More than eight months after the White House first asked for it, Congress has finally agreed on some funding to help fight the Zika virus and study its effects. President Barack Obama signed the stopgap spending bill Thursday, according to NBCNews. It provides $1.1 billion to use in continuing work on a vaccine against Zika virus infection, as well as studies of the effects on unborn babies, adults and children. It will also help states control the mosquitoes that spread the virus.#Congress has finally agreed on funding to help fight the #Zikavirus and study its effects Click To Tweet
The bill brings to a shameful conclusion a partisan fight that has had the unusual effect of delaying funding to deal with what all sides agree is a public health emergency. The delay stemmed from disagreement over side issues like funding for Planned Parenthood and whether the money should be considered “emergency” spending.
“Congress has finally treated Zika like the emergency it is and shown the American people that it is capable of rising above partisanship for the health of its citizens,” said Dr. Thomas Gellhaus, president of the American Congress of Obstetricians and Gynecologists.
It’s just over half what federal health agencies say they need, and the approval squeaked through just two days before the end of the fiscal year on Sept. 30.
“We’ll be able to put that money towards the Zika fight as soon as the new fiscal year begins,” said Health and Human Services Department spokesman Kevin Griffis.
The National Institutes of Health and the Centers for Disease Control and Prevention said they had run out of fresh money to fight Zika. The administration had already pulled $589 million from other programs, including $500 million meant to help prevent another Ebola outbreak. The CDC and NIH had robbed emergency preparedness, cancer, and vaccine and HIV programs for more cash.
This bill does not give back any of the borrowed money, said National Institute of Allergy and Infectious Diseases director Dr. Anthony Fauci. That includes $11 million from tuberculosis, malaria, flu; $47 million from reprogrammed Ebola funds and $34 million from the National Cancer Institute and other NIH institutes. “We may never get to officially pay that back,” Fauci told NBC News.
“All the $152 million that (NIAID) will receive will go to Zika projects, predominantly the vaccine work. It’s disgraceful that Congress took so long responding to this deadly health crisis,” said Florida Rep. Vern Buchanan, a Republican who fought for Zika funding. “This was a case of Washington dysfunction at its worst.”
HHS Secretary Sylvia Burwell said she did not know what other funds she could plunder.
Republicans and Democrats in Congress sparred for months over where the Zika money should come from and whether any spending bill should limit how it’s spent. Republicans wanted to repurpose existing funds and keep them away from Planned Parenthood clinics in Puerto Rico; Democrats wanted what they called a “clean” bill without such restrictions.
Senior health officials like Fauci and CDC Director Dr. Tom Frieden were forced to beg, repeatedly, for funds both on and off Capitol Hill. While Congress argued, Zika arrived in the U.S. The CDC reports thousands of confirmed Zika cases in U.S. travelers, including more than 800 pregnant women. CDC experts say there are likely thousands more that haven’t been reported.
Florida reports 134 home-grown cases–presumably caused by travelers infected in other Zika zones who were then bitten by local mosquitoes. Southern states, including Florida, are home to the Aedes aegypti mosquito that spreads Zika.
When it’s all said and done, the legislation directs $394 million for mosquito control and $397 million for work on vaccines and better tests to diagnose Zika infections in people. It also provides $66 million to help people infected with Zika in U.S. territories–mostly Puerto Rico, which has a full-blown Zika epidemic.
Burwell said it can cost anywhere between $1 million and $10 million to care for a child born with microcephaly. Some babies die soon after birth while those that survive need various degrees of care, depending on their impairment. Fan Tait of the American Academy of Pediatrics says Zika-affected babies will impact federal, state and local health providers. “This will stretch every system of care,” she told a meeting on Zika sponsored by the NIH last week.
Steve’s Take: After covering this disgraceful seven-month display of partisan politics triumphing over an immediate, dire threat to our nation’s health, I can only say, finally.Steve's Take: Disgraceful 7-month display of #ZikaVirus partisan politics is finally over Click To Tweet
As I’ve said on countless occasions, the $800 million difference in Obama’s initial request for Zika funding and the GOP’s counter was a mere $800 million–exactly 0.013% of our national defense budget. But time after time the peripheral issues stopped progress on getting funds into the hands of the scientists working on a vaccine.
In gauging Congress’s apparent lack of comprehension of what’s at stake with funding the war on Zika, CDC Director Frieden recently said,
“I think we’ll look at this delay in time and say, ‘How could they have waited so long?’ This was so urgent. It was the very definition of an emergency. Not only is this unanticipated, it’s unprecedented. It’s potentially catastrophic, and it’s certainly that for the kind of brain damage we’re seeing.”
But not only has our health as US citizens been brushed aside these past seven months, the wrangling over funding Planned Parenthood marked an additional insult, regardless of which camp you are in, politically.
“Women’s health should never be treated like a political football,” said Sen. Patty Murray (D-WA), who is the ranking member of the Senate’s Health Education Labor and Pensions Committee. “I am glad that Republicans finally agreed to set aside the extreme provisions that would have specifically blocked Planned Parenthood healthcare providers from accessing critical funding.”
By the way, more than 23,000 people in the mainland U.S. and Puerto Rico have now contracted the Zika virus, according to the Centers for Disease Control and Prevention.
Let’s take a brief look, offered up to us in a compassionate, yet sobering, piece in The New York Times by Perri Klass, MD, at what’s actually coming to our cities, towns and rural areas, no matter what Congress may do at this late stage to fund the Zika fight.
In the pediatric field, Zika looms as a kind of developmental doomsday virus, attacking the vulnerability of early brain development, striking at the neurological basis of human potential. While Puerto Rico, a United States territory, will experience the first wave of children affected by Zika, the rest of the United States is bracing for the spread of the virus.
As of Sept. 23, the Puerto Rico Department of Health (pdf) reported 22,358 cases of Zika exposure, including 1,871 pregnant women. The Centers for Disease Control and Prevention’s latest statistics, as of Sept. 15, list 1,348 pregnant women with “any laboratory evidence of possible Zika virus infection” in United States territories and 749 in the United States, according to The Times.
Exposure to Zika while pregnant does not mean a child definitely will be born with microcephaly, an unusually small brain and head, or have Zika-related health problems. But the risk is real, says Dr. Klass, and pediatricians are trying to figure out how to follow these children, and how to take care of the ones who do have problems.
While nobody knows the actual risk of Zika exposure to a fetus, studies have suggested that between 1% and 13% of pregnant women infected with Zika in the first trimester will have a child with microcephaly, but more could have children with more subtle developmental problems related to in utero exposure to the virus.
Earlier this month, the American Academy of Pediatrics (AAP) announced a $350,000 grant from the Department of Health and Human Services to create a network of pediatricians prepared to deal with a generation of children with Zika-related health problems. When babies are born with damaged brains because of Zika they will need medical care and their families will need support.
Dr. Peter Jay Hotez, the dean for the National School of Tropical Medicine at Baylor College of Medicine in Houston, said several big questions need to be answered. How does the virus do its damage? What is the full spectrum of damage, from the clearly visible microcephaly to less visible neurological changes? And what happens to babies exposed to Zika after birth, when the brain is still developing?
For the children born with microcephaly, whose fetal brain growth has clearly been disrupted by the virus, the recommendations draw on the very recent and quickly evolving experience of doctors in Brazil. These babies are at risk for seizures, feeding problems, tightly contracted joints, thyroid problems, eye problems, and developmental delays. They need regular neurological examinations, hearing tests, vision tests, hormone tests and lots of medical backup, says Dr. Klass.
“If you see a child who has such significant microcephaly, you know the issues,” said Dr. Fan Tait, a pediatric neurologist who is one of the associate directors at the AAP and took part in the meeting.
To provide decent care for these children, to support their families, requires subspecialists, coordination, and a profound commitment to complex care. That kind of care is not always available, especially for children from less advantaged homes, and there’s a concern that Zika, like so many other diseases, may play out along the lines of privilege, with poor people more likely to be exposed, either because of less protected living situations or jobs that keep them outside.
“No one’s really sure of the magnitude of what we will be dealing with,” said Dr. Tait.
“And what about the children with normal sized heads at birth, who are known to have been exposed to this virus, which targets the developing brain?” asked Dr. Sonja Rasmussen, a pediatrician and clinical geneticist who is the director of the Division of Public Health Information Dissemination at the CDC. “Is the microcephaly just the tip of the iceberg or are those kids without microcephaly at birth going to be just fine?”
What kind of monitoring is necessary when the babies look normal?
“We do know that if children have hearing loss, vision problems, developmental delay, it’s best if it’s identified early,” Dr. Rasmussen said.
The interim guidelines recommend “additional monitoring, until further information is available regarding outcomes,” including regularly testing vision, testing hearing, and educating parents about problems to watch for.
While Congressional representatives have played righteously to their particular political constituencies on side issues, the Zika virus has continued to spread on its own time clock. Meanwhile, the health, indeed the very lives of Americans, especially our children, has been eerily neglected. And if that’s not disturbing enough, there’s the presidential campaign.