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A New Mosquito-Borne Epidemic Threatening The Americas

Chikungunya, which causes high fever and severe joint pain, arrived from Africa last December, and has killed 33 and infected 300,000 in the Western Hemisphere. How to stop the spread.

An epidemic in the making
An epidemic in the making
Rodrigo Lara Serrano

-Analysis-

SAO PAULO — Chikungunya, a mosquito-born virus that causes fever and severe joint pain in humans, arrived from Africa to the Caribbean last December, and has since killed 33 people and infected some 300,000 on the American continent and the Caribbean islands. The numbers may not seem great considering the region's 600 million population, but its advance is notable and somewhat disturbing when considering that it has spread from just one person, who traveled to the island of St. Andrews and was diagnosed in December.

Chikunguya literally means to bend over — in this case, due to pain. The pain lasts days in most cases, but can continue for months or years, and so far has no cure. Only palliative treatment is available to ease the symptoms.

The virus is transmitted through certain mosquitos types commonly found in the southcentral regions of Chile and Argentina and in the southern United States. Starting in the Caribbean, the disease spread over May, June and July to mainland states, including Mexico, Chile and Brazil — evidently through tourists returning from Haiti or the Dominican Republic. There were 43 confirmed cases in Venezuela by July 14, prompting authorities to take quarantine measures. Experts fear Colombia and Brazil will be the next large-scale targets.

The arrival of a new disease with the potential to become a regional epidemic presents governments with some old dilemmas about their public health systems and the risks posed to businesses and citizens. There is also the question of the media's role and how they should coordinate their actions to avoid or minimize its impact.

What not to do

The first temptation is to maintain a “technical” and vertical approach — a purely medical response at the local level. Epidemic experts advise governments what to do, and officials will decide if they have the resources to comply. Health authorities also have to consider how to proceed without causing public alarm (which can worsen matters) or eroding their power.

The next risk is complacency. Because the disease is not fatal in most cases — and its effects will be concentrated in particular regions, neighborhoods or socio-economic sectors where mosquito control is lax — there is the danger that the media will cease to give it attention, unless it explodes into spectacular proportions. The problem with this approach is that we don’t know the medium- or long-term effects of how chikungunya will operate in a new environment, never mind the social discrimination this approach implies.

A third risk would be to give a fragmented response. For example, countries or regions reasonably protected by natural barriers such as Peru's coastline and mountains, Chile, Argentine Patagonia or northern Mexico, will need to coordinate observation and early warning protocols with companies transporting people and goods, in addition to implementing disease checks at ports and entry points. This means costs, delays and complications, at least initially — and will inevitably trigger some indignation and conflict.

Paradoxically, while resisting these temptations may limit the disease's harm or curb its ability to establish itself, the “success” of doing so will bring no rewards to the public agents implementing the strategic improvements. They may even be accused of overreacting to a minor or imagined threat. Voters and shareholders rarely reward those who avoid disasters.

Thus authorities must turn to innovative tools that work upward. The minds and technical capabilities of citizens must be used within a system of clear rules, through social networking and the Internet, to achieve a decentralized response alongside the official one. This could limit the life cycles of mosquitoes and help establish a rapid medical response to new infections.

There will soon be new ways to neutralize this virus. The U.S. firm Arbovax has announced it could develop a vaccine by 2015, if the FDA moves quickly to approve it. An Austrian firm has also announced promising treatment tests. But while we await a scientific solution, it would be wrong, if not cruel, to provide a purely mechanical response to the situation. Combining the best traditional methods with an innovative focus on social participation is the best way for now to prevent millions from bending over in pain.

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