The Zika virus, ethical questions, and the potential rolling population impactFebruary 1, 2016
The Zika virus has South and Central America in a near panic. With no vaccine and no known cure, the fear associated with delivering a baby with severe neurological problems has led to the recommendation that all women of child-bearing age avoid getting pregnant until at least 2018.
The Centers for Disease Control say that about 1 in 5 people who are infected through the bite of an infected mosquito will become ill. Symptoms are minor (flu like) and Zika is not deadly. But the effect on babies in utero appears serious. Zika infection has been linked to cases of microcephaly, in which babies are born with underdeveloped brains. 4000 children with microcephaly have been born in Brazil since October. 400,00 Brazilian women are currently pregnant and the World Health Organization is concerned the virus could spread to Africa and Asia.
With no known prevention and no known cure, four countries are urging women to avoid getting pregnant for the next few years. El Salvador, Ecuador, Jamaica, and Columbia have issued a recommended two year hiatus on pregnancies and therefore, births.
That has led to both commendation and condemnation but neither the commenders nor the condemners are offering alternatives to the women in the region. And the region we’re talking about is truly massive: all of South America, Central America, Mexico and all the islands in between.
It is hard to imagine no babies being born for the next two or three years in Mexico, Bolivia, Brazil, Colombia, Ecuador, French Guiana, Guyana, Paraguay, Suriname, Venezuela, El Salvador, Guatemala, Honduras, Panama, Samoa, Barbados; Dominican Republic; Guadeloupe; Haiti; Martinique; Puerto Rico; Saint Martin; Jamaica and the U.S. Virgin Islands. But its also difficult to imagine the potential devastation to the people, families and nations if children continue to be born at current rates in affected countries in the midst of a Zika pandemic.
Add to this we must soberly add the complicated truth that as many as 50% of pregnancies in the region are unplanned, access to birth control is limited and Roman Catholic teachings forbidding birth control remain a cultural fixture.
Looking from problem toward solution, the bio-ethical questions we confront are myriad.
- Where and how will experimental Zika vaccines be developed? How will they be tested? On whom? What are the ethics related to use of placebo controls when the risk to developing children is so high?
- If experts are right and a vaccine may be 3-10 years away, Is avoiding pregnancy a real option?
- How will whole-life pro-life advocates, including the Roman Catholic Church, answer the potentiality of hundreds of thousands of children born with severe neurological problems in a region already impoverished?
- How will nation states in the region prepare to care for and support families of children born with congenital microcephaly?
- How do nations balance the need for immediate mosquito control measures with the use of chemicals known to be hazardous to human health or the environment?
In addition to bio-ethical questions there are political-ethical questions, like:
- What kind of visa waivers will be sought by women from the region who are pregnant now and want to avoid infection by spending the remainder of their pregnancy in a nation to the north of the hot zone?
- How will U.S. taxpayers and other donor level nations respond when public health solutions include the preventative termination of pregnancies of infected pregnant women?
The larger ethical question may be urban poverty in general which brings us back to the impact of a gap in births in the affected region until a vaccine or cure is identified.
The rolling effect of a three year virtual hiatus in child-bearing in a nation, let alone a region spanning all of Latin America, would be enormous. From 2021-2023 there would be no children entering Kindergarten. There would be no high school graduates from 2034-2036. No college graduates from 2038-2040. And that three year gap would then be magnified as those missing young adults fail to bear a future generation.
Now consider it takes 10 years to find a vaccine instead of three.
A coordinated collaborative response by governments, faith-based NGO’s and humanitarian aid organizations is urgently needed. Lessons learned recently from the Ebola outbreak are relevant but those seeking solutions on Zika could take some pointers from the response to AIDS in Uganda. Abstinence education in that country was very effective.
If we think that that the impact of a post-WWII baby boom has had an impact in the United States, imagine the post-Zika population depression now threatening our southern neighbors.