Zika Threat Prompts Health Experts to Urge WHO to Move Rio 2016 Games

In an open letter copied to the International Olympic Committee, 150 health experts from around the world urged the director-general of the World Health Organization (WHO), Margaret Chan, MD, MPH, to either postpone or move both the Olympic and Paralympic Games, for the sake of public health.

The Situation

Brazil has been experiencing active Zika transmission since 2015. In addition, “the Brazilian strain of Zika virus harms health in ways that science has not observed before,” according to the authors of the open letter. In an attempt to protect the public from Zika virus infection, the authors urged WHO to move the Games. In support of this, the authors cited past Olympic Games which were cancelled due to threat of disease, and highlighted the recent case where Major League Baseball recently moved a two-game series from Puerto Rico, which currently has 1,072 cases of locally-acquired Zika infections, to Miami, earlier this month.

It would seem that the authors are not being alarmist. A Zika situation report released by WHO on May 26 concluded that, thus far, “there is scientific consensus that Zika virus is a cause of microcephaly and GBS [Guillain-Barré syndrome].” The Zika virus has been proven to live in semen for at least 62 days, and can be transferred from a man to a partner through sexual intercourse (both vaginal and anal). Moreover, on June 2, 2016, a letter to the editor of the New England Journal of Medicine reported a case which confirmed that Zika infection is transmissible through oral sex with ejaculation.

In addition, WHO recently updated its interim guidance for the prevention of sexually transmitted Zika infection. Women of childbearing age are advised to postpone conception for at least 8 weeks after suspected infection, while men are advised to abstain from sexual intercourse, or practice safe sex with their pregnant partners or partners of childbearing age for up to 6 months after symptoms subside. Pregnant women should only engage in sexual intercourse with the use of a condom, or abstain from sex for the full length of the pregnancy, if she or her partner live in or are returning from a region with active Zika transmission.

Moreover, there is currently no designated therapy or vaccine for the Zika virus, and experts believe it may take up to two decades to manufacture one.

Making Their Case

As a result of the threat of the virus, many athletes have expressed their concern, with some stating that they do not plan to partake in the Games. Recently, Tejay van Garderen, an American road racer, withdrew from the Olympics because his wife is expecting a baby in October. Garderen is the highest-ranked American road cyclist in the Union Cycliste Internationale’s world rankings. He is a two-time winner of the USA Pro Challenge, placed fifth in the Tour de France twice, and competed in the 2012 London Olympics.

Along with the concerns of high-profile athletes, the authors of the letter cited the Center for Disease Control and Prevention’s earlier travel recommendations, which advised individuals not to travel to areas where Zika is endemic. The authors write, “If that advice were followed uniformly, no athlete would have to choose between risking disease and participating in a competition that many have trained for their whole lives.”

It was further argued that 500,000 individuals are at risk of contracting the virus and potentially spreading it in their native countries upon their return from the Games. The authors warned that “should that happen to poor, as-yet unaffected places (e.g., most of South Asia and Africa) the suffering [could] be great. It is unethical to run the risk, just for Games that could proceed anyway, if postponed and/or moved.”

In their letter, the authors outlined seven major concerns that they believe should prompt WHO to “reconsider” holding the 2016 Games in Rio de Janeiro, Brazil.

1. First, they note that the viral strain found in Brazil is harmful in that it causes permanent complications, such as microcephaly or GBS. The authors further believe that since human, animal, and in vitro studies have proven that Zika causes cell death, there may be other “as yet undiscovered neurological injuries,” such as with similar viruses like Dengue.
2. Although Zika is not particularly harmful to individual people, it poses a great threat to large populations. Currently, Brazil has reported 120,000 possible Zika infections, resulting in 1,300 confirmed Zika-related microcephaly cases, with more than 3,000 microcephaly cases still under investigation. This number greatly exceeds Brazil’s reported cases of microcephaly prior to active Zika transmission.
3. Rio has the fourth highest rate of incidence, demonstrating active transmission, with 195 cases for every 100,000 individuals. It also ranks as the city with the second highest number of suspected Zika cases in all of Brazil, with a whopping 32,000 cases.
4. The rate of transmission of vector-borne diseases has risen, despite Rio’s efforts to control Aedes aegypti, the mosquito which transmits Zika and other flaviviruses, populations. As an example, the authors state that the number of reported Dengue cases from January to April 2016 have gone up 320% since the same time period in 2015, and 1150% since the same time period in 2014. They state, “in the specific neighborhood of the Olympic Park (Barra da Tijuca) there have been more Dengue cases in just the first quarter of 2016 than in all of 2015.”
5. The healthcare system in Rio is too weak to make a “last-minute push against Zika.” The state’s government recently cut mosquito-disease funding by 20%. Rather than the strength of the virus, the state’s Zika readiness, or lack thereof, is what’s causing such high proportions of Zika infections within the city, state the authors. They argue that diverting the “shrinking health resources” towards the Olympic Games will not help the situation.
6. The country’s Aedes aegypti population was completely eradicated in the 1950s, but returned as mosquito control efforts in the country dropped. As a result, the authors believe that holding the Olympic Games in a city with Zika-carrying mosquitoes “is a choice and not necessary.”
7. The Olympic Games are set to commence in August, which is winter in the southern hemisphere. Nonetheless, the authors warn that “one cannot count on nature for defence.” They argue that although mosquito prevalence in Brazil during the winter months reduces the risk of contracting a Zika infection, travelers returning to the northern hemisphere will have an increased risk of transmitting the infection to the increased mosquito population in the north, due to warm climates. In addition, the infection can also be spread from one individual to another through blood transfusions, especially in those countries which do not have adequate resources to test blood for the virus.

The authors concluded their letter by urging WHO officials to reassess the situation at hand. They write, “WHO must revisit the question of Zika and postponing and/or moving the Games. We recommend that WHO convene an independent group to advise it and the [International Olympics Committee] in a transparent, evidence-based process in which science, public health, and the spirit of sport come first. Given the public health and ethical consequences, not doing so is irresponsible.” They further warn that failing to take action will quicken the spread of the Brazilian Zika strain to uninfected regions of the world.

WHO Responds

In response to the open letter, WHO released a statement in which it was noted that neither canceling nor changing the location of the Games will “significantly alter the international spread of Zika virus.” However, pregnant women were advised against traveling to areas with active Zika transmission, including Rio de Janeiro, the site of the 2016 Games.

Currently, WHO and the Pan American Health Organization (PAHO) are “providing public health advice to the Government of Brazil on the Rio 2016 Organizing Committee, on ways to further mitigate the risk of athletes and visitors contracting Zika virus during the Games.” One of the main focal points in preparation for the Games is the reduction of vector prevalence in Rio. WHO will continually “monitor the situation and update [their] advice as necessary.”

The fate of the games remains to be seen; however, all signs seem to indicate the “show will go on.” With the opening ceremonies two months away, health officials will be on high alert, tracking the virus and its impact across the globe.