Emerging Zika pandemic requires more WHO action now, experts say

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.