Emergency and permanence of the Zika virus epidemic: an agenda connecting research and policy

Abstract

Cad. Saúde Pública 2018; 34(8):e00075718Recently, the Zika virus epidemic has caused a setting of health emergency in Brazil. This event has mobilized several stakeholders to look at this reality -where women, men and children born with the marks of these diagnoses are differently affected -as one with vectors, illnesses and obscure diagnosis situations. Recalling this recent memory means summoning the political realms to demand the commitment to the health of the population in contexts of health emergencies and their repercussions in the daily life.The Zika virus epidemic is characterized as a total social fact 1 , precisely because it synthesizes several determinations about epidemic processes by combining factors of economic and social inequality and revealing processes of vulnerability. This situation triggers a chronology of events that establish and dismiss the emergency: in November 2015, the Brazilian Ministry of Health issued a National Public Health Emergency 2 ; in February 2016, the World Health Organization (WHO) classified the Zika virus epidemic as a public health emergency of international concern 3 ; in March 2016, the Protocol for Surveillance and Response to the Occurrence of Microcephaly Related to Zika Virus Infection 4 was published; in November 2016, the WHO no longer considered the Zika virus as an international emergency 5 ; and, in May 2017, the Brazilian Ministry of Health declared the end of the emergency 6 .These sequential events, responsible for inaugurating and ceasing emergencies, do not suspend the living experience: babies will grow up and need, in addition to rehabilitation services, nurseries and schools able to receive them; and parents and relatives will need to work and most likely will be burdened by their exhausting routines. The emotional vulnerability to which professionals and users of health system are submitted are equivalent within a chain of iniquities and search for knowledge. Moreover, this chronology delimits a process that risks sexual and reproductive rights in the name of securitization of epidemics 7 , reinforcing fears and stigmatization.If, on the one hand, international agencies and the Brazilian government position themselves and qualify emergencies, on the other, by anticipating them very closely, the scientific field -both clinicians and researchers -mobilizes itself for answers 8,9,10 .Given this context, the National Network of Specialists of Zika and Related Diseases (RENEZIKA), among others, and studies on the biological and social aspects had the initiative of coming forward in a cooperation between national and international researchers to investigate and propose articulations for action.

Access to healthcare for children with Congenital Zika Syndrome in Brazil: perspectives of mothers and health professionals

“…For the healthcare professionals, the CZS epidemic exposes a bottleneck in specialized care in SUS and highlighted the unmet demand for healthcare services and activities already experienced by other children and people with disabilities (Moreira et al , 2018).…”

Hope and trust in times of Zika: the views of caregivers and healthcare workers at the forefront of the epidemic in Brazil

“…These children experience a range of health conditions, often resulting in severe physical, sensory and cognitive impairment ( Miranda-Filho et al , 2016 ). They have high healthcare needs from a range of providers, putting considerable time and emotional pressure on caregivers ( Moreira et al , 2018 ). Yet the impact of the Zika epidemic on families has received little attention, even though research from a variety of settings, including Brazil, shows that parents of severely disabled children are likely to experience depression, anxiety, stress ( Santos Oliveira et al , 2017 ), spousal separation ( Joesch and Smith, 1997 ; Hartley et al , 2010 ; Lederman et al , 2015 ) and negative economic consequences due to the direct and indirect costs incurred through attending to their child’s caring needs ( Diniz et al , 2017 ).…”

Proposal for integrated analysis of public health emergencies involving arboviruses: the case of the Zika virus in Brazil

“…CZVS has proven to be more common than microcephaly alone, potentially affecting infants without apparent alterations in head circumference 74,75 , so that on-going follow-up of the children in this cohort is necessary. Reprogramming should focus on the growing demands for support for the mother, the child, and the person with disabilities, including: access to 'assistive technologies' 76 ; intensive rehabilitation, including braces and prosthese 44 ; early stimulation with a physical therapist, consultations with pediatricians, psychologists, and ophthalmologists, audiometry, and management of the children's difficulties eating and with mobility 77 ; access to income and transportation benefits; supply of caregivers; openness to these children in the school system 78 ; and psychosocial support for caregivers and families 79 .…”