Pan American Health Organization
Topic B: The Zika Crisis
HACIA Democracy XXIV Summit of the Americas
Committee Chairs: Cora Neudeck and Sara Surani
Director of English Committees: Benjamin Schafer
Dear Delegates,
We are both exceptionally excited to be serving as Co-Chairs of the Pan American Health
Organization Committee! Both of us have a wealth of experience in writing, debating,
and all things fun. We will strive to bring our shared experience in global health, health policy,
the biology behind it, and international relations to Latin American policy and the political
context from the perspective of the PAHO Committee. We cannot wait to meet you all at the
summit and are looking forward to seeing a great development of ideas that have the potential to
truly tackle some big issues!
Cora is a junior studying Integrative Biology with a secondary in Global Health and
Health Policy. She is originally from a very small, rural town in Indiana, where she lives with her
6 family members and 11 pets. In her free time, she enjoys singing, breakdancing, and eating
gobs of salmon sushi. Cora is also currently the co-head delegate of the Harvard Undergraduate
Ivy Council, which helps focus on issues of intercollegiate communication and policy exchange,
as well as a frequent Model UN delegate. She volunteers avidly within the Cambridge
community, particularly with Y2Y, a student-run youth homeless shelter, and Best Buddies, a
friendship-building organization focused on supporting those with intellectual and
developmental disabilities. In the future, she hopes to bring all of these passions together in order
to supplement her dreams of becoming a pediatrician focused on global health issues, while also
maintaining her love of British boy bands and recreational tennis. Cora is so excited for the
chance to meet all of the delegates of HACIA this year, while also enjoying the amazing beauty
and culture that Latin America has to provide!
Sara Surani is a senior studying Social Studies with a focus in Global Health & Health
Policy. Originally from Corpus Christi, Texas, Sara grew up swimming in the ocean, frequenting
2
taco festivals, and trying to tackle the diabetes and obesity epidemic in her community.
Academically, Sara is interested in how different diseases emerge and how they impact
individuals on a sociocultural level. Last summer, Sara spent her summer in Nicaragua
researching the Zika virus and how Zika impacts individuals across a community. On campus,
she is involved as a peer advising fellow, a mental health peer counselor, and a piano teacher.
She is also actively involved with the Institute of Politics, the Global Mental Health Coalition,
and the Interfaith Forum. In her free time, she loves writing poetry, scuba diving, trying new
foods, learning new languages, and experimenting with different adventure sports. In the future,
Sara hopes to travel the world and address different public health issues. Sara is ecstatic to visit
Latin America for HACIA and can’t wait to meet each and every one of you!
Please feel free to contact us if you have any questions about our committee—no
question can ever be too small! We cannot wait to meet and work with you all at HACIA’s 2017
summit!
Sincerely,
Cora Neudeck and Sara Surani
Co-Chairs, Pan American Health Organization
Introduction
3
In 2015, Brazil reported a dramatic increase in babies born with microcephaly, a
condition in which babies have smaller heads and a combination of neurological defects.1
Eventually, scientists deduced that Zika was the culprit causing these severe birth defects.
According to the World Health Organization, Zika is a virus primarily transmitted via the Aedes
mosquito, native to Africa.2 Symptoms of the Zika virus are similar to those from other
mosquito-borne illnesses—mild fever, skin rash, conjunctivitis, muscle pain, joint pain, and
headaches. However, what makes Zika different from other mosquito-borne illnesses (like
dengue and chikungunya) is that Zika can also be sexually transmitted.3 Because of this, the Zika
virus has been difficult to contain and is spreading like wildfire.
In the span of one year, the Zika virus has spread from the northern regions of Brazil to
all over the Americas, with cases currently reported in more than 60 countries and territories.4
The rapid spread, lack of knowledge about the virus, and large implications it has on Latin
America led the World Health Organization to declare Zika a global health emergency in
February 2016.5 Despite efforts to mitigate the spread of the virus, Zika still persists in many
Latin American countries today. Since Zika has an impact on the health of infected babies, the
virus has far-reaching implications on the individual, societal, and national levels.
Although the scientific and developmental implications of the Zika virus are drastic, this
committee will strive to go beyond that and discuss sociocultural implications as well.
1 Butler, Declan. "Zika virus: Brazil's surge in small-headed babies questioned by report." Nature News. Nature Publishing Group, 28 Jan. 2016. Web. 13 June 2017.2 "News: Zika and complications." World Health Organization. World Health Organization, 1 Feb. 2016. Web. 13 June 2017.3 "Zika Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 01 May 2017. Web. 13 June 2017.4 dos Santos, C. N. D., & Goldenberg, S. (2016). Zika Virus and microcephaly: challenges for a long-term agenda. Trends in Parasitology.5 "News: Zika and complications." World Health Organization. World Health Organization, 1 Feb. 2016. Web. 13 June 2017.
4
Specifically, this session of the Pan American Health Organization (PAHO) will seek to discuss
the social, cultural, and economic consequences of the spread of the Zika virus and how member
states can effectively address them.
Because 80% of individuals who contract Zika do not display symptoms of the virus, the
exact number of infected individuals remains unknown.6 However, the more extreme symptoms
of the virus include microcephaly in infants (a condition where babies are born with smaller
heads and severe neurological defects) and a rare autoimmune condition called Guillain-Barré
syndrome (a condition that can lead to temporary paralysis).
Currently, no vaccine or cure for Zika exists.7 While researchers are actively working on
creating a vaccine, panic regarding the contagious nature of Zika is pervasive. Moreover, rising
temperatures lead to increased mosquito breeding grounds, contributing to an even faster
transmission of the Zika virus. This not only increases the risk of pregnant mothers contracting
the virus and transmitting it to their babies but also negatively impacts the health, economy, and
social sectors of communities across Latin America and the Caribbean.
As Zika continues to plague Latin American and Caribbean communities, it is up to you
to contemplate, analyze, and discuss how to address these issues from an interdisciplinary
perspective. This committee will discuss the sectors influenced by the Zika virus, the resources
that Latin America and the Caribbean have available to tackle rising numbers of babies infected
with microcephaly, and current initiatives that are being implemented. Finally, delegates will
propose alternate solutions to help respond to and mitigate the concerns of rising Zika cases.
6 "20 alarming facts about the Zika virus." CBS News. CBS Interactive, 20 Dec. 2016. Web. 13 June 2017.7 "News: Zika and complications." World Health Organization. World Health Organization, 1 Feb. 2016. Web. 13 June 2017.
5
History and Powers of the Committee
The Pan American Health Organization was founded in 1902 with the mission of
strengthening regional and national health systems and improving the health of all residents of
the Americas.8 Today, PAHO holds the distinction of being the oldest international public health
organization, and throughout this history it has contributed to huge strides in health achievements
and cooperation. The organization has a staff of scientific and medical experts as well as over
100 partners in PAHO/WHO (World Health Organization) Collaborating Centers, and it works
with government agencies, professional associations, academic institutions, and other civil
society organizations to achieve its goals.9 PAHO is a member of the United Nations system as
the Regional 10 Office for the Americas of the WHO and further is the dedicated health branch
of the Inter-American system.10
In its constitution, adopted in 1947, the stated purpose of PAHO is “to promote and
coordinate efforts of the countries of the Western Hemisphere to combat disease, lengthen life,
and promote the physical and mental health of the people.”11 Originally founded as the
International Sanitary Bureau, the organization concentrated at first on dealing with information
regarding health in the Americas and creating a framework of sanitary regulations and
procedures to prevent the spread of communicable diseases like cholera, yellow fever, and
smallpox, while avoiding excessive quarantines.12 The International Sanitary Bureau became the
8 “Key Facts about PAHO.” Pan American Health Organization. PAHO, 29 May 2015. Web. 13 July 2016.9 Ibid. 10 Ibid. 11 “Constitution of the Pan American Health Organization.” Pan American Health Organization. PAHO, 30 May 2013. Web. 13 July 2016.12 “Governing Bodies.” Pan American Health Organization. PAHO, 10 August 2015. Web. 13 July 2016.
6
Pan American Sanitary Bureau in 1923 and the Pan American Sanitary Organization in 1947.13
To reflect the shift in focus from only the sanitary aspects of global health to a broader
perspective on inter-American health cooperation, the name was changed to PAHO in 1958.14
PAHO is currently composed of 35 Member States hailing from throughout the Western
Hemisphere, as well as four Associate Members, three Participating States, and two Observer
States. Each Member State votes once. Associate Members may vote in technical commissions,
but not in the governing bodies of PAHO. Participating States vote only in PAHO budgetary
matters, and this status is typically given to states that are responsible for territories in the
Western Hemisphere but have their seat of government in another part of the world. Observer
States may engage in discussions with the governing bodies but cannot vote or make substantive
proposals, procedural motions, or requests.15 PAHO is governed by three bodies: the Pan
American Sanitary Conference, which meets every five years and serves as the supreme
governing body of PAHO; the Directing Council, which meets annually in years that the Sanitary
Conference does not convene; and the Executive Committee, which is composed of nine
Member States elected for three-year terms that meets semiannually.16 At the 2018 HACIA
Summit of the Americas, the PAHO Committee, in which the 35 Member States will be
represented, will simulate the real-world process of discussing and remedying healthcare
inequalities throughout the Americas.
Under the direction of Chile’s Dr. Abraham Horowitz, the first Latin American director
of PAHO in 1958, the organization grew rapidly from its previous role in occasionally
13 “The Fred L. Soper Papers: Soper and the Pan American Health Organization.” National Library of Medicine. National Institute of Health, n.d. Web. 14 13 July 2016.14 Ibid. 15 “Constitution of the Pan American Health Organization.”16 “Governing Bodies.”
7
exchanging information between regional health offices.17 Instead of relying solely on research
produced in the United States, PAHO established several regional health centers that would work
at a more local, grassroots level. This new outreach also served to increase local research
capabilities and enabled each regional center to tailor health care technologies and innovations to
the needs of the community it served.18
The 1961 Punta del Este Charter recognized primary care as the most effective tool to
provide health services to both rural citizens of member countries and rapidly-growing urban
populations. Primary care is the first tier of health care, aimed at identifying symptoms and
prescribing basic treatment, while secondary health care involves more specialized care and
healing.19 This Charter further sought to promote the idea that health was an integral part of
socioeconomic development.20 However, the significant disparities in health outcomes
throughout the Americas despite recent gains in poverty reduction have indicated that economic
growth does not necessarily promote the desired health outcomes for all. The huge inequality
prevalent throughout many parts of the region remains one of the greatest inhibitors of progress
on health objectives for much of the population. Former PAHO director Dr. George A. O.
Alleyne has argued that the primary cause of major health problems in the Americas is the
hemisphere’s high level of income inequality and other forms of inequality. In an effort to
provide what it calls “social medicine,” PAHO examines the social and economic roots of health
concerns. A major challenge for the organization is the pursuit of greater equality in the areas of
physical, social, and ecological contributors to health outcomes.21
17 Fee, Elizabeth, and Theodore M. Brown. “100 Years of the Pan American Health Organization.” American Journal of Public Health 92.12 (2002): 18 1888. Print.18 Ibid.19 “Primary, Secondary, and Tertiary Care.” Dumfries & Galloway Advocacy Service. Dumfries & Galloway Advocacy Service, n.d. Web. 13 July 2016.20 Fee, Elizabeth, “100 Years,” 1889.21 Ibid.
8
Aims and Powers of the Committee
Since the spread of Zika impacts nearly all sectors of society, this committee will have
several goals in order to focus our discussions and ensure that we tackle all aspects of the
problem at hand. Through this committee, we will address, mitigate, and respond to the rising
number of Zika cases across Latin America. Since PAHO aims to strengthen health systems by
improving access and quality of health care, this committee’s mission is to prioritize health
equity while addressing these separate but interrelated objectives:22
1. To educate individuals and communities about how individuals contract Zika through
both infected mosquitos and unprotected sex with an infected partner.
2. To address teenage pregnancies in Latin America.
3. To increase funding for babies born with microcephaly and other Zika-related
neurological defects.
4. To create long-term initiatives to support the increasing number of babies with Zika-
related neurological problems who will need governmental funding to support
themselves.
5. To increase collaboration between Latin America, the Caribbean, and the rest of the
world in order to promote discourse on the global consequences of the spread of Zika.
In order to achieve these aims, PAHO delegates will incorporate present and past
research to creatively design and implement different initiatives.23 To effectively and accurately
reflect the goals of PAHO, delegates must come up with timely, cost-effective, socially aware,
and culturally sensitive solutions that address the above points. Although a vaccine for Zika does
22 PAHO. “About the Pan American Health Organization.” 30 May 2013. Web. 09 June 2017.23 Ibid.
9
not yet exist, delegates should focus more on addressing the consequences of Zika, rather than
working to find a cure for the virus. Achieving this goal is both multifaceted and complicated;
however, it is achievable. Through rigorous analysis, collaboration, creativity, debate, and
deliberation, PAHO will achieve its mission of both addressing and responding to the spread of
the Zika virus in Latin America.
The Topic in Context
In order to fully understand the implications of the Zika virus, delegates must first
examine the history of mosquito-borne illnesses in Latin America. Presently, a wide variety of
mosquito-borne illnesses exist in Latin America and the Caribbean.24 These illnesses include
yellow fever, malaria, dengue, chikungunya, West Nile, Western Equine Encephalitis, Western
Equine Encephalitis, and Zika.25 Although there are many mosquito-borne illnesses present in the
region, the three most emergent diseases that do not have cures or preventable medications are
dengue, chikungunya, and Zika. All three of these illnesses are transmitted via infected female
Aedes aegypti mosquitoes.26
While each of these illnesses have unique characteristics, they all have negative impacts
on the individual and community. Approximately one third of the global population resides in a
region where they are at-risk of contracting dengue.27 Many of these at-risk regions are in Latin
America, making dengue a critical cause of disease across Latin American countries.
24 Sims, Alexandra. "Eight mosquito-borne diseases that are not the Zika virus." The Independent. Independent Digital News and Media, 30 Jan. 2016. Web. 30 June 2017.25 Ibid. 26 Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL et.al. The global distribution and burden of dengue. Nature; 496:504-507.27 Sims, Alexandra. "Eight mosquito-borne diseases that are not the Zika virus." The Independent. Independent Digital News and Media, 30 Jan. 2016. Web. 30 June 2017.
10
Unfortunately, over the past two decades, rising temperatures have contributed to higher
incidences of dengue in tropical regions across Latin America. 28 Symptoms of dengue include
high fever, headache, eye pain, joint pain, muscle pain, nausea, vomiting, swollen glands, and
rash.29 Occasionally, dengue evolves into severe dengue, which can be characterized by
respiratory distress, severe bleeding, fluid accumulation, plasma leaking, organ impairment,
abdominal pain, and hemorrhaging. Individuals who contract severe dengue are often
hospitalized.30
Similar to the spread of dengue, infected Aedes aegypti mosquitoes also transmit
chikungunya. Unlike dengue, which has been around since the 1600s, chikungunya was first
discovered in Latin America and the Caribbean in 2013.31Joint pains, muscle aches, headaches,
swelling, rash, conjunctivitis, and fever characterize the symptoms of the virus.32 Although the
symptoms of chikungunya pale in comparison to dengue, the virus continues to complicate the
health of the individuals who contract it.
More recently, media attention has shifted to another mosquito-borne illness, the Zika
virus. Even though Zika first appeared in 1947, knowledge regarding Zika only became more
pervasive after an outbreak on Yap Island of Micronesia in 2007, where it infected nearly 75% of
the local population.33 In 2013, six years after the outbreak in Micronesia, Zika appeared in
28 Torres, Jaime R., and Julio Castro. "The health and economic impact of dengue in Latin America." Cadernos de Saúde Pública 23 (2007): S23-S31.29 "Dengue and severe dengue." World Health Organization. World Health Organization, n.d. Web. 30 June 2017.30 Ibid. 31 Sims, Alexandra. "Eight mosquito-borne diseases that are not the Zika virus." The Independent. Independent Digital News and Media, 30 Jan. 2016. Web. 30 June 2017.32 "Chikungunya Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Nov. 2015. Web. 30 June 2017.33 Weaver, Scott C., et al. "Zika virus: History, emergence, biology, and prospects for control." Antiviral research 130 (2016): 69-80.
11
French Polynesia. The virus spread from French Polynesia throughout the South Pacific, and
eventually materialized in Brazil in 2015.34
Although Zika is transmitted through the Aedes aegypti mosquito, the virus can also be
sexually transmitted. Symptoms of Zika are similar to those of dengue and chikungunya and
include mild fever, rash, headaches, and conjunctivitis. On rare occasions, individuals infected
with Zika can contract Guillain-Barré syndrome, a disorder when the body’s immune system
attacks the body’s nervous system. In extreme cases, this disorder can lead to paralysis.35
However, most individuals who contract Zika are asymptomatic and only 20% of individuals
actually exhibit symptoms.36
Although this may seem beneficial, this unique feature of the Zika virus makes it both
complicated to diagnose and impossible to control.37 Since Zika is sexually transmitted, this leads
to a rapid spread of the virus. Even though individuals may not exhibit symptoms of the virus,
the virus can be vertically transmitted from pregnant mothers to their fetuses in utero.38 While the
most common symptoms of Zika are milder than those associated with dengue and chikungunya,
if a fetus contracts Zika in utero, the child is at risk of developing a variety of neurological,
auditory, and visual impairments.39 Zika-infected babies are also at-risk of developing
microcephaly, or a condition where the baby’s brain does not fully develop during pregnancy
and leads to the baby having a smaller head. As a result, the baby is prone to seizures,
developmental delays, intellectual disabilities, problems with mobility and balance, feeding
34 Ibid. 35 “Zika Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 29 Sept. 2016. Web. 30 June 2017.36 Ibid. 37 Ibid.38 Ibid. 39 Oliveira Melo, A. S., et al. "Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?." Ultrasound in Obstetrics & Gynecology 47.1 (2016): 6-7.
12
problems, hearing loss, and vision problems. Because the babies’ brains fail to completely
develop, this premature cessation of brain development leads to mental disabilities and special
needs that affect victims for the rest of their lives. Unfortunately, up to 13% of Zika-infected
babies contract microcephaly.40 This not only leads to complications in individual families but
also has larger societal ramifications.
According to researchers from the Johns Hopkins Carey Business School and the United
Nations Development Program (UNDP), the social and economic impact of Zika will cost Latin
America and the Caribbean up to $18 billion between 2015 and 2017.41 As a response to Zika’s
impact, Jessica Faieta, United Nations Assistant Secretary-General and UNDP Director for Latin
America and the Caribbean, remarked, “Aside from tangible losses to GDP and to economies
heavily dependent on tourism, and the stresses on health care systems, the long-term
consequences of the Zika virus can undermine decades of social development, hard-earned
health gains, and slow down progress towards the Sustainable Development Goals.”42
In other words, the implications of Zika span beyond the conceivable short-term
repercussions. The cost of providing for Zika prevention resources as well as financially
supporting babies born with Zika-related neurological complications will surely place a strain on
countries’ economies. This influx of babies with neurological disabilities and special needs also
suggests that there will be significant changes to both healthcare and special education.
Furthermore, since many immediate solutions to addressing the rise and prevention of babies
born with extreme neurological disabilities involve options such as abortion and contraception
use, the Zika virus also proposes a moral quandary.
40 Ibid. 41 "Social and economic costs of Zika can reach up to US$ 18 billion in Latin America and the Caribbean." UNDP. N.p., 6 Apr. 2017. Web. 30 June 2017.42 Ibid.
13
Specifically, during the heat of the epidemic, many countries encouraged women to delay
pregnancy from 6 months to 2 years.43 The public received these instructions with ambivalence,
since more than 56% of pregnancies in the region are unintended.44 Many factors contribute to
this high rate of unintended pregnancies including limited access to contraception, inadequate
sexual education, high incidences of rape, and “cultural barriers” that serve as obstacles to men
using contraception.45 Moreover, another issue that complicates interventions, and one that is
important for delegates to consider, is their individual country’s stance on women’s reproductive
rights. After many women contracted Zika and learned that their babies might have neurological
delays, they questioned how to safely carry the pregnancy and whether law permits an abortion.
Different countries have different legislation regarding abortion. While abortion is completely
outlawed in El Salvador and women can face up to 40 years in prison for induced miscarriages,
other countries like Colombia give women the right to have an abortion and permit terminating a
pregnancy if a child is a risk to the woman’s health.46
The spread of Zika further complicates this issue. While some countries, like Brazil,
loosened their firm stance on women’s reproductive rights and allowed women to qualify for
legal abortions if their fetus had severe enough brain defects from microcephaly, other countries
like El Salvador, Nicaragua, Dominican Republic, Haiti, Honduras, and Suriname continued to
ban abortions without exception.47 This led to an increase in unsafe self-induced abortions as
well as an increase in babies with microcephaly carried to full-term. Thus, while PAHO
43 Roa, Mónica. "Zika virus outbreak: reproductive health and rights in Latin America." The Lancet 387.10021 (2016): 843.44 Sedgh, Gilda, Susheela Singh, and Rubina Hussain. "Intended and unintended pregnancies worldwide in 2012 and recent trends." Studies in family planning 45.3 (2014): 301-314.45 Roa, Mónica. "Zika virus outbreak: reproductive health and rights in Latin America." The Lancet 387.10021 (2016): 843.46 Ibid.47 Cauterucci, Christina. "How the Zika Epidemic Could Change Latin America's Relationship with Abortion ." Slate. Slate, 20 Jan. 2016. Web. 15 July 2017.
14
delegates must address the prevention of Zika and how to move forward from the aftermath, they
must also strongly consider their respective countries’ stances on issues related to reproductive
rights.48
Consequently, it is critical to note that the aftermath of Zika impacts every sector of
society: government, policy, the tourism economy, health, education, and the social sector.
Because of this, many Latin American and Caribbean countries are designing programs and
initiatives to address the short-term and long-term implications of Zika.
While Brazil and Colombia spearheaded Zika response efforts in Latin America, it is
pivotal to note that large-scale multilateral organizations including the World Health
Organization (WHO), Pan American Health Organization (PAHO), and US government were
vital forces in reducing Zika cases around the world.49 Different countries handled the Zika
epidemic in different ways depending on the country's’ political, economic, social, and moral
stances. While some countries took more conservative approaches to isolate the virus, other
countries opted to fumigate entire regions of the country or introduce genetically modified
species into their environment.
Addressing the Rise of Zika in Brazil
In the 1950s, the Brazilian government launched a large-scale effort to eradicate the
Aedes aegypti mosquito from the country in order to reduce cases of dengue and chikungunya.50
Unfortunately, the following decades marked a sudden resurgence in Brazil’s mosquito
48 Ibid. 49 Seelke, Clare Ribando, et al. “Zika Virus in Latin America and the Caribbean: U.S. Policy Considerations .” Congressional Research Service, 29 June 2016, fas.org/sgp/crs/row/R44545.pdf.50 "Brazil is 'badly losing' the battle against Zika virus, says health minister." The Guardian. The Guardian, 26 Jan. 2016. Web. 11 July 2017.
15
population due to travel and trade with neighboring countries.51 When Zika emerged in 2015,
public health experts and government representatives were not concerned because the symptoms
of Zika are milder than the symptoms of dengue. As more knowledge of the virus surfaced,
however, officials began to worry. At the beginning of 2016, Brazil went into crisis mode. The
virus left no town unreached, spanning from the underdeveloped north-eastern side of the
country to the modern and bustling city-sides.
In order to address the rising number of babies born with microcephaly, the Brazilian
government attempted to adopt a multi-strategy approach to mitigate the spread and aftermath of
the Zika virus.52 Marcelo Castro, current congressman and former Minister of Health of Brazil,
reported that approximately 220,000 members of Brazil’s armed forces were deployed to
fumigate houses for improved mosquito eradication efforts.53 Moreover, Castro initially proposed
that the government would distribute mosquito repellent to around 400,000 pregnant women who
at the time received cash-transfer benefits.54 Unfortunately, due to the high demand of mosquito
repellent, many pharmacies ran out of vector control products and prices tripled and quadrupled
for existing repellent supplies. This exacerbated fears of officials and civilians alike.
Increased fear and rising cases of microcephaly motivated Brazil to enforce more radical
measures, some being controversial. Since 2015, the government has employed thousands of
health workers to fumigate homes. Overall, approximately 20 million homes were fumigated.55
51 Ibid.52 Heukelbach, Jorg, et al. "Zika virus outbreak in Brazil." The Journal of Infection in Developing Countries 10.02 (2016): 116-120.53 "Brazil is 'badly losing' the battle against Zika virus, says health minister." The Guardian. The Guardian, 26 Jan. 2016. Web. 11 July 2017.54 Ibid. 55 Phippen, Weston. "Brazil Declares an End to Its Zika Health Emergency." The Atlatic. The Atlantic, 12 May 2017. Web. 13 July 2017.
16
That said, then-president Dilma Rousseff’s efforts sparked controversy because she granted the
health workers the right to “force themselves” into any building, whether public or private.56
Additionally, Brazil experimented with genetically modified mosquitoes.57 The country
released millions of these mosquitos into the environment. When these mosquitoes mated with
other Aedes aegypti mosquitoes, their offspring were born sterile. Consequently, this resulted in
an 82% decrease in Aedes aegypti larvae. The Brazilian government also addressed the Zika
crisis by introducing infectious bacteria into mosquito breeding grounds.58 Specifically, the
government reproduced the bacteria Wolbachia and inserted it into common breeding grounds
for mosquitos in effort to prevent mosquitoes from transmitting the virus. While their efforts
were successful in reducing the number of Zika cases they faced some criticism from
environmental and health expects around the world.59
In January 2016, Brazil reported more than 4,000 cases of microcephaly in newborns
since the start of 2015. This number is exponentially higher than the 150 cases that were present
in all of 2014. As knowledge of Zika’s dire symptoms spread, so did the fear associated with it. 60
Eventually, in 2016, the Brazilian government, along with officials in El Salvador and Colombia,
suggested delaying pregnancies until the Zika crisis passed, especially with the onset of the 2016
Rio Olympics.61
Although the Zika virus continues to spread across South America, North America, and
parts of Asia and Africa, in May 2017 the CDC announced the end of Brazil’s public health
56 Ibid.57 Ibid.58 Ibid. 59 Ibid. 60 Brazil is 'badly losing' the battle against Zika virus, says health minister." The Guardian. The Guardian, 26 Jan. 2016. Web. 11 July 2017.61 Phippen, Weston. "Brazil Declares an End to Its Zika Health Emergency." The Atlantic. The Atlantic, 12 May 2017. Web. 13 July 2017.
17
emergency over Zika. From January to April 2017, Brazil reported 95% fewer cases of Zika than
the year prior. However, despite Brazil’s successful measures to effectively decrease cases of
Zika in the country, the virus still persists and continues to have long-term implications on the
health, education, development, environmental, and financial sectors of Latin American
countries.
Addressing the Rise of Zika in Colombia
While countries with high incidences of microcephaly embraced radical Zika-prevention
efforts, countries with lower incidences of microcephaly enjoyed less aggressive measures.
Although Colombia’s tropical climate serves as the perfect haven for mosquito breeding, the
number of infant microcephaly cases is significantly fewer.62 As of October 31, 2016, more than
2,000 babies in Brazil were born with microcephaly. At the same time, only 47 babies were born
with microcephaly in Colombia.63 While scientists are still uncertain as to why microcephaly
incidences are lower in Colombia, some attribute it to Colombia’s smaller population and the
fact that nearly half of Colombians live in higher altitudes that are less preferable to mosquitoes.
Others speculate differently.64
Additionally, since the Zika virus spread to Colombia after Brazil, many Colombians
were aware of the consequences of contracting the virus. In order to prevent delivering a baby
with microcephaly, many women heeded the government’s “controversial” advice to delay
62 McNeil, Donald G., and Julia Symmes Cobb. “Colombia is Hit Hard by Zika, but Not by Microcephaly.” NYTimes, 31 Oct. 2016, www.nytimes.com/2016/11/01/health/colombia-zika-microcephaly.html. Accessed 15 Aug. 2017.63 McNeil, Donald G., and Julia Symmes Cobb. “Colombia is Hit Hard by Zika, but Not by Microcephaly.” NYTimes, 31 Oct. 2016, www.nytimes.com/2016/11/01/health/colombia-zika-microcephaly.html.64 Ibid.
18
pregnancies. Some women even sought ultrasounds and aborted deformed babies.65 According to
Dr. Parra-Saavedra, head of a study of Zika-related birth defects in collaboration with the
Centers for Disease Control and Prevention, “Abortion is legal in Colombia to protect a mother’s
health, and the health ministry considers a severely deformed baby a threat to maternal mental
well-being.”66 Moreover, Dr. Fernando Ruis, Colombia’s vice minister for public health, further
notes that “Colombia has some of the most progressive laws and regulations in South America”
and that even a small increase in the abortion rate could significantly contribute to a decrease in
incidences of microcephaly.67 Although abortions are legal in special circumstances, many
insurance companies do not approve them in time and women are forced to self-induce abortion
by consuming Misoprostol (a drug that causes strong contractions).
Because incidences of microcephaly were lower than anticipated in Colombia, the
government did not take radical measures to actively prevent cases of microcephaly. Rather, the
Colombian government encouraged women to delay pregnancies for at least six to eight
months.68
Addressing the Rise of Zika in the Caribbean
Although the rise of Zika seems dire in countries like Brazil, the Caribbean is the region
that is the most economically affected, with a financial impact five times greater than that of
South America.69 Initially, when Zika spread to the Caribbean, government and public health
officials were very concerned: the Caribbean’s hot, tropical, and rainy climate serve as the
65 Ibid.66 Ibid. 67 Ibid. 68 Ibid.69 "Social and economic costs of Zika can reach up to US$ 18 billion in Latin America and the Caribbean." UNDP. N.p., 6 Apr. 2017. Web. 30 June 2017.
19
perfect breeding ground for a mosquito-borne virus like Zika to proliferate. Because of this
increased tension, on February 8, 2016, the Obama Administration programmed US $1.9 billion
in funding the Zika outbreak, allocating $526 million of the funds to international efforts.70
As of April 21, 2017, PAHO’s epidemiological reports illustrated that there have been
only a limited number of Zika cases in the Caribbean.71The Center for Disease Control (CDC),
however, is still wary of removing a travel notice for the islands. Currently, 37 Caribbean
countries are on a “Level 2” alert, indicating that travelers to the countries should “practice
enhanced precautions.”72 Because the virus still persists in areas of the Caribbean, tourism
numbers will likely decrease. This will negatively impact not only the health of individuals in the
Caribbean but also the economy, which is dependent on the tourism sector. Countries that are
currently impacted by this advisory include: Anguilla, Antigua and Barbuda, Aruba, The
Bahamas, Barbados, Belize, Bonaire, British Virgin Islands, Cayman Islands, Cuba, Curaçao,
Dominica, Dominican Republic, Grenada, Guyana, Guadeloupe, Haiti, French Guiana, Jamaica,
Martinique, Montserrat, the Commonwealth of Puerto Rico, Saba, Saint Barthelemy, Saint Kitts
and Nevis, Saint Lucia, Saint Martin, Saint Vincent and the Grenadines, Suriname, Saba, Saint
Bathelemy, Saint Eustatius, Saint Maarten, Trinidad and Tobago, Turks and Caicos Islands and
the US Virgin Islands.73
The Crux of the Debate
70 Seelke, Clare Ribando, et al. “Zika Virus in Latin America and the Caribbean: U.S. Policy Considerations.” Congressional Research Service, 29 June 2016, fas.org/sgp/crs/row/R44545.pdf.71 "CDC Still Warning Travelers About Zika in the Caribbean." NEWS Americasnow, 20 Apr. 2017. Web. 13 July 2017.72 Ibid.73 Ibid.
20
There are a number of conflicting moral, economic, social, political, and ideological
differences that complicate the issue of addressing Zika in Latin America. Because Zika is
sexually transmitted, leadership of many South and Central American countries urged women to
delay pregnancy up to a year in order to reduce incidences of newborn microcephaly. However,
delaying pregnancy is contingent on increasing access to contraception and family planning
services. Therefore, it is important for delegates to determine their countries’ stances on
contraception, family planning, and abortion in regards to Zika prevention and control.74
Additionally, delegates must also consider their country’s geography and determine the
extent to which they are in a region that has favorable conditions for the Zika virus to thrive. If a
country has a climate that is more favorable to the Aedes aegypti, then delegates should
determine how to maximize vector control efforts. Similarly, if a delegate’s country is next to
another country that is experiencing more severe consequences of the virus, then delegates
should consider the implications of working with those neighboring countries. Furthermore,
delegates should examine differences in Zika transmission between urban and rural areas within
their country. Often, rural areas have limited access to adequate health care services and
education, so delegates should assess whether different interventions should be adapted to
incorporate community health workers in these settings. Even though adapting programs is both
timely and cost-ineffective, PAHO is committed to ensuring and promoting quality care for all
citizens in the Americas, despite their geographic location or economic circumstances.75 Despite
this commitment, PAHO has limited financial and social resources, so member states must
evaluate how programs, policies, and budgetary allocations can be both effective and cost-
efficient.
74 Roa, Mónica. "Zika virus outbreak: reproductive health and rights in Latin America." The Lancet 387.10021 (2016): 843.75 “Key Facts About PAHO.”
21
In addition, PAHO representatives should focus on preventing new Zika cases by
understanding the underlying factors that allowed the virus to thrive, and they should also debate
the future implications of such a virus on the social and public sectors. How does the spread of
the Zika virus exacerbate current social and economic inequalities across the region? What are
alternatives to current programs and policies, and how can we build on strengths of current
interventions? How will interventions like delaying pregnancy impact primary and secondary
school enrollment numbers in the future? How will the cost of financially and socially dependent
Zika babies influence the health and economic infrastructure of a country? Delegates can use
these questions as a starting point to guide their discussion throughout their debates.
A variety of interventions were discussed, ranging from the biological introduction of a
new species of mosquitoes to changes in abortion policies. As delegates debate policy proposals,
programs, and prevention interventions, they should ensure that they are fairly and accurately
representing their countries position on every issue. However, delegates should also note that
PAHO’s primary mission is “to strengthen national and local health systems and improve health
outcomes for all people in the Americas.”76 In other words, delegates should focus not only on
how to improve health outcomes in their respective countries but also on how to improve
healthcare for all people in the Americas. Cooperation, negotiation, and compromise are
essential to ensuring health equity across all countries represented within PAHO.
Throughout the debate, representatives should strive to achieve the goals of PAHO while
being as specific as possible in program and policy proposals. Member states should not only
consider what types of programs to implement, but also the cost, duration, financial implications,
quantity of resources needed (both physical resources and human resources), region of
implementation, and the type of support needed to sustain the program. Delegates should also
76 Ibid.
22
consider potential drawbacks in their decisions in order to be fully prepared for the
implementation of their proposals.
Power of the Committee to Address the Topic
While negotiating and drafting resolutions with other countries, delegates should
remember both the powers and limitations of PAHO. While PAHO can suggest legislation and
policy changes, the body is limited in its power of implementing these policies and cannot
control or challenge countries’ differing jurisdictions. However, PAHO delegates can still offer
multilateral policy recommendations and strategize cross-national initiatives in order to address
the present crisis and impending aftermath surrounding the Zika epidemic. Throughout this
process, conducting effective research, being specific in resolutions, and collaborating with other
nations to discover efficient solutions will be essential.
On February 2, 2016, PAHO released a statement on Zika virus transmission and
prevention and stated, “There are two main reasons for the virus's rapid spread: (1) the
population of the Americas had not previously been exposed to Zika and therefore lacks
immunity, and (2) Aedes mosquitoes—the main vector for Zika transmission—are present in all
the region's countries except Canada and continental Chile. PAHO anticipates that Zika virus
will continue to spread and will likely reach all countries and territories of the region where
Aedes mosquitoes are found. The most effective forms of prevention are (1) reducing mosquito
populations by eliminating their potential breeding sites, especially containers and other items
(such as discarded tires) that can collect water in and around households; and (2) using personal
protection measures to prevent mosquito bites.”77 Although research on Zika still has gaps,
77 Mitchell, Cristina. "PAHO WHO | PAHO Statement on Zika Virus Transmission and Prevention." Pan American Health Organization / World Health Organization. Pan American Health Organization, n.d. Web. 21 July 2017.
23
PAHO currently recommends reducing mosquito breeding sites, using insect repellent, sleeping
under mosquito nets, and covering as much of the body as possible. However, despite these
measures, Zika is still spreading to neighboring American countries through mosquito vectors
and sexual transmission.
In order to propose comprehensive and accurately represented resolutions, member states
must communicate with one another to assess their positions on different social, economic, and
political issues. While states with more politically and socially exploratory policies may propose
to loosen abortion laws and encourage contraceptive access and usage, states possessing a higher
degree of religious influence may collaborate with the Catholic Church in order to encourage
abstinence and condemn contraceptive uses. Moreover, countries with a higher mosquito
population may want to allocate more resources towards addressing the future implications,
while countries with a lower mosquito population might be hesitant to devote a multitude of its
resources towards vector control efforts. Additionally, countries with higher GDPs and higher
percentages of their populations living in urban areas might find large-scale educational
programs and prevention efforts to be more cost-effective than countries with lower GDPs and
higher percentages of their populations living in rural areas. Although there might be a variety of
positions, perspectives, and ideological differences, the countries of PAHO must work together,
discuss, and decide how they can most effectively and efficiently address the rise of the Zika
epidemic in the Americas.
Questions a Resolution Paper Must Answer
While the issue of Zika is multilateral and complex, these questions should provide
delegates with a framework to structure their debate and arrive at their resolutions.
24
● How can Zika prevention be addressed in both urban and rural areas? How will
educational programs and other initiatives differ depending on rural and urban areas?
How will these efforts differ across countries that are affected by Zika to varying
degrees?
● How will the social, economic, and financial implications of Zika be addressed in
countries that are most affected by Zika? How can PAHO prepare for future changes in
the health care and education sectors?
● How can the sexual transmission of the Zika virus be addressed, given stigmas around
abortion, contraception, and family planning?
● What private and public entities should PAHO collaborate with to ensure PAHO is taking
a multilateral approach to addressing Zika? Will these organizations take a vertical or
horizontal approach? How can PAHO ensure that all nations’ voices are represented?
● Where should funding go? Where should funding come from? Should individual nations
determine their source of funding, or should a larger international fund determine
financial distributions? How can PAHO account for some nations needing more financial
resources than others?
Framing Position Papers
In order to determine countries’ stances and strengthen representatives’ understandings of
their positions, PAHO delegates will research and submit position papers. These position papers
will explain current health situations in each country. Papers will also highlight the policies and
initiatives that member states will propose during the course of the conference. Position papers
should be comprehensive, serving as a framework for arguments during debate.
25
In order to write successful position papers, representatives must understand what is
negotiable and what is non-negotiable. While PAHO’s recommendations should prioritize the
needs of Latin America and the Caribbean over the needs of individual countries, delegates
should not propose policies that contradict their country’s position. For example, if El Salvador
is vehemently opposed abortions, then delegates from El Salvador should not side with programs
that contradict this policy. Member states should also consider the financial limitations of
PAHO. While it may seem idealistic to fumigate all houses in Latin America and the Caribbean
as a vector control effort, this is neither feasible nor cost-effective. Therefore, representatives
should set reasonable time limits to achieve their proposed goals. Moreover, since PAHO cannot
enforce policy or legislation, member states must also be cautious of being too confrontational in
their recommendations.
Beyond these limitations, PAHO delegates are encouraged to be creative. Representatives
can expand the scope of past initiatives, create new initiatives, or implement a vibrant
combination of realistic ideas and proposals. Finally, it is strongly encouraged that delegates
research and analyze their country’s past initiatives. This will not only help delegates understand
their country’s position, but it will also help them craft an effective position paper.
Proposed Solutions
Because the spread of Zika is a multi-faceted issue affecting different sectors of the
country, delegates will need to take a multilateral approach when proposing solutions.
Furthermore, while short-term solutions are often easier to visualize and exert resources into,
delegates should not compromise on long-term strategies and solutions. Additionally, while the
solutions proposed below address the rise of Zika, they are by no means comprehensive or
26
exhaustive. There are many ways to go about addressing the Zika crisis and the solutions below
are only a few examples. Finally, creativity is key. The more creative an approach is, the more
rewarding delegates’ experiences of PAHO will be.
In order to design successful proposals, delegates must consider vector control efforts as
well as family planning efforts. PAHO delegates can consider the strengths of implementing a
large-scale vector control effort across countries in Latin America that have high populations of
Aedes egyptis mosquitoes. Where this funding comes from and the quantity of resources
distributed to individual countries remains to be discussed. From an infrastructural perspective,
PAHO can recommend to open more maternity and health-screening clinics in areas that have
limited access to health care facilities. Additionally, delegates can consider implementing
community-centered public health education efforts. Governments can invest financial resources
into hiring community health workers to travel to different rural communities and educate
individuals about ways to prevent Zika. It is also important to note the populations that are most
vulnerable to the virus. Expanding on this, PAHO delegates should contemplate how youth can
be encouraged to engage in Zika prevention efforts. Perhaps delegates can create Zika-education
carnivals or encourage contraceptive use in secondary schools. While this list includes possible
solutions, this should not limit delegates. Rather, this list should serve as a starting point for
delegates: the possibilities are endless.
Although there is not one correct solution to this issue, it is important to consider the
drawbacks and repercussions of every potential solution. By working together and creatively
analyzing the pros and cons of each solution, PAHO delegates will be able to achieve effective
solutions to the rise of Zika across the Americas.
27
Closing Remarks and Recommendations for Future Research
The rise of the Zika virus across Latin America is an issue of increased importance. Zika
not only threatens the lives of newborn children, but it also has a long-term impact on the lives of
neurologically affected babies. Solving Zika is not easy. Conflicting moral ideologies, restricted
financial resources, and limited health care facilities in areas most vulnerable to large
populations of breeding mosquitoes demonstrate that addressing this issue will be complicated. It
is up to this assembled body to adequately research the topic, collaborate with other delegates,
and creatively suggest solutions in a timely manner.
There are a plethora of resources available to delegates throughout the research process.
The WHO, CDC, CRS Report, and PAHO websites have resources and reports that delegates
might find valuable. Different academic journals will also prove advantageous in getting a
historical understanding of viruses. However, since Zika recently emerged in Latin America,
delegates might find it more helpful to thoroughly research the impact of Zika on reliable online
news sources.
Finally, I want every delegate to understand that I am here for you if you need any help,
clarification, advice, or motivation throughout the HACIA process. No question is too small or
too inconsequential. PAHO delegates face a large and important task, and I am here for you
during the entire process. I can’t wait to meet each and every one of you in March! Good luck
researching!
Sincerely,
Sara Surani
Harvard College Class of 2018
28
29
References
Butler, Declan. "Zika virus: Brazil's surge in small-headed babies questioned by report." Nature News. Nature Publishing Group, 28 Jan. 2016. Web. 13 June 2017.
"News: Zika and complications." World Health Organization. World Health Organization, 1 Feb. 2016. Web. 13 June 2017.
"Zika Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 01 May 2017. Web. 13 June 2017.
dos Santos, C. N. D., & Goldenberg, S. (2016). Zika Virus and microcephaly: challenges for a long-term agenda. Trends in Parasitology.
"News: Zika and complications." World Health Organization. World Health Organization, 1 Feb. 2016. Web. 13 June 2017.
"20 alarming facts about the Zika virus." CBS News. CBS Interactive, 20 Dec. 2016. Web. 13 June 2017.
"News: Zika and complications." World Health Organization. World Health Organization, 1 Feb. 2016. Web. 13 June 2017.
“Key Facts about PAHO.” Pan American Health Organization. PAHO, 29 May 2015. Web. 13 July 2016.
“Constitution of the Pan American Health Organization.” Pan American Health Organization. PAHO, 30 May 2013. Web. 13 July 2016.
“Governing Bodies.” Pan American Health Organization. PAHO, 10 August 2015. Web. 13 July 2016.
“The Fred L. Soper Papers: Soper and the Pan American Health Organization.” National Library of Medicine. National Institute of Health, n.d. Web. 14 13 July 2016.
“Governing Bodies.”
Fee, Elizabeth, and Theodore M. Brown. “100 Years of the Pan American Health Organization.” American Journal of Public Health 92.12 (2002): 18 1888. Print.
“Primary, Secondary, and Tertiary Care.” Dumfries & Galloway Advocacy Service. Dumfries & Galloway Advocacy Service, n.d. Web. 13 July 2016.
Fee, Elizabeth, “100 Years,” 1889.
30
Sims, Alexandra. "Eight mosquito-borne diseases that are not the Zika virus." The Independent. Independent Digital News and Media, 30 Jan. 2016. Web. 30 June 2017.
Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL et.al. The global distribution and burden of dengue. Nature;496:504-507.
Sims, Alexandra. "Eight mosquito-borne diseases that are not the Zika virus." The Independent. Independent Digital News and Media, 30 Jan. 2016. Web. 30 June 2017.
Torres, Jaime R., and Julio Castro. "The health and economic impact of dengue in Latin America." Cadernos de Saúde Pública 23 (2007): S23-S31.Bhatt S, Gething PW, Brady OJ, Messina JP, Farlow AW, Moyes CL et.al. The global distribution and burden of dengue. Nature;496:504-507.
"Brazil is 'badly losing' the battle against Zika virus, says health minister." The Guardian. The Guardian, 26 Jan. 2016. Web. 11 July 2017.
Cauterucci, Christina. "How the Zika Epidemic Could Change Latin America's Relationship with Abortion." Slate. Slate, 20 Jan. 2016. Web. 15 July 2017.
"CDC Still Warning Travelers About Zika in the Caribbean." NEWS Americasnow, 20 Apr. 2017. Web. 13 July 2017.
"Chikungunya Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 16 Nov. 2015. Web. 30 June 2017.
"Dengue and severe dengue." World Health Organization. World Health Organization, n.d. Web. 30 June 2017.
Heukelbach, Jorg, et al. "Zika virus outbreak in Brazil." The Journal of Infection in Developing Countries 10.02 (2016): 116-120.
McNeil, Donald G., and Julia Symmes Cobb. “Colombia is Hit Hard by Zika, but Not by Microcephaly.” NYTimes, 31 Oct. 2016, www.nytimes.com/2016/11/01/health/colombia-zika-microcephaly.html. Accessed 15 Aug. 2017.
Mitchell, Cristina. "PAHO WHO | PAHO Statement on Zika Virus Transmission and Prevention." Pan American Health Organization / World Health Organization. Pan American Health Organization , n.d. Web. 21 July 2017.
Oliveira Melo, A. S., et al. "Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg?." Ultrasound in Obstetrics & Gynecology 47.1 (2016): 6-7.
PAHO. “About the Pan American Health Organization.” 30 May 2013. Web. 09 June 2017.
31
Phippen, Weston. "Brazil Declares an End to Its Zika Health Emergency." The Atlatic. The Atlantic, 12 May 2017. Web. 13 July 2017.
Roa, Mónica. "Zika virus outbreak: reproductive health and rights in Latin America." The Lancet 387.10021 (2016): 843.
Sedgh, Gilda, Susheela Singh, and Rubina Hussain. "Intended and unintended pregnancies worldwide in 2012 and recent trends." Studies in family planning 45.3 (2014): 301-314.
Seelke, Clare Ribando, et al. “Zika Virus in Latin America and the Caribbean: U.S. Policy Considerations.” Congressional Research Service, 29 June 2016, fas.org/sgp/crs/row/R44545.pdf.
Sims, Alexandra. "Eight mosquito-borne diseases that are not the Zika virus." The Independent. Independent Digital News and Media, 30 Jan. 2016. Web. 30 June 2017.
"Social and economic costs of Zika can reach up to US$ 18 billion in Latin America and the Caribbean." UNDP. N.p., 6 Apr. 2017. Web. 30 June 2017.
Torres, Jaime R., and Julio Castro. "The health and economic impact of dengue in Latin America." Cadernos de Saúde Pública 23 (2007): S23-S31.
Weaver, Scott C., et al. "Zika virus: History, emergence, biology, and prospects for control." Antiviral research 130 (2016): 69-80.
“Zika Virus." Centers for Disease Control and Prevention. Centers for Disease Control and Prevention, 29 Sept. 2016. Web. 30 June 2017.
32
Endnotes
33
