JAMA
June 14, 2016, Vol 315, No. 22
http://jama.jamanetwork.com/issue.aspx

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Viewpoint
Is the United States Prepared for a Major Zika Virus Outbreak? FREE
Lawrence O. Gostin, JD; James G. Hodge Jr, JD, LLM
[Initial text]
From its initial discovery in Ugandan forests nearly 70 years ago, Zika virus has emerged as a worldwide public health crisis, with active transmission in more than 40 countries in the Americas and Caribbean. On February 1, 2016, the World Health Organization (WHO) declared a Public Health Emergency of International Concern (PHEIC), concerned about clusters of microcephaly and Guillain-Barré syndrome (GBS). A week later, the Centers for Disease Control and Prevention (CDC) triggered the highest “level 1” activation of its emergency operations center, and President Obama requested $1.86 billion in emergency funding.1 On April 7, the WHO reported there is scientific consensus that Zika is a cause of microcephaly and GBS.

Although none of the continental states has reported local mosquito-borne transmission, Health Secretary Sylvia Burwell warned that Zika has a “significant potential to affect national security or the health of Americans.”2 The virus severely threatens Puerto Rico, with one-quarter of its 3.5 million inhabitants projected to be infected.3 The Olympics in Brazil will have an amplifying affect because the competition will be during the Northern summer. Travelers visiting or returning to the United States could likely escalate the spread of Zika. Epidemiologists estimate that Zika could affect a majority of US states including large cities where Aedes species mosquitos are active.

Is the United States prepared for major clusters of Zika? Certainly, a highly functioning health system will help protect the domestic population. Yet there are signs of unpreparedness with insufficient resources and variable legal authorities…