family planning are essential to ensuring that women avoid unintended pregnancies. FHI 360 teams have generated and applied evidence that community health workers can improve access to family planning services, including long-acting and permanent methods of contraception. 

Accelerating vaccine development

The U.S. National Institute of Allergy and Infectious Diseases announced on March 10, 2016, that efforts to develop Zika vaccine candidates were progressing faster than expected. Phase I safety trials of potential Zika vaccines could begin as early as this summer.

Experience in rapid initiation of vaccine clinical trials can help accelerate the search for a Zika vaccine. In 2015, an FHI 360 clinical research team worked with partners to initiate a Phase II safety study of a potential vaccine against another mosquito-borne virus in just five months. As a subcontractor to Leidos Biomedical and with funding from the U.S. Vaccine Research Center, FHI 360 manages this study of a vaccine candidate against Chikungunya virus and provides technical assistance in cold-chain maintenance at six sites in five Caribbean countries. Rapid start-up was possible because of FHI 360’s existing relationships with research institutions in the region and our deep experience in designing, managing and supporting clinical trials worldwide. 

That experience — and those relationships — offer opportunities to develop better tools, strengthen local capacity and engage affected communities in an effective response to the public health threat posed by the Zika virus.

Strengthening water, sanitation and hygiene

Experts are beginning to understand that the recent rise in Zika infection may be partly attributed to lack of access to safe water and other aspects of urbanization. Thus, improving water and sanitation services may be key to addressing the Zika virus outbreak. Zika-carrying mosquitos lay eggs in household water storage containers that are used due to the lack of regular piped water. Mosquito breeding sites also proliferate in areas with inadequate sanitation and increasing urban solid waste. FHI 360’s WASHplus project has shown that poor sanitation where water runs through open pits leads to stagnant water — a perfect mosquito habitat. 

Tackling these longstanding development issues will help prevent future outbreaks — not just of Zika, but also of other viruses. FHI 360 has a long history of demonstrating innovative solutions that merge science, rights and community-based responses, as well as structural changes that improve health — no matter the epidemic.

Photo caption: This is a digitally colorized transmission electron micrograph of the Zika virus.

Photo credit: Cynthia Goldsmith/CDC