U.S. and Puerto Rico must cooperate on Zika

The rapid spread of the Zika virus in Puerto Rico is a very, very big problem for the U.S. and Puerto Rico but the colonial relationship between the U.S. and Puerto Rico is making it a lot worse.  The reason this matter is so important to the United States – beyond the obvious concern for the well-being of our fellow citizens in Puerto Rico, of course – is that thousands of U.S. tourists and visitors go back and forth to Puerto Rico and thousands of Puerto Ricans leave the Island permanently for life in the U.S., driven out by the financial crisis gripping the Island.  Zika is the first mosquito-borne virus known to cause birth-defects and to be sexually transmitted, so an outbreak of the magnitude that has already hit Puerto Rico is a public health crisis for the United States as well.

If you talk to average Puerto Ricans on the Island as I often do, they are not experiencing Zika as a big issue.  They do not think the threat is real.  Most people who are infected feel no symptoms and the negative consequences only affects pregnant women – or so most people think.  Puerto Ricans, having lived with mosquito transmitted diseases for decades, have become immune to dire warnings from so-called experts and some are resigned to the false notion that nothing can be done.

{mosads}Even with 13,791 cases reported, an estimated 2,000 pregnant women already infected and a disease trajectory that indicates 20-25% of the population will be affected this year, Puerto Rico has resisted guidance or help coming from Washington.

Why?  The colonial attitude of the U.S. towards Puerto Rico and the understandable response to such treatment effects the psyche of the population.  A half-century of Navy target practice bombing on the inhabited Island of Vieques (among other places in and around Puerto Rico) was followed by decades of U.S. government denials that cancers and environmental destruction in Vieques were connected to the U.S. government’s actions.  History is informative: Previous public health interventions from Washington included forced sterilization of women of my mother’s generation. This treatment as second-class (at best) citizens of the United States deeply impacts the Puerto Rican psyche, with long term effects.  And this is helping Zika spread.

Now, a control board imposed by the U.S. government through Congress’ PROMESA legislation is preparing to take over decision-making that will determine the future of all Puerto Ricans living on the Island.  Distrust of Washington is at an all-time high in Puerto Rico, based on my observations.

And unfortunately, this is making it harder for health officials to do what needs to be done to control the Zika outbreak.  Unlike in Miami, Florida, there was a swift and sharp backlash from Puerto Ricans when the idea of spraying Naled – an insecticide – was raised.  The CDC (Centers for Disease Control and Prevention) sent a shipment to the Island in anticipation of the Island requesting help, but the backlash in local media ranged from basic environmental concerns all the way up to elaborate conspiracy theories that a fictitious colonial genocide of the Puerto Rican people was at hand.  

In reality, CDC Director Dr. Tom Frieden has personally assured me that Naled is a pesticide used widely for a long time – including in Miami and other U.S. cities – with very few consequences for people.  The consequences for the environment and other insects – including bees – can be minimized through sensible application of Naled.  But, in this era of deep distrust, none of the facts are reassuring to Puerto Ricans.  The Naled shipment, if it is still in Puerto Rico, remains unused.  Due to years of random unchecked chemical pesticide use by private providers, mosquitos in Puerto Rico are highly resistant to common chemical strategies.  Naled was one of the only effective options currently available.  Mosquitos breed quickly, bite quietly and thrive in urban and rural areas – sometimes hitting four or five people in a single meal – so the spread of the disease in Puerto Rico is happening astonishingly quickly.

Part of the problem can be addressed if the CDC and Puerto Rico work together to build on the success they have had in addressing the Dengue Fever virus, another mosquito-borne disease that – like Chikungunya – has hit Puerto Rico hard.  The CDC scientists have provided research and resources to combat Dengue for over 35 years.

An important first step would be for Puerto Rico to create an integrated, comprehensive mosquito control center, but given the financial crisis in Puerto Rico, this will only happen if the federal government funds it and the Puerto Rican people accept it.  A group of international and local technical experts in vector control management met in San Juan in May of 2016 and came to this same conclusion.  The potential to control and eliminate the Zika-carrying  mosquito from Puerto Rico is possible with a well-funded mosquito control center that implements an integrated comprehensive vector management approach using safe, effective and innovative strategies. Miami and every major U.S. jurisdiction has a vector control unit and Miami’s sprang into action to address the outbreak there, including spraying with Naled.  Such a unit provides the infrastructure and expertise to address an outbreak like Zika, manage its spread, and is constantly working to provide protection from mosquitoes that cause diseases like Dengue and Chikungunya, which are endemic in Puerto Rico.

The Environmental Protection Agency (EPA) could help by addressing the crisis of more than two dozen toxic municipal landfills that seem to be flying under EPA’s radar.  These are breeding grounds for mosquitos and the Island’s government needs help to address these hazards, as I and others have noted to EPA Administrator Gina McCarthy.

This must be combined with an investment to address the immediate needs of those infected and to help women avoid or delay pregnancy.  Access to modern, effective, reversible birth control has been late in coming to the public health system in Puerto Rico, but access is growing.  Women’s reproductive health is a critical need, but for Republicans in Congress, contraception and women’s health care are lightning rods that tend to induce divisiveness or paralysis or both.

The most important thing Congress can do is stop squabbling and fund the President’s request for a national strategy to fight Zika, which would include funding to help Puerto Rico address the disease at ground zero.  Doing nothing is what this Congress is good at, but there comes a time when Republican leaders need to put their country before their party – even in an election year – and let the resources and experts of the federal government fight this disease.

Let us prevent as best we can an outbreak that will be tremendously costly in lives and hardship in the decades to come.  Congress must act now.  The CDC must be allowed to act now.  The next generation, the future of Puerto Rico, is likely to be born with reduced brain capacity, birth defects and a range of developmental disabilities.  Let’s face it, in the arena of evolution – the mosquitos are winning. Puerto Rico – and Puerto Ricans – must understand how serious this really is and address it aggressively with all tools at their disposal, including help from the federal government.  We need to act in concert for the good of Puerto Rico and the United States.

The views expressed by authors are their own and not the views of The Hill.