Responding to Zika; the imperative to ensure rights and protection

ABSTRACT

The Zika virus, transmitted by the Aedes aegypti mosquito, has spread extensively throughout Latin America and the Caribbean. It is the first mosquito-borne disease known to be sexually transmitted and to cause neurological damage to foetuses and neonates, with the developmental sequelae now known as ‘congenital Zika syndrome’. ‘A Socio-economic Impact Assessment of the Zika Virus in Latin America and the Caribbean’ highlights the disproportionate impacts of Zika on the poorest and most vulnerable groups, particularly women and children in peri-urban communities. This distribution of impact has the potential to widen existing inequities and undo impressive health and development gains in the region over the past few decades. The short-term cost for Latin America and the Caribbean is estimated in the range of US$7–18 billion over the period 2015–2017, while the lifetime cost of caring for infants with congenital Zika syndrome (including long-term medical care and lost productivity) is projected between $3 and $29 billion. This article expands on one of the Assessment’s recommendations: for governments to ensure the rights of the affected through the enhancement and adaptation of social protection in the context of Zika, while better identifying and including groups susceptible and vulnerable to the impacts of Zika. We analyse the relevant human rights obligations of states and social protection instruments that can be provided to families affected by Zika. We argue that current welfare adaptations, while needed, are insufficient and that further changes should be based on redefined minimum standards of care and support. Country-specific assessments are needed to identify relevant unit costs to inform fiscal planning. Further analysis of the nature and extent of the unfolding impacts of Zika on vulnerable groups and the efficacy of social protection systems will better inform and strengthen multisectoral responses and support to affected communities.

KEYWORDS:

• Zika
• social protection
• socio-economic impacts
• human rights

Disclosure statement

The views presented in this article do not necessarily represent those of the United Nations Development Programme.  No potential conflicts of interests are reported by the authors.

Notes

1. Microcephaly is now thought to be found in only the most severe cases of congenital Zika syndrome; however, the virus can still cause significant brain damage in babies with normal-sized heads (Society for Maternal-Fetal Medicine, 2017).

2. ‘A teratogen is an agent that can disturb the development of the embryo or foetus. Teratogens can halt pregnancy or produce a congenital malformation (a birth defect). Classes of teratogens include radiation, maternal infections, chemicals,and drugs’. Source: Medicinet, http://www.medicinenet.com/script/main/art.asp?articlekey = 9334.

3. Convention on the Elimination of All Forms of Discrimination against Women, art. 5(a), G.A. Res. 34/180, U.N. GAOR, 34th Sess., Supp. No. 46, at 193, U.N. Doc. A/34/46 (1981) (hereinafter CEDAW).

4. Convention on the Rights of Persons with Disabilities, G.A. Res. 61/106, U.N. Doc. A/Res/61/106, art 8(b) (hereinafter CRPD).

5. CRPD, G.A. Res. 61/106, U.N. Doc. A/Res/61/106, art 8(a).

6. Committee on Economic, Social and Cultural Rights (ESCR Committee), General Comment No. 14: The right to the highest attainable standard of health, 12(a) (2000), U.N. Doc. HRI/GEN/1/Rev.9 (Vol. I), at 78 (2008).

7. CEDAW Committee, General Recommendation No. 24: Article 12 of the Convention (women and health), 22 (1999), U.N. Doc. HRI/GEN/1/Rev.9 (Vol. II), at 358 (2008) International Covenant on Economic, Social and Cultural Rights, art. 10(2), G.A. Res. 2200A (XXI), U.N. GAOR, Supp. No. 16, U.N. Doc. A/6316 (1966).

8. CEDAW Committee, General Recommendation No. 21: Equality in marriage and family relations, para. 22 (1994), U.N. Doc. HRI/GEN/1/Rev.9 (Vol. II), at 337 (2008); Committee on the Rights of the Child (CRC Committee), General Comment No. 4: Adolescent health and development in the context of the Convention on the Rights of the Child, para. 28 (2003), U.N. Doc. HRI/GEN/1/Rev.9 (Vol. II), at 410 (2008).

9. Human Rights Committee (CCPR Committee), General Comment No. 28: Article 3 (The equality of rights between men and women), para. 10 (2000), U.N. Doc. HRI/GEN/1/Rev.9 (Vol. I), at 168 (2008)

10. Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, Interim rep. of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, para. 65(d), U.N. Doc. A/66/254 (2011).

11. CRPD, Concluding Observations: Argentina, para. 32, U.N. Doc. CRPD/C/ARG/CO/1 (2012).

12. L.C. v. Peru, CEDAW Committee, No. 22/2009, paras. 9(b)(i), 9(b)(iii); CEDAW Committee, Concluding Observations: Sri Lanka, para. 283, U.N. Doc. A/57/38, Part I (2002); CRC Committee, Concluding Observations: Chad, para. 30, U.N. Doc. CRC/C/15/Add.107 (1999); CRC Committee, Concluding Observations: Chile, para. 56, U.N. Doc. CRC/C/CHL/CO/3 (2007); CRC Committee, Concluding Observations: Guatemala, para. 40, U.N. Doc. CRC/C/15/Add.154 (2001); CCPR Committee, Concluding Observations: Dominican Republic, para. 15, U.N. Doc. CCPR/C/DOM/CO/5 (2012); CCPR Committee, Concluding Observations: Guatemala, para. 20, U.N. Doc. CCPR/C/GTM/CO/3 (2012); CCPR Committee, Concluding Observations: Panama, para. 9, U.N. Doc. CCPR/C/PAN/CO/3 (2008); ESCR Committee, Concluding Observations: Chile, para. 53, U.N. Doc. E/C.12/1/Add.105 (2004); ESCR Committee, Concluding Observations: Costa Rica, paras. 25, 46, U.N. Doc. E/C.12/CRI/CO/4 (2008); ESCR Committee, Concluding Observations: Nepal, para. 55, U.N. Doc. E/C.12/1/Add.60 (2001); Committee against Torture, Concluding Observations: Peru, para. 23, U.N. Doc. CAT/C/PER/4 (2006).

13. CRPD, art. 25(b).

14. CRPD, art. 26.

15. CRPD, art. 24.

16. CRPD, arts. 28(1), 28(2)(b).

17. CRPD, art. 28(2)(c).

18. Access to comprehensive sexual and reproductive health services includes respect for women’s decision-making; access to accurate and comprehensive information; access to contraception; and access to maternal health care, including family planning and prenatal diagnostic services as laid out in the Beijing Declaration and Platform for Action and the International Conference on Population and Development Programme of Action (1995).

19. These incorporate the following cost components: direct medical costs; direct non-medical costs; lost productivity due to increased morbidity and premature mortality; and lost productivity due to caregiving parent withdrawing from the labour force. The estimates suggest relatively large (direct and indirect) care costs regarding children with microcephaly over their lifetime. For indirect costs, lost income due to new childcare obligations alone could represent losses of $1.5 billion for the region.

20. Infants with microcephaly face a 20% probability of death during the first year and a life expectancy of 35 years beyond the first year.

21. In the absence of country-specific data for the costs associated with microcephaly in the region, unit cost estimates from the USA were used as proxy. It should be noted that the Assessment’s average estimate for the lifetime cost of microcephaly in the region (between US $800,000 and $1 million) falls within the lower end of the CDC estimate for the lifetime costs of microcephaly (between $1 and $10 million).

22. Another example of a social protection response to Zika is the J$50 million fund established by the Jamaican government to provide support for families of babies with congenital Zika syndrome. The earmarked funds will include early stimulation therapy for infants and psychosocial counselling for mothers. The Jamaican government has also pledged to train community health workers to conduct Zika community awareness and prevention activities (Jamaica Observer, 2016). Yet there are no congenital Zika syndrome cases reported in Jamaica, and it is unclear if the fund has supported any families affected by Zika.

23. When devising response strategies, national ministries of health must proactively engage with other national institutions and with a wide range of stakeholders (e.g. civil society organizations, international organizations, communities, other line ministries and the private sector). Comprehensive plans are key to establishing and maintaining flexible, updated and evidence-based risk communication channels. The positioning of health as a central, cross-governmental issue has led to the more frequent use of multisectoral action frameworks to combat disease, such as malaria (Rollback Malaria Partnership & UNDP, 2013).