Public health is not sexy. In fact, a lot of it goes unseen unless there's an outbreak or an emergency of some kind. So last year, when we started seeing images in the media of precious little babies being born with abnormally small heads because their mothers caught the Zika virus from something as common as a mosquito bite, we started paying attention.
Microcephaly is one, and the most physiologically noticeable, birth defect linked to Zika. It's only been a year since researchers at the CDC confirmed the connection, and much more work needs to be done to understand how the infection—which can be passed by mosquitos or through sex—affects children in the long term.
But with money from an emergency infusion drying up this summer—and President Trump's proposed federal budget slashing funds from the CDC—it may be a while before we make any more breakthroughs in research.
In February 2016, President Obama requested supplementary funding to accelerate the studies needed to help find a vaccine for Zika. It took Congress eight months to approve that request and allocate $1.1 billion to the states, thanks to an ill-timed effort by Republicans to strip dollars from Planned Parenthood.
The Trump administration is more focused on ensuring that people have access to care than funding public health preparedness.
Since receiving those funds, says Mike Fraser, executive director of the Association of State and Territorial Health Officials (ASTHO), the states have used that money for a handful of programs: testing pregnant women who may have come into contact with Zika; checking in on the kids born to women who were infected with the virus; upgrading their labs for research and testing; and working to control the mosquito population.
But, Fraser tells VICE Impact, money for birth defects surveillance is expected to run out at the end of July; as a result, efforts to understand the long-term consequences of Zika will be stymied. "States now are using that money primarily to track those kids, and they may have to let those kids go if those dollars run out," he says. Without the ability to keep tabs on them, we may eventually see a cohort of children present with development disabilities or other abnormalities, he continues, and their care could end up being "fragmented or uncoordinated if they're lost in the follow-up."
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Compounding these concerns is what the president included in his budget proposal—or, rather, what he didn't include. In an effort to reduce overall federal spending, the White House aims to strip about $1.3 billion from the CDC, or about 17 percent compared to 2017 funding levels. (This, in the face of almost 700 vacancies at the organization, and an interim director manning the ship.) Among the cutbacks is about $35 million from the National Center on Birth Defects and Developmental Disabilities—the CDC agency that actually first confirmed Zika causes microcephaly and other birth defects.
If there is an emergency and the states run out of money to fight Zika, will Congress be able to step in and address the problem?
Former CDC Director Tom Friedan, who stepped down in January, weighed in on Twitter, saying the proposal "risks Americans' health and safety." He also pointed out that the budget "cuts birth defects research and prevention deeply, just when Zika babies need more help and support."
Fraser says the administration is more focused on ensuring that people have access to care than funding public health preparedness. "You understand what it means to walk into your physician's office, have your annual exam, be told to quit smoking and lose weight," he explains, "but you don't know the other pieces going on behind the scenes. Public health is invisible. Folks don't understand what it means every day to protect you from food-borne outbreaks and to make sure water and air is clean, and all those things that health departments do that go largely unseen."
Trump's budget, if approved as is, will force states to make hard choices, Fraser says. "It's not adequate for what we anticipate states needing for any public health threats. Do you respond to Zika or do you make sure you're on top of your food-borne outbreaks or your tobacco prevention or cancer prevention work? Those are choices we should never have to make."
It's still too early to tell how widespread the Zika virus will get in the coming months. By the CDC's count, this year there have been 122 cases confirmed in travelers returning from affected areas, and one acquired through either sexual, laboratory or blood transmission. None have been reported through a presumed local mosquito infection. But considering how mild this past winter was, there's no telling what the summer months will bring.
The bigger question is: If there is an emergency and the states run out of money to fight Zika, will Congress be able to step in and address the problem? "It took eight months last year, and we don't have that kind of time to wait," Fraser says. "Many of the health officials I've spoken to where Zika presented last year are really concerned that this could be another bad year."
For all the uncertainty surrounding Zika, though, one thing we do know is that one in 10 pregnant women with the virus gave birth to a kid with serious birth defects. And unless we find a way to better understand how the long-term effects of the virus, it'll be hard to feel safe in its presence.