Since Congress left for recess seven weeks ago without approving funding to address the Zika virus, the Obama administration has declared a public health emergency in Puerto Rico and the Florida Health Department has identified two areas in Miami-Dade County with local transmission of Zika. Now that Congress is returning to the capital, I hope this evidence of Zika’s spread will convince them to provide sufficient funding for all of the following:

• Research into vaccines and other healthcare measures to reduce Zika’s impact;
• Mosquito control and outreach campaigns to slow Zika’s spread (which occurs via sexual transmission as well as mosquitoes); and
• Full access to reproductive healthcare.

Back in February, President Obama requested $1.9 billion in Zika response funding for mosquito control, disease testing, vaccine development, and support for maternal health. Some members of Congress insisted the executive branch first use remaining Ebola funds, even though that disease has not been eradicated and should remain a public-health priority.

Over the past several months, the Obama Administration has shuffled money around to allow Zika work to continue, but in early August HHS Secretary Sylvia Mathews Burwell warned that with the last transfer of funds “we have exhausted our ability to provide even short-term financing to help fight Zika.” In a Washington Post op-ed CDC director Tom Frieden and National Institute of Allergy and Infectious Diseases director Anthony S. Fauci described the toll these moves have taken on other important work for public health:

The most recently transferred funds supported the CDC’s work to immunize children, fight HIV/AIDS, and stop other outbreaks. NIH had to take more than $7 million out of its research into fighting cancer and more than $4 million from our work to turn the tide on the illness that claims more American lives than any other: heart disease.

It’s also appalling – though not surprising – that a House Republican agreement on Zika restricts entities that can receive funds to provide contraception, with Planned Parenthood being the most obvious omission. Refusing to fund Planned Parenthood is a direct blow to many of the women who are most vulnerable to Zika: low-income women living in areas with few other healthcare options. The Guttmacher Institute’s Jennifer Frost and Kinsey Hasstedt gave some numbers on this at the Health Affairs blog:

Our analysis shows unequivocally that Planned Parenthood plays a major role in delivering publicly supported contraceptive services and supplies to women who are in need of such care nationwide. In two-thirds of the 491 counties in which they are located, Planned Parenthood health centers serve at least half of all women obtaining contraceptive care from safety-net health centers. In one-fifth of the counties in which they are located, Planned Parenthood sites are the sole safety-net family planning center.

Further, the average Planned Parenthood health center serves significantly more contraceptive clients each year than do safety-net centers run by other types of providers, such as federally qualified health centers (FQHCs) or county health departments. As a result, Planned Parenthood centers serve a greater share of safety-net contraceptive clients than any other type of provider. And, Planned Parenthood sites are more likely to make contraceptive care quickly and easily accessible to the women who need it.

They wrote that a year ago, when House Republicans promoted the phenomenally damaging idea of eliminating funding for the Title X program, which funds family planning services for low-income women and men. I explained at the time why that was a terrible idea for public health. Now that we’re facing a virus that causes severe harm to developing fetuses and makes prevention of unwanted pregnancies even more important … well, House Republicans once again want to eliminate Title X funding – and funds for teen pregnancy prevention, too.

Insufficient funding for family planning providers is especially problematic in Puerto Rico. Obstetrician/gynecologist Kristyn Brandi, who worked with local community health centers in Puerto Rico during the summer, offered this description and recommendation:

Some clinics had some forms of contraception, but the majority barely had oral contraceptive pills in their office to offer patients. Most did not have the newer forms of long-acting reversible contraception (LARC) like the intrauterine devices (IUDs) or an implant. Many providers do not offer abortion services and do not have a place to refer patients that desire counseling on their options. Community health centers, the poorest of clinics there, are doing their best to give people information while barely being able to stock free condoms. Between concerned patients and frustrated physicians, there is so much to be done.

…  The only scientifically proven weapons we have against more babies born with Zika-related birth defects are reproductive health services. The sad fact is that while Congress delays access to much-needed resources because of ideological differences about whether family planning should be funded by a portion of the Zika bill, more and more women and men are becoming infected. Reproductive autonomy — the ability to control when and if a woman becomes pregnant or chooses to continue a pregnancy — is at the heart of all of these delays. But the bottom line is: Providing reproductive health services to those in Zika-affected areas is vital to protecting women’s and children’s health.

Congress can’t rewind the clock seven months and respond more appropriately to President Obama’s original funding request, but they do have a chance to do the right thing this month. I hope they’ll keep in mind the words of Drs. Frieden and Fauci:

The potential cost of a funding shortfall will be measured in human misery and even death. Every child born with microcephaly as a result of the Zika infection of the mother during pregnancy could require care that costs the family and our health-care system anywhere between $1 million and $10 million over the lifetime of the child. Every child born with microcephaly faces a difficult future, filled with intensive therapy and support. It is a price that no child — no mother, no father, no family — should have to pay, especially given that it can be avoided.

Secretary Burwell put it even more succinctly: “Our nation’s ability to mount the kind of Zika response that the American people deserve sits squarely with Congress.”

Some of our past posts on Zika
The spread and toll of Zika (January 5, 2016)
Zika research: Microcephaly, stem cells, and, Guillain-Barré (March 7, 2016)
Zika in the US: Resources from CDC, disappointing responses from lawmakers (April 11, 2016)
With mosquito season around the corner, Congress drags its feet on Zika funding (May 12, 2016)
State, local public health lose critical funding because Congress fails to act on Zika: ‘Yes, we should be scared’ (May 27, 2016)
Florida reports first locally transmitted Zika cases; advocates push Congress to act on funding (July 29, 2016)