With the World Health Organization officially declaring the Zika virus a public health emergency of international concern, the potential for a U.S. outbreak demands immediate attention. The largely Aedes mosquito-borne virus is already overwhelming U.S. territories such as Puerto Rico, where more than one-quarter of civilians are expected to be affected within a year. As of June 15, the Center for Disease Control and Prevention, or CDC, has reported 756 Zika cases in the U.S. states—virtually all of which have been confirmed as travel-related, with none so far being the result of direct mosquito transmission within the country. But as warm and humid weather spreads throughout the country, the mosquito population in question—Aedes aegypti—will flourish, especially during July, August, and September. This will increase the risk of local outbreaks and necessitate major action from federal, state, and local governments.
Although the number of Zika cases may not be high, the effect could be large nonetheless. In early April 2016, the CDC confirmed that the Zika virus causes microcephaly—a serious birth defect that results in babies having smaller heads than the average size of most newborns. Furthermore, there is scientific consensus that Zika can, in some cases, cause Guillain-Barré Syndrome—a sickness that can result in muscle weakness and paralysis in adults. Moreover, there is currently no vaccine or treatment for Zika—meaning that awareness campaigns, mosquito control, and travel advisories are the primary lines of defense against the virus.
In February 2016, President Barack Obama requested $1.9 billion in emergency funding that would primarily assist state and local governments. The funding would also provide for rapid response teams that would mobilize as soon as a new case of Zika appeared in the United States, as well as research to develop a vaccine and better diagnostic tests. To date, however, Congress has not passed final legislation to grant any emergency funding. Although the Senate and House passed smaller Zika funding bills, the House’s bill included only $622 million in repurposed funds and no new money. Delaying funding is irresponsible and detrimental to efforts to prepare properly for mosquito season. Compounding this problem, state and local health budgets remain abysmally low following the 2008 recession, leaving mosquito control efforts woefully underfunded.
Despite not obtaining additional funding, the CDC is coordinating a domestic and international response to Zika. The CDC activated its Emergency Operations Center in January 2016 and hosted a Zika Action Summit in April to educate state and local officials on the Zika virus and identify potential preparedness gaps. The CDC also has published response guidance for states, as well as tips and recommendations for state, tribal, local, and territorial officials.
Coordination between state and local governments is key to combating this virus, since states and localities will only be as strong as the least protected areas. To understand what cities and localities can do to prepare for the Zika threat, the Center for American Progress reviewed four cities that are already taking action based on the CDC’s recommendations: New York City, Houston, Washington, D.C., and Miami.
New York City
New York City has taken steps to put in place one of the strongest plans to fight Zika in the United States. The $21 million plan spans three years and covers three broad areas: clinical services, mosquito control, and public awareness. Elements of the plan include increasing human testing capacity; trapping and monitoring the Aedes mosquito populations on a weekly basis; and targeting areas with high Aedes populations with breeding ground control and pesticides. To improve public awareness, New York City is implementing the Fight Back NYC campaign—which costs $1.2 million—as well as scheduling more than 200 community outreach events.
The plan is expansive, pre-emptive, and well-informed, with input from critical partners and experts. Importantly, New York City’s plan is working in tandem with the state of New York’s action plan, which includes measures such as distributing pesticide starter kits to use on bodies of standing water; expanding mosquito trapping and testing capacity; distributing free Zika protection kits to pregnant women; and sending rapid response teams to known Zika transmission sites.
The city of Houston is no stranger to vector-borne diseases, and its concerted efforts to prepare for Zika stem from its ripe conditions: high poverty rates, such as in Houston’s Fifth Ward; a proliferation of Aedes aegypti mosquitoes in summer months; and high rates of travel in and out of Houston’s international airport—especially to areas where Zika is already prevalent, such as Latin American countries. As of May 18, 2016, the city had six confirmed cases of Zika.
Houston falls within the mosquito control district of Harris County, which has a $4 million mosquito control budget to trap and test mosquitoes year-round. After realizing the threat that Zika poses, Harris County Public Health established a Zika Readiness Team tasked with planning for overall preparedness and response. A noteworthy element of Harris County and Houston’s response is its remarkable collaboration and coordination across community partners. One example of this can be seen in the public school system, which began educating students on the Zika virus in April.
According to the Houston Public Health Authority, Houston and Harris County have structured their response to Zika in two phases. In Phase I—prior to local cases of direct mosquito transmission–authorities will conduct breeding site cleanups and educate the public. In Phase II—starting in mid-to-late April and continuing into May—authorities will focus on containing mosquito breeding. But even a city as invested in Zika prevention as Houston is having trouble carrying out its plans without additional federal funding. Right now, Harris County spends $4 million on mosquito control, but officials say another $2 million is necessary for effective Zika preparation.
As a city that was built on a flood plain, Washington, D.C., has had more than its share of mosquito-borne disease scares, and Zika is likely to hit it hard if it does not prepare effectively. The District of Columbia recently announced its enhanced action plan. Similar to New York City’s plan, it also focuses on three elements: mosquito surveillance, Zika mitigation, and Zika educational outreach.
The city began to trap and test mosquitoes in April and will continue to do so until the end of October. The city will also treat standing water with pesticide through September. Residents can contact the U.S. Department of Health to receive mosquito protection kits and can contact the Animal Disease Control Division to report high concentrations of mosquitoes in their areas. Zika awareness and access to Zika prevention information likely will be vastly uneven across different societal groups, with impoverished areas faring worse. District of Columbia officials are attempting to mitigate that effect by hosting two community information nights in each district ward, with one in May and one in July. According to Trust for America’s Health, the District of Columbia’s public health lab has the general capacity to manage a significant testing surge in response to an outbreak.
In Florida, mosquito control is handled at the county level—in this case, Miami-Dade County. Policy, however, is established at the state level. In early February, Florida Gov. Rick Scott (R) issued an executive order that directed the state surgeon general to declare a public health emergency in appropriate geographical areas. One of those areas was Miami-Dade County, which has had 45 cases of Zika as of May 18, 2016. Unfortunately, Miami-Dade’s last reported spending on mosquito control was a mere $1.8 million annually. Miami-Dade County has a history of underfunding mosquito control despite the fact that it is Florida’s most populous county and the largest port of entry into the United States from Latin America. Gov. Scott’s executive order designated the Florida Department of Health the lead state agency in the Zika preparation effort and created a state Zika virus information hotline. Florida’s testing capacity for the active Zika virus is currently 6,552 people.
Miami-Dade’s preparedness will be tested soon. May through October are Miami’s warmest and wettest months, making this the most suitable time for the Aedes aegypti mosquito to come out in full force.
The Zika virus is a serious threat to public health in America, and Congress must act to provide emergency supplemental funding. Cities and states that meet any or all of the criteria that could foster the Zika virus—such as warm, wet weather; high numbers of air or land travelers to and from Zika-affected areas; and high concentrations of poverty—should take action now. Ultimately, there are several avenues at the state and local levels to prepare for and fight Zika. However, overall, states and localities need to improve funding for mosquito control and other preparedness measures; educate their citizens; and demonstrate a willingness to work together for the sake of public health.
Anupama Warrier is a former intern with the Health Policy team at the Center for American Progress.