The great HG Wells once said, "Human history becomes more and more a race between education and catastrophe." As we discover more and more about the spread of and serious outcomes from Zika infection, it's clear that we urgently must prepare for this latest threat. At the same time, we must also ask ourselves why we were caught by surprise and try to unravel the root causes of the unfolding Zika tragedy.
As the Centers for Disease Control, the White House administration and other federal and state agencies grapple with how best to deal with Zika, it's critical that we all take special note of communities that are likely to face even greater threats than the general population from these diseases. Individuals living near or below the poverty line are at higher risk of exposure to the mosquitoes that carry Zika virus.
Take a moment and look at these two maps. Some of the most impoverished urban areas in the United States are also located in the Aedes aegypti mosquito belt.
1) The most impoverished areas in the United States - Source: U.S. Census - 2014
2) The estimated range of Aedes aegypti and Aedes albopictus (mosquitos that cause Zika, dengue fever and other vector-borne diseases) in the United States (2016) - Source: CDC
Why does this matter? Mosquito control measures and surveillance techniques are critical to respond to any potential disease outbreak. Particular attention must address impoverished areas where small outbreaks can turn into epidemics.
Communities in the US with sanitation, improved housing, and air conditioning are less likely to be exposed to Zika or any other vector-borne diseases, like dengue fever or West Nile virus. However, in the US places with inadequate housing in densely populated urban areas often create perfect conditions for mosquitoes to breed and transmit viruses. Once infected, persons with insufficient access to healthcare can potentially seed new cases amplifying risks throughout the community.
While there's still a great deal we don't know about how far Zika will spread in the United States or the degree of severity, there are several things we do know:
• Changing climate conditions are creating ideal environments for the Aedes aegypti mosquitoes to breed (NOAA predicts the unprecedented strong El Niño is expected to hang around throughout the spring and early summer of 2016)
• Even small changes in climate conditions can impact how quickly vector-borne diseases evolve and spread
• The mosquitos capable of spreading the Zika virus are already in the
United States, making Zika transmission a near certainty in the United States
We also know that the administration must be willing to address poverty if it hopes to prevent the spread of future epidemics like Zika, starting with those areas in the United States where high poverty rates overlap with the known range of the Aedes aegypti mosquito.
As the CDC and local health departments in the US accelerate efforts in preparation for the soon arrival of locally transmitted Zika virus, they should target poor communities with the highest risk. Mosquito traps for surveillance should be located in these poorer populations to quickly know when mosquitoes might start carrying Zika virus in that location. At the same time, housing improvement programs (both governmental and non governmental) should focus on: 1) repairing window screens and eliminating mosquito breeding sites; and 2) arduously educating communities toward this end. Remember, Aedes aegypi is known as the "small container breeding mosquito," therefore, any yard debris, flower pots, and other containers prone to catching rainwater should be dealt with.
The costs for prevention may be high, but the significantly higher healthcare costs and substantial human suffering due to a volatile epidemic would be unimaginable. In the end, if we succeed in preventing disease in those communities that are most vulnerable, we will more likely succeed in preventing disease for all of us.