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A Menace Wrapped in a Protein: Zika and the Global Health Security Agenda

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A Menace Wrapped in a Protein: Zika and the Global Health Security Agenda See discussions, stats, and author profiles for this publication at: https://www.researchgate.net/publication/320677119 Title: A MENACE WRAPPED IN A PROTEIN: ZIKA AND THE GLOBAL HEALTH SECURITY AGENDA Technical Report · September 2017 DOI: 10.13140/RG.2.2.25050.85443 CITATIONS READS 2 129 5 authors, including: Helen Epstein Wilmot James Bard College Columbia University 28 PUBLICATIONS 925 CITATIONS 5 PUBLICATIONS 15 CITATIONS SEE PROFILE SEE PROFILE Ángel G Muñoz Lawrence Stanberry Columbia University Columbia University 121 PUBLICATIONS 694 CITATIONS 238 PUBLICATIONS 7,326 CITATIONS SEE PROFILE SEE PROFILE Some of the authors of this publication are also working on these related projects: Climate informed malaria prevention, control and elimination View project ENACTS (Enhanced National Climate Services) View project All content following this page was uploaded by Ángel G Muñoz on 27 October 2017. The user has requested enhancement of the downloaded file. Title: A MENACE WRAPPED IN A PROTEIN: ZIKA AND THE GLOBAL HEALTH SECURITY AGENDA Authors: Helen Epstein, Wilmot James, Ángel G. Muñoz, Lawrence Stanberry & Madeleine C. Thomson. Reference: Columbia GHS&D Working Group Papers 2017-01 Date: September, 2017 Place: Columbia University Medical Center, Morgan Stanley Children’s Hospital, Office 102, 3959 Broadway CHC 1-102, New York City NY 10032, USA. Copyright: This work is licensed under the Creative Commons Attribution-NonCommercial- ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/. A MENACE WRAPPED IN A PROTEIN1: ZIKA AND THE GLOBAL HEALTH SECURITY AGENDA Preface Stephen Nicholas & Marc Grodman… i 1.Zika: Implications for Global Health Security Helen Epstein… 1 2.Zika Pathogenesis, Diagnosis and Vaccines Lawrence Stanberry… 12 3.Climate Change, the Environment and the Zika Outbreak Madeleine C. Thomson & Ángel G. Muñoz… 15 4.Global Health Security and Diplomacy Wilmot James… 25 5.Timeline of the Zika Virus Pandemic 39 6.Zika Reading List 48 7.Conference: Zika and the Global Health Security Agenda 50 Stephen W. Nicholas, M.D., is Senior Associate Dean for Admissions at the College for Physicians and Surgeons and Professor of Pediatrics and Population & Family Health at Columbia University Medical Center and founder/director of The Program for Global and Population Health (established in 1999 as the IFAP Global Health Program). Marc Grodman, M.D., is an Assistant Professor of Clinical Medicine at Columbia University College of Physicians and Surgeons (P&S) and the Founder Chairman and CEO of BioReference Laboratories Inc. He serves as a member of the CUMC Board of Advisors. Helen Epstein, Ph.D., is Visiting Professor of Global Health and Human Rights at Bard College. Lawrence Stanberry M.D. Ph.D., is a leading specialist in congenital infections and authority on viral infections and vaccine development. He is the chief pediatrician at Morgan Stanley Children’s Hospital and Chairman of the Department of Pediatrics at the College of Physicians and Surgeons at Columbia University. Wilmot James, Ph.D., is Visiting Professor of Pediatrics (non-clinical) and International Affairs and Director of Global Health Security & Diplomacy at The Program for Global and Population Health at Columbia University. He is a former MP and Shadow Health Minister (South Africa). Madeleine Thomson, Ph.D., is Senior Research Scientist at the International Research Institute for Climate and Society, The Earth Institute, and the Mailman School of Public Health, Department of Environmental Health Sciences, Columbia University. She also leads the WHO/PAHO Collaborating Center for Malaria early warning systems and other climate sensitive diseases. Ángel G. Muñoz, Ph.D., is a climate scientist at Atmospheric and Oceanic Sciences, Princeton University and the International Research Institute for Climate and Society, The Earth Institute, Columbia University. 1 The title is inspired by Nobel Laureate Peter Medawar’s description of a virus as ‘bad news wrapped in a protein’. PREFACE: GRODMAN & NICHOLAS Preface Marc Grodman and Stephen Nicholas Finding simplicity in complexity. That was our aim in holding a one-day meeting in April 2017 to address Global Health Security through the prism of the Zika virus epidemic. This meeting brought together colleagues from across the Columbia University campus, many of us meeting for the first time, from the College of Physicians and Surgeons, the Mailman School of Public Health, the School of International and Public Affairs, the Earth Institute and the International Research Institute for Climate and Society. We were joined by individuals from outside Columbia, bringing together experts from vastly different domains— from academia, government, industry, journalism— specialists in health and public health, policy formulation, sustainable development, climate and earth studies, etymology, informatics, vaccine and drug and diagnostics development— to consider the Zika epidemic, which has swept Latin America and the Caribbean and left damaged babies in its wake. We examined Zika as a means by which to explore the multiple dimensions that must be considered when the health, security and well-being of our world is endangered by such a frightening outbreak. Global threats to well-being don’t fit into one discipline. Understanding the challenges, providing the solutions don’t belong to one profession or share any specific line of training. To be effective, physicians need to understand informatics, public health professionals need to understand policy, climate change scientists need to understand health. These challenges stretch the perspective of all of us. The other reason is that pandemics and global threats that are not limited by borders or boundaries are frightening, not because of what we know about them but rather what we don’t. Zika is an accurate example of this paradigm, since it took time to diagnose the outbreak, time to understand its scope, time to understand the appropriate diagnostics, time to understand the clinical presentations and even more, it will still take a great deal more time to understand its long term effects. This is a threat whose parameters are still being defined. The uncertainty is disturbing, for those of us who want immediate answers. While the Zika epidemic is anything but simple, using it as a way to begin to examine the vastly more complex topic of Global Health Security was a useful exercise. What was most memorable i PREFACE: GRODMAN & NICHOLAS about this meeting was the high degree of enthusiasm that participants voiced in support of continued broad collaborative relationships. This subsequently has led to the formation of: The Working Group on Global Health Security and Diplomacy at Columbia University (Executive Director, Dr. Wilmot James (P&S, Program for Global and Population Health and SIPA) and Co-Director, Dr. Madeleine Thomson (Earth Institute/IRI). The Working Group’s Steering Committee includes Steven Cohen (Earth Institute), Marc Grodman (P&S, CUMC Board of Advisors), Merit Janow (SIPA), Theresa McGovern (Mailman SPH) and Stephen Nicholas (P&S and Mailman SPH) and Lawrence Stanberry (P&S). Zika Conference: April 3, 2017, CUMC: Left to Right: K. Modjarrad, M. deWilde, M. Grodman, and P. R. Vagelos ii 1 EPSTEIN ZIKA: IMPLICATIONS FOR GLOBAL HEALTH SECURITY 1: ZIKA: IMPLICATIONS FOR GLOBAL HEALTH SECURITY Helen Epstein Zika and the Urgency of Pandemic Preparedness Until very recently, Zika, a mosquito-borne virus closely related to the one that causes yellow fever, was unknown outside of Africa and Asia and was thought to be virtually harmless. Then about a decade ago it began island hopping across the Pacific Ocean, and as it did, its terrifying nature gradually became known. First there was an outbreak on tiny Yap Island in Micronesia in 2007, where three quarters of those infected came down with rash, conjunctivitis, fever, and joint pain. In 2013, Zika struck some 20,000 people in French Polynesia, sharply increasing the incidence of Guillain-Barre syndrome, in which the immune system attacks nerve cells, causing weakness and paralysis, which is usually temporary. In 2015, Zika cases exploded in the New World, landing first in Brazil and sweeping on through all of Latin and Central America, the Caribbean, and into Florida, Texas and other parts of the United States. It was only then that epidemiologists recognized Zika’s most tragic manifestation. Thousands of infants infected with Zika in the womb were born with microcephaly, a condition in which the virus destroys the neuronal scaffolding upon which brain cells travel during early development. The cerebral cortex of microcephalic infants is smaller than normal, and these children suffer severe and lifelong visual and hearing defects as well as delays in speech and learning. Most will never be able to feed or care for themselves or even sit, stand or walk unaided. Microcephaly is found in about one baby in ten born to Zika-infected mothers. Why some pregnancies are more vulnerable than others is not known. Zika followed fast on the heels of Ebola, and once again raised questions about how governments, university laboratories, pharmaceutical companies and other international partners can best work together to control deadly epidemics, whether natural or created deliberately by hostile nations or terrorists. With this broader question in mind, a group of scientists, doctors, public health specialists and diplomats gathered at Columbia University
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