From relative obscurity, the Zika virus burst into global consciousness in early 2016 as the arbovirus spread rapidly across the Latin American region and threatens to hit the United States. In its wake, the Zika virus is leaving countries scrambling to stop it before more people become infected, with particular focus on pregnant women.
Although known since its identification in 1947 in Uganda, the virus surged to prominence once the link between the virus and an increase in the cases of microcephaly in Brazil was first suspected, raising alarms worldwide. In just a few months, the virus has been identified in more than 20 Latin American countries and territories, with Brazil and Colombia reporting the highest numbers of infections, and cases of Zika acquired by travelers have been reported worldwide.
Controlling the virus in Latin America will be challenging, since there are no vaccines or specific treatments currently available. The association of the virus with a mosquito vector endemic in much of Latin America will make its control difficult, as mosquitos, unlike humans, do not know the meaning of international borders, and are able to propagate in very small volumes of stagnant water. Each country’s capacity to control and track the virus will also depend on its economic capacity. Venezuela – already immersed in a significant economic and social crisis – faces shortages of symptomatic medicines, mosquito repellents and insecticides. In addition, the weekly epidemiological bulletin, which helps keep track of disease-specific prevalence in the country, has not been published regularly, which makes the number of Zika infections difficult to assess. While larger countries may possess the economic, professional and infrastructure resources necessary for an effective control of the virus, smaller countries may fall short, constraining regional efforts at a time when a united front will be needed to contain this virus.
As reports about the virus became more frequent, Latin American countries scrambled to find measures to control the mosquito vector and the virus. Campaigns educating the population, identification and destruction of the mosquito breeding sites, extensive fumigations, and in some places the use of bacteria (Nicaragua and Costa Rica) and genetically modified mosquitos (Brazil) have been considered or are already in place. However, the measures taken by Brazil set it apart from the remaining countries and may represent opportunities for those considering developing vaccines, treatments or diagnostics for Zika. Although Brazil is currently experiencing a recession and economic struggles, it is demonstrating that it is willing to make the efforts to protect the population and find a solution for the Zika virus, and also offers a regulatory environment that makes it an appealing country. In February, the Minister of Health reinforced the country’s commitment in the control of the virus by announcing that despite the economic problems that the country is facing, there would be money available for the destruction of mosquitos and for the development of a vaccine.
Early in the year, the Brazilian government announced that the country was looking for international partners for developing and producing a vaccine against Zika. Shortly after the announcement, Brazil’s President, Dilma Rousseff, announced that the local Butantan Institute and the US’s National Institutes of Health would collaborate in the development of a Zika vaccine. Both institutes have previously worked together to develop a vaccine against Dengue, another arbovirus, which is currently undergoing clinical trials, and the knowledge and experience gathered from the collaboration can be used to leverage the development of a vaccine against Zika. Two other Brazilian public institutes, Evandro Chagas and Bio-Manguinhos have also started to work on the development of a vaccine. Brazil has a history of establishing technology transfer agreements and public-private partnerships for the development of drugs considered strategic, which represent a good opportunity for manufacturers. Products developed through those partnerships become very well positioned to stock the public healthcare system, which offers free healthcare to more than 200 million Brazilians. Moreover, since July 2015 that the European Union recognizes the quality, control and enforcement of the regulatory policies for medicines in Brazil; this recognition may make Brazil an important target for the release of new molecules, as it will make the exportation of medicines easier.
In addition to the efforts targeting a vaccine, Brazil’s National Health Surveillance Agency (ANVISA) has also announced that any product related with the diagnosis and treatment of Zika would be granted priority review. True to its word, the agency granted registration to several diagnostic tests for Zika, Dengue and Chikungunya in a record time of 28 days, highlighting the importance that is being given to this emerging disease – most registration requests usually take several months to be evaluated. Prioritized review in Brazil can also be granted to products that are developed through public-private partnerships, and to products that are completely developed in the country, among others.
With the possibility of Zika to become endemic in much of Latin America closer to a reality, it is likely that many of the control measures will go through the use of medicines, either for the prevention or treatment of the infection. While this will be a challenging process, there are also opportunities available, and Brazil seems ready to offer them.