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Free Lunch: The Development Argument for Taking Zika More Seriously
May 16, 2016 By Alaka M. BasuI recently returned to Washington, DC, after 10 days in India. New Delhi was warm, moist, crowded – and buzzing with mosquitoes. Fortunately, at least for now, their bites are little more than an itchy nuisance, which is just as well.
In India and most parts of the world far from the current epicenter of Zika, there is lackadaisical official and public complacency; a feeling that it cannot happen here, in spite of the Aedes Egypti mosquito being endemic in many places. At the Delhi airport, I did not see a single person stop to read the small notices warning passengers to report suspicious symptoms and be “strict” about protection if they were traveling to Zika-affected parts of the world.
There is some of the same disinclination to anticipate and confront the fast-spreading virus in the United States, in spite of the Centers for Disease Control and White House ringing alarm bells. In response to President Obama’s request for $1.9 billion to fight Zika as temperatures rise and the virus threatens to spread into the mainland United States, Congress has dithered, prompting the White House to divert $510 million in existing Ebola funding instead. Puerto Rico already has several hundred locally transmitted cases.
The hesitation is doubly unfortunate because it undercounts some very timely benefits of winning the war on Zika. There is more than one free lunch to be had here.
The potential additional rewards of fighting Zika hinge on the perverse fact that there are multiple ways to acquire the infection and several links in the chain from the physical existence of the virus to its impact on the individual. Each of these pathways and links has deep connections to many of the Sustainable Development Goals (SDGs), the global development problems the international community, both rich and poor countries, unanimously committed to addressing last year.
A Host of Co-Benefits
While advocates tend to overdo the “win-win” impact of attending to their specific causes, in this case, there really are some very topical and wide cost savings to be had by narrowing one’s attention to something as specific as Zika.
The first of these secondary benefits relates to general public health improvements. The Aedes Egypti mosquito is the carrier not only of Zika, but of the pathogens that cause dengue, yellow fever, and chikungunya, which are all debilitating and sometimes life-threatening diseases. Anti-Zika strategies that rely on preventing the reproduction of this mosquito will reduce the incidence of these infections too, thereby contributing to meeting SDG 3 (universal good health), Target 3.3 (reducing the incidence of infectious diseases).
Many families simply have no choice but to store water in ways that are attractive to mosquitoesAnother larger public health benefit accrues from targeting the breeding sites of Aedes Egypti. The problem is not merely the inadvertent collection of water in poor neighborhoods; many households deliberately collect and store water in open containers because they have no other choice.
According to the UN Millennium Development Project just 58 percent of the world’s population has access to piped water on premises. Many of the remaining households gather water from shared sources and store it in fully or partially open plastic containers or other receptacles. Moreover, this figure hides the fact that in most poor areas, “access to piped water” actually means a few hours of access per day – if that – thanks to perpetually short supplies and poor governance. Many families simply have no choice but to store water in ways that are attractive to mosquitoes.
Those without regular running water are disproportionately poor and living in crowded conditions that increase their chances of contracting other water-borne diseases, like the far more lethal gastrointestinal infections, diarrhea, dysentery, and cholera. Increasing access to piped water therefore not only combats Zika but helps achieve SDG 6 (universal access to clean water and good sanitation) and SDG 3 (universal good health).
Moreover, given that poor women and girls are in many places the ones primarily responsible for household water collection in the absence of an assured piped supply, doing something about water access will also contribute to achieving SDG 5 (gender equality).
The potential benefits for gender equality deserve mention for other reasons too. Many governments are controversially recommending that women in areas where Zika is rife consider postponing pregnancy and practice “safe” sex if they are already pregnant. To follow these recommendations, women and girls must have easy access to contraception and the ability to negotiate condom use with their partners. Unfortunately, both these factors are universally in short supply.
The Zika threat is an opportunity to reopen conversations around these aspects of reproductive health (Targets 3.7 of SDG 3 and 5.4 of SDG 5). We know from the history of birth control movements and the more recent history of the HIV/AIDS epidemic in Africa how important such public discourses on supposedly private maters can be. Public discussion helped push governments to provide contraceptive services in today’s developed countries, and several recent Demographic and Health Surveys from African countries document the large numbers of men and women who now agree that a woman has the right to insist on condom use if she knows her partner has a sexually transmitted infection.
How Zika Is Shaping the Sexual and Reproductive Health and Rights Agenda Expanding the popular understanding and discussion of sex and birth control in a non-controversial health care context could do more for women’s empowerment (SDG 5) than haranguing governments to address it more directly.
On all these matters – water and sanitation, vector-borne illnesses, gastrointestinal disease, contraceptive access, the ability to demand safe sex – it is the poor, the rural, the young, the female, and the indigenous that suffer the most. As they do in their risk of exposure to Zika itself. If we believe inequalities in health care are unjust (and all the SDGs stress the need to reduce inequalities, especially SDG 10), then we are passing up more than one free lunch.
Targeting the many pathways to Zika described above will take us a little closer to reducing disparities in a range of SDG indicators. Every government has committed to accomplishing these global development challenges, and many governments will soon face questions about what they’re doing to stop Zika. Why not start addressing both and save money too?
Correction, May 18, 2016: An earlier version of this article said Congress had offered a diversion of existing Ebola funding in response to Zika when in fact it was a White House plan.
Alaka M. Basu is a senior fellow at the United Nations Foundation in Washington, DC, and a professor of development sociology at Cornell University in Ithaca.
Sources: The DHS Program, NBC News, U.S. Centers for Disease Control and Prevention, United Nations.
Photo Credit: Zika prevention efforts in the Dominican Republic, courtesy of the Office of the President of the Dominican Republic.
Topics: Africa, development, Dot-Mom, environmental health, family planning, featured, funding, gender, global health, Guest Contributor, HIV/AIDS, human rights, India, Latin America, MDGs, poverty, sanitation, SDGs, U.S., video, water