Notes from the Zika zone: Tropical diseases belong to all of us
Inspired by Georgia Perry's recent Three Stats and a Map "Zika has a 60-year history", I decided that I would send out a dispatch from the tropics, from Nicaragua, from the Zika zone.
As you probably already know, Zika is carried by the Aedes aegypti species of mosquito. This is the same species that also carries Dengue, Yellow Fever, and the Chikungunya virus. Chikungunya arrived in Nicaragua in July of 2014 and within 18 months, it had ravaged the country. Despite the Nicaraguan health department's aggressive response (at least weekly fumigations, frequent distribution of larvacides for stored water, and a wide-spread education campaign teaching how to prevent the propagation of the Aedes aegypti mosquito), by the end of 2015, nearly everyone that I know here had contracted Chikungunya.
Zika was first reported in Nicaragua in November of last year. As of August 19, there have been 1,425 confirmed cases — 661 of which have been among pregnant women. It's hard to know just how many actual cases there have been, though, since nearly 80 percent of infected people show no symptoms. Also, since Zika is almost never fatal, nor is it anywhere near as painful as Chikungunya, even when a person here has symptoms of Zika (which in the last two months, many people that I know have had), he/she isn't likely to seek medical treatment and get formally tested for it, the logic being that unless Zika develops into Guillan-Barre syndrome (which is extremely rare — it hasn't even been reported here yet), there isn't much that the doctors can do for it anyway. So why bother spending the time and/or money seeking a non-existent cure? Better to just wait it out and recover in the tranquility of one's own home. From a public health perspective, it's a nightmare.
There are other public health nightmares though, which brings me to tropical diseases in-general: both Chikungunya and Zika were identified over 60 years ago, yet there is neither a vaccine, nor a specified cure for either of them. The World Health Organization lists at least 18 "neglected tropical diseases" (NTD's) — communicable diseases that are primarily found in tropical and subtropical regions in 149 countries and affect more than one billion people (approximately one seventh of the world's population). In addition to making people sick and/or causing them to die, NTD's also cost developing economies billions of dollars each year. Among these NTDs are Chikungunya, Dengue, Chagas disease, Schistosomiasis, Sleeping Sickness, and River Blindness.
It shouldn't be surprising that the pharmaceutical industry hasn't shown much of an interest in developing treatments for these diseases — after all, there's not much money to be made in developing medications that are primarily used to treat people who don't have resources to buy them. It's much more lucrative to develop yet another treatment for a non-life-threatening condition (such as acne or erectile dysfunction) that can then be marketed to those who have the money to pay a high price for it, or to invent new ways to deliver the same old medications so that the pharmaceutical company can maintain the monopoly that comes with a patent. (This is how epinephrine costs roughly $10 per dose in the U.S., and the EpiPen Jr., which delivers the epinephrine, can run over $600 per dose.)
I used to have some sympathy for the pharmaceutical companies — after all, it takes a lot of money to do the research and studies required to bring a new medication to market, right? Then, I read an article which pointed out that the pharmaceutical industry spends approximately 19 times more on marketing than it does on research and development. It's hard to have sympathy in the face of such data.
With the increasingly widespread effects of climate change, as well as unprecedented travel at the global level, tropical diseases are no longer staying in the tropics. We saw this with the Ebola outbreak of 2014 and are seeing it again with Zika. The correlation that the Zika virus appears to be having with microcephaly is more than tragic and it has at least put one of the tropical diseases into the world's spotlight — prompting governments, private foundations, universities, and possibly the pharmaceutical industry itself to invest in finding a vaccine and/or a cure for it. Wouldn't it be nice if there was similar motivation to fight all of the tropical diseases?
Let us pray for the billion or so people who are currently being affected by Zika and neglected tropical diseases as we continue to seek ways to prioritize the search for effective preventative measures and cures.
[Kari Pohl is a Sister of St. Joseph of Baden, Pennsylvania, who has been serving in Nicaragua since 2010 in the fields of community health education and pastoral ministry.]