In the summer of 2016, more than 10,000 athletes and 500,000 fans prepared to descend on Rio de Janeiro for the summer Olympic games—and they were all expected to compete against a common foe: the Zika virus, which can cause serious birth defects in pregnant women and had become an epidemic in Brazil. To help ward off a potential public health calamity, Kelly McBride Folkers, working as a research associate in bioethics at the NYU School of Medicine, used research from scientists and public health organizations to write a guide for Rio travelers. To spur further action, she also decided to pen an op-ed. “I started thinking about why this epidemic was so interesting, and a lot of it has to do with the fact that it’s spread by both mosquitoes and by sexual transmission, which is an unprecedented thing in the history of human disease,” says Folkers, who finished her master’s in bioethics last May. Her essay, titled “Zika: The Millennials’ S.T.D.?”, was eventually accepted by The New York Times. Here, Folkers discusses the ongoing response to Zika—still very much a threat, though it’s fallen from mainstream media attention—and what that says about our public health priorities.
Zika is mostly thought of as mosquito-borne, but it is also a sexually transmitted disease. Why hasn’t it been framed in that way? There’s reluctance to acknowledge sexually transmitted diseases as something deserving of an objective approach. We come at them with this moral lens, which I think is incorrect. It’s also been debated whether Zika is in fact a sexually transmitted disease, and I’ve argued in the scientific literature since The New York Times piece that it should be treated as one. It’s still really hard to get a diagnostic Zika test if you think you might have been exposed to it. If we treat Zika like a sexually transmitted disease, we can apply some of the same principles used in STD screening and counseling to better inform patients of their individual risks for passing it along to a sexual partner.
Why have we, as Americans, seemingly stopped paying attention to Zika? I don’t think we’re looking too far outside our own country right now, and I think that was reflected in the 2016 election. But Zika is still a problem. Climate change is going to be a major driver of the spread of insect-borne diseases, especially in areas like Puerto Rico and the U.S. Virgin Islands, where hurricane damage has left many without access to medicines. At one point in time last year, public health officials estimated that 25 percent of the Puerto Rican population would be infected with Zika. It’s still certainly something that we ought to be paying attention to—not just for this issue, but any sort of global equity issue right now.
The World Health Organization recently announced that there won’t be a Zika vaccine available until 2020. What are some important things we can do until then? Zika vaccine development faces significant funding hurdles, and I think 2020 might be an optimistic estimate for when a vaccine will be on the market. I’m currently analyzing the ethical issues surrounding Zika vaccine development, like how to include pregnant women safely in biomedical research studies. No studies enroll pregnant women at this time, which may cause problems later if an experimental vaccine is made available in an emergent outbreak situation. Until a vaccine is approved, it’s important to remain vigilant—but not fearful—while traveling to areas of Florida, Texas, the Caribbean, and Latin America, where Zika outbreaks have occurred. A main principle in American bioethics is autonomy, so I don’t want to tell people what to do. Rather, I want people to have all of the information necessary to make an informed decision. But it never hurts to use bug spray and practice safe sex!
—Dan Morrell