At­tack of the tiny eco­nomic dis­rupters

▶ Based on dam­age from malaria and dengue, the spread of Zika will prove costly ▶ “It’s a fight against an al­most in­vis­i­ble en­emy”

Bloomberg Businessweek (North America) - - Contents - �John Tozzi, Ja­son Gale, Anna Edgerton, and Yinka Ibukun The bot­tom line Re­spond­ing to the Zika epi­demic, the lat­est mos­quito-borne ill­ness to catch the world by sur­prise, could cost bil­lions of dol­lars.

The Aedes ae­gypti mos­quito weighs less than a grain of rice, lives only a few weeks, and doesn’t stray more than 100 yards from where it hatches. For a crea­ture of such lim­ited scope, it has an out­size in­flu­ence on hu­man health and global com­merce. In 1793 a mosquito­car­ried epi­demic of yel­low fever in Philadel­phia shut down trade and killed a 10th of the city’s res­i­dents. A cen­tury later, the same dis­ease foiled France’s ef­fort to build a canal across Panama.

Aedes ae­gypti is now spread­ing the Zika virus through Latin Amer­ica. The virus, de­tected in Brazil for the first time last May, is sus­pected of caus­ing an in­crease in ba­bies born with ab­nor­mally small heads, a se­ri­ous birth de­fect known as mi­cro­cephaly. With no vac­cine or cure for Zika, “the most ef­fec­tive pro­tec­tive mea­sures are the con­trol of mos­quito pop­u­la­tions and the preven­tion of mos­quito bites,” Mar­garet Chan, di­rec­tor- gen­eral of the World Health Or­ga­ni­za­tion, told re­porters on Feb. 1. Of­fi­cials in Texas on Feb. 2 iden­ti­fied a case of sex­ual trans­mis­sion of the dis­ease.

“Mos­quito-borne dis­eases are among the most pre­ventable and yet the most ex­pen­sive,” says Lawrence Gostin, a pro­fes­sor of global health law at Ge­orge­town Law. He es­ti­mates that the costs of re­spond­ing to the Zika epi­demic will reach “well into the bil­lions,” count­ing money spent on a vac­cine. The pat­tern of other mos­quito-borne ill­nesses sug­gests Zika will be costly in a va­ri­ety of ways. The num­ber of years lost due to ill health, dis­abil­ity, or early death, “not to men­tion the huge cost to health-care sys­tems, is very sub­stan­tial,” says Stephen Higgs, pres­i­dent of the Amer­i­can So­ci­ety of Trop­i­cal Medicine & Hygiene and the di­rec­tor of the Biose­cu­rity Re­search In­sti­tute at Kansas State Univer­sity.

The WHO es­ti­mates there could be 3 mil­lion to 4 mil­lion cases of Zika in the Amer­i­cas this year. In Brazil, Pres­i­dent Dilma Rouss­eff’s ad­min­is­tra­tion has warned preg­nant for­eign­ers against trav­el­ing to Rio for the Olympics in Au­gust. Preg­nant women across Brazil are scour­ing phar­ma­cies for bug re­pel­lent. Many are can­cel­ing trips to north­east Brazil, the out­break’s epi­cen­ter.

In the middle of its worst re­ces­sion on record, Brazil will spend more than 1 bil­lion reais ($256.7 mil­lion) on mos­quito eradicatio­n in 2016. It’s mo­bi­liz­ing 220,000 sol­diers and 309,000 health work­ers to go door to door, check­ing for stand­ing wa­ter and dis­tribut­ing pam­phlets on mos­quito preven­tion. Work­ers have vis­ited al­most 11 mil­lion homes so far in an aware­ness cam­paign that Rouss­eff’s chief of staff, Jaques Wag­ner, called “our only vac­cine” for now. “It’s a fight against an al­most in­vis­i­ble en­emy that spreads quickly,” he said af­ter an emer­gency cab­i­net meet­ing. Wag­ner said the chance of can­cel­ing the Olympics “doesn’t ex­ist.”

Brazil­ian au­thor­i­ties are likely “hop­ing against hope that peo­ple don’t stay away” from the Olympics, says Grant Hill-cawthorne, a med­i­cal vi­rol­o­gist who teaches pub­lic health at the Univer­sity of Syd­ney. In past out­breaks such as the SARS virus in Asia in 2003, the eco­nomic costs of dis­rup­tions to travel and com­merce out­weighed the di­rect med­i­cal costs of the dis­ease. “We know from West Africa with the Ebola out­break that it can hit economies hard,” Hill-cawthorne says.

Dengue is also spread by Aedes ae­gypti, which breeds in stand­ing wa­ter, bites dur­ing the day, and thrives in cities in the trop­ics. Symp­toms nor­mally con­sist of flu-like pains and fever. But in the worst cases, dengue hem­or­rhagic fever can lead to cir­cu­la­tory sys­tem fail­ure. The num­ber of re­ported cases of dengue each year has jumped from about 125,000 in the 1970s to more than 3 mil­lion in 2013. By some es­ti­mates 390 mil­lion peo­ple get in­fected each year, though not all will de­velop symp­toms. More than 2 bil­lion peo­ple live in places that put them at risk for dengue.

Dengue costs the world about $9 bil­lion a year, says Don­ald Shep­ard, a health econ­o­mist at Bran­deis Univer­sity. That counts the cost of treat­ment and the value of time lost to ill­ness and death. It in­cludes spend­ing on sur­veil­lance and preven­tion and re­duc­tions in trade and travel. Most of the costs fall to “coun­tries that can very ill-af­ford that kind of bur­den,” Shep­ard says, not­ing that Brazil has the most dengue cases in the world.

By far the great­est dam­age is in­flicted by malaria, trans­mit­ted by the Anophe­les mos­quito. In the U.S., the pre­de­ces­sor to the Cen­ters for Dis­ease Con­trol and Preven­tion was founded dur­ing World War II to fight malaria in the South­east. “It wasn’t that long ago when malaria was a terri

ble eco­nomic drag

on de­vel­op­ment” in the U.S., says Mark Honigs­baum, a med­i­cal his­to­rian at Queen Mary Univer­sity of Lon­don.

Columbia Univer­sity econ­o­mist Jef­frey Sachs ob­served in 2001 that coun­tries with se­vere malaria had lower eco­nomic growth while those that re­duced malaria grew faster. Anophe­les bites at night; spray­ing walls and in­stalling in­sec­ti­cide-treated bed nets can stop them. A con­certed global cam­paign against malaria sup­ported by the Bill & Melinda Gates Foun­da­tion has helped drive down the death rate by 60 per­cent since 2000. The world spent $2.7 bil­lion treat­ing and fight­ing malaria in 2013.

In Nige­ria, one of the coun­tries most af­fected by malaria, the Zika virus raises fears of a new mosquito­borne threat. “I don’t want that sick­ness to come to Nige­ria,” says Christina Richards, a cleaner in La­gos who is 24 weeks preg­nant. “Nige­ria can­not han­dle it if it comes.” The coun­try has be­come com­pla­cent about malaria, says Chikwe Ihek­weazu, an in­fec­tious dis­ease epi­demi­ol­o­gist and editor of Nige­ria Health Watch. “That mes­sage of pro­tect­ing our­selves from get­ting bit­ten has been ham­mered in the pub­lic health space for years, but we have a lais­sez-faire at­ti­tude to­ward malaria,” he says. “We all think, OK, we all get malaria, we’ll all get bet­ter.”

There were 214 mil­lion malaria cases glob­ally in 2015 and 438,000 deaths, com­pared with about 13,000 from dengue. Elim­i­nat­ing malaria by 2040 would cost $90 bil­lion to $120 bil­lion and yield $2 tril­lion in ben­e­fits from health and pro­duc­tiv­ity gains, ac­cord­ing to a re­port from the Gates Foun­da­tion and the non­profit Malaria No More. The plan is to de­ploy a vac­cine and elim­i­nate Anophe­les.

While the world has shrunk malaria’s foot­print in Asia and Africa, flare-ups of dis­eases such as dengue, Zika, and chikun­gunya (sim­i­lar to dengue) in the Amer­i­cas pose a dif­fer­ent sort of chal­lenge. First iden­ti­fied in Uganda in 1947, Zika spread fast across Latin Amer­ica be­cause the pop­u­la­tion had never seen it be­fore, so no one had im­mu­nity. “Pathogens that used to be con­fined to par­tic­u­lar eco­log­i­cal niches, now they can get out of those niches” on ships and planes, says Queen Mary Univer­sity’s Honigs­baum. “And when they do, you can’t pre­dict where they’re go­ing to turn up.”

“You’re al­ways go­ing to be be­hind the curve on the vac­cine side or the hu­man treat­ment side,” says Grayson Brown, di­rec­tor of the Pub­lic Health En­to­mol­ogy Lab­o­ra­tory at the Univer­sity of Ken­tucky. “The only thing we can do to pro­tect our­selves is to upgrade our abil­ity to man­age mos­qui­toes.”

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São Paulo Spray­ing pes­ti­cide fog in a res­i­den­tialneigh­bor­hood

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