University of Miami President Julio Frenk called on Congress to approve emergency federal funding for Zika research, treatment, and monitoring at a Zika forum hosted by UM Thursday. “We need to weigh the cost of inaction with the modest price tag of this proposal,” Frenk said, referring to a deadlock in Washington over allocating $1.1 billion to $1.9 billion to address this immediate public health threat.

“The cost of caring for children born with serious health challenges, as well as the failure to develop new treatments and the loss of our collective sense of security from government inaction, is many times higher than the dollars being discussed in Congress,” Frenk said at the panel discussion presented by the Miller School of Medicine and UHealth – the University of Miami Health System at the Lois Pope LIFE Center.

Laurence B. Gardner, interim dean of the Miller School, welcomed faculty, staff, students, public officials and many members of the media to the Zika forum, which included presentations by Miller School experts on the front lines of research, infectious disease, obstetrics and pediatric care, prevention, and the spread of vector-borne disease.

Questions from attendees ranged from the University’s leading-edge laboratory research on potential Zika vaccines, treatments, and diagnostic tools to the latest clinical advice for pregnant women and the importance of aerial spraying in Miami Beach to control the Aedes aegypti mosquito that spreads the virus.

‘’We take this threat very seriously,” Frenk said, noting growth of the University of Miami Zika Global Network, which focuses on research, discovery, education, and care. “We are collaborating locally, nationally, and internationally to deal with this global threat.”

Research priorities

From a research perspective, the most pressing priority is development of a simple, inexpensive diagnostic tool for the Zika virus, followed by development of a vaccine and treatment both pre- and post-infection, said David Watkins, vice chair of research in the Department of Pathology. “There is a DNA-based vaccine that has protected monkeys against Zika that should be going into human trials in November,” he said. “Other vaccines are also being developed, and there is great hope on this front.”

Mario Stevenson, professor of medicine, chief of the Division of Infectious Diseases, and director of the Institute of AIDS and Emerging Infectious Diseases, said the Miller School’s longstanding collaboration with infectious disease researchers in Brazil provided a “heads up” on the serious nature of Zika. “That has helped us respond more quickly to this threat and leverage the research infrastructure in place here,” he said.

Frenk also emphasized that point, noting the importance of being ready for the next pandemic. “From AIDS to Zika, we face an entire alphabet of viruses,” he said. “Investing in our capacity for fundamental scientific research lets us retool our capabilities to meet new threats.”

Clinical care

Currently there are 80 pregnant women in Florida with confirmed exposure to the Zika virus, said Christine L. Curry, assistant professor of obstetrics and gynecology, who consults with the state Department of Health. “While Gov. Rick Scott has said all pregnant women have the right to be tested, the lack of resources has affected our ability to conduct tests and provide timely results,” she said.

As a clinician, Curry says her patients have a long series of questions about Zika, including the risks of microcephaly, a birth defect in which the infant’s head is smaller than normal, as well as vision, hearing and potential developmental delays. “It is very difficult to quantify those risks, because new data keeps emerging,” she said. “As we learn more about Zika, we are finding that some infants may look normal at birth, but fail to meet developmental milestones in their first year.”

Later in the forum, when asked about exposure to insecticides to repel or kill mosquitoes, Curry came down firmly on the side of protection.  Staying indoors, wearing long sleeved tops and pants and using repellents are important steps in reducing the risk of mosquito bites, she said.

In pediatrics, one of the clinical challenges is early diagnosis of children carrying the Zika virus, according to Ivan A. Gonzalez, assistant professor of clinical pediatrics and specialist in pediatric infectious diseases. “Knowing an infant or child has been exposed to Zika could help physicians develop clinical protocols,” he said. “We also need to monitor these children closely to learn more about the long-term outcomes.”

The public health challenge

As Florida faces the Zika threat, there is much that can be learned from other countries where tropical diseases are endemic, said several panelists.  Mosquito control has been shown to be effective in many regions, and should be a priority for Wynwood, Miami Beach and all of Miami-Dade County, said John Beier, professor of public health sciences and chief of the Division of Environment and Public Health.

“We are all at risk in South Florida, especially with so many visitors moving through our neighborhoods,” Beier said. “We need to invest in mosquito control, because it’s essential to our quality of life here.”

Paola N. Lichtenberger, assistant professor of clinical medicine and director of the Tropical Disease Program, noted that there are significant differences between Zika and dengue, Ebola, and yellow fever. “This is the first time we have seen a tropical virus associated with microcephaly, and the first time we have seen sexual transmission of the virus,” she said. “In some ways, we are starting from zero. But we need to know how this virus behaves in order to develop vaccines and treatments.”

Alina Hudak, deputy mayor of Miami-Dade County, also addressed the Zika public health challenge facing the region. “We need to educate the community about the importance of taking individual precautions, controlling mosquitoes, and breaking the cycle of transmission,” she said. “Our efforts in Wynwood have dramatically reduced mosquito counts, and we are hopeful that aerial and truck spraying in Miami Beach will have the same results.”

Concluding the session, Frenk and several panelists emphasized the importance of a collaborative approach to combating Zika. “It’s not just what the city, county, or state can do to fight mosquitoes,” Lichtenberger said. “It is everyone’s responsibility to prevent a generation of children growing up with birth defects from this virus. Learn about Zika, pay attention to what’s happening here, and take action to protect our community.”