Zika Action Plan Summit: Lessons for Local Health Departments

Aedes_aegypti_biting_humanOn April 1, the Centers for Disease Control and Prevention hosted the Zika Action Plan Summit to convene state, local, and tribal representatives to improve Zika preparedness and response in the United States. Dr. LaMar Hasbrouck, Executive Director, and Dr. Oscar Alleyne, Senior Adviser for Public Health Programs, attended on behalf of NACCHO. I spoke with Dr. Alleyne about his experience, reflections, highlights, and implications for local health departments from the Zika Action Plan Summit.

What was your overall impression of the Zika Action Plan Summit?
It was very well-attended. There was good representation of local health departments and other partners in public health who were very engaged. The part I felt was most beneficial were the breakout technical assistance roundtables where many different partners sat together in small group discussions. We explored various topical areas, interests, strategies, and best practices that could be enacted across jurisdictions. The discussion that struck me as the most engaging and enlightening was about sexual transmission of the virus, notably how different groups are identifying opportunities for education, awareness, and improvement. Additionally, there was a lot of discussion around coordinating efforts related to surveillance, epidemiology, and laboratory activities.

The large group sessions included Dr. Frieden and Amy Pope from the White House who provided a nationwide overview of the status of Zika, as well as a call to actions using some of the solutions that are at our fingertips. We asked some big questions: Where is the funding to support this response? How can we take this information and turn it into action? How do you flesh out some of the recommendations of having a Zika ‘czar’ or Zika coordinator in each locality—what does that mean? Are we trying to engage key segments of our population and our health system to improve our response efforts?

What stood out from the open science plenary that is important to share with local health departments?
The updates around the fast-tracking of tests for detection and the growing understanding of the length of time it takes for an individual to become viremic seem very promising. The next questions to consider would be how rapidly those tests would be made available to those who need them and whether or not tests are still going to be located in certain state laboratories or if we will see a push for commercial access.

From a local perspective, the maps displayed showing potential Zika transmission may be skewed with county-level generalizations. The graphical representations focused on giving the big picture but might have missed existing gaps and inefficiencies due to reduced capacity and funding. One example came from Westchester County, NY, who commented that they had decided to stop larviciding this year, which could have a negative impact if they have Aedes mosquitos. Local health departments should take into consideration their unique risks, challenges, and capacities in vector control and other activities when planning for the local Zika response.

The big picture takeaway was that there are a lot more unknowns than there are knowns. Especially critical is the length of time an individual should be mindful of exposure risk if they are trying to become pregnant and the recommendations about avoiding sexual activity or engaging in safe sexual activity. While not expressed consistently before but emphasized strongly at the Summit is that a woman who is pregnant is at risk in any trimester. More work needs to be done to address these unknowns, but local health departments can see that at least we have some steps forward and can figure out what their agency should focus on.

What stood out from the State and Local Panel on Controlling and Responding to Mosquito-borne Illnesses that is important to share with local health departments?
States and locals presented about the degree of work and activity that it takes to engage in Zika and mosquito-borne illness response activities. The panel was made up of Carina Blackmore, Chief of the Bureau of Environmental Public Health Medicine in Florida; Daniel Kass, the Deputy Commissioner for Environmental Health at the New York City Department of Health and Mental Hygiene; Umair Shah, Executive Director of the Harris County Public Health and Environmental Services in Texas; and Brenda Rivera-Garcia, the Territorial Epidemiologist at the Puerto Rico Department of Health. New York City showed the cascading history of its more than 15 years of working on West Nile Virus and reflected on the need to take a different approach for Zika given the differences in the mosquitoes involved. Harris County did a great job of demonstrating their own efforts and the magnitude of how Zika is impacting their other work. Puerto Rico illustrated the need for better risk communication and tools because they implemented some strategies that were not liked by the pregnant women of Puerto Rico. They also shared that the duct tape that they used on screens for windows didn’t stick to concrete; illustrating that things that we would think would be a simple fix were not as easy or efficient as intended. The real strength of the panel was that it translated and moved the discussion from the high ceiling of what we need to do to the more manageable conversation around what we can do at the local level.

What stood out from the Surveillance to Detect Local Transmission and Monitor Outcomes of Zika Infection breakout session you attended that is important to share with local health departments?
Some of the questions that were raised were: What are the inroads in vector surveillance and human surveillance? How can we capture a better picture of what is best to enact for reducing local transmission? How do we look at some of the needs around how testing can be done, particularly the amount of testing and triggers for them? How does the case definition change for surveillance of travelers versus local transmission so that you can differentiate between the two for appropriate local response?

One of the capstone comments that was made was, “We can’t spray ourselves out of the situation.” The vector control session focused on issues of response planning and case identification; the many needs of surveillance are recognized but need to be clearly defined. The only way we can improve them based some of the conversations with locals, states, and partner agencies depends on funding to support these human and vector response issues as it pertains to disease identification, entrapping, and mapping, including birth defects and the registry.

What stood out from the closing plenary that is important to share with local health departments?
The closing plenary included report outs of strategies from the different sessions. One of the biggest areas that was stressed was the importance of federal funding and how we should use a common sense approach to adequately fund things for more than one year resulting in greater sustained efforts. We can use these as an opportunity to develop a more comprehensive approach. We have so many de-funded activities and need to look at how we can strengthen infrastructure to ensure that we are truly prepared to fight Zika. Here is where Congress needs to act and help.

It was an upbeat overall closing plenary. There were comments from Dr. Frieden and Dr. Judith Monroe with one of the White House advisors setting the challenge for how we can really galvanize this momentum to get movement and progress in providing the resources necessary for response efforts.

What were the most important takeaways for local health departments? Any other thoughts or reflections that you would like to share?
The most important takeaway was just the level of engagement and the need for real responsibility. NACCHO played a key role in working with our partners to ensure that local health departments coordinated with their state to request an invitation to the Summit or to share their perspective. We know that everything is local. The way that funds are taken, dispersed, and enacted are best done from the local perspective. If we want to be successful against Zika and other emerging health threats, we have to remain engaged and vigilant. The great work that local health departments do will help us find innovative opportunities and strategies that translate into action.

About Christina Baum

Christina Baum serves as a Program Analyst for infectious disease at NACCHO. Her work includes projects on surveillance, epidemiology, and emerging infectious diseases.

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