Communities across the country are preparing for the arrival of the Zika virus, but they aren’t preparing equally.
As the mosquito season kicks into full swing, the story playing out across the country is one of haves and have-nots. With no aid in sight from the federal government, local officials are preparing as best they can for the possibility that Zika could soon spread within the United States. But the task has fallen to a patchwork of state and local programs that have a huge disparity in financial resources and manpower.
In Lee County, Florida, the country’s best-funded mosquito control authority plans to mobilize its fleet of helicopters, airplanes and on-the-ground workers over a one-square-mile area wherever a Zika case surfaces.
In Alabama and New Mexico, officials are handing out hundreds of thousands of mosquito-themed coloring books to schoolchildren, hoping to teach them and their families how to avoid the mosquitoes that carry the Zika virus.
In South Dakota and a few other states, authorities are collecting and shredding mountains of old tires, a favorite breeding ground for the mosquitoes that spread Zika.
Places with ample funding, such as New York City, have extensive efforts underway to control the mosquitoes that carry the virus and respond aggressively should the disease begin to spread locally. Yet many areas of the South and Southwest — which are at far higher risk of Zika because they are home to the disease’s primary mosquito vector — have so few dollars that they are relying largely on a mixture of public education and good luck.
Zika infections are especially dangerous for pregnant women, putting their fetuses at risk of developing severe birth defects, including microcephaly, in which the brain fails to grow properly. The Centers for Disease Control and Prevention is monitoring at least 265 pregnant women with Zika infections in the continental United States, and that number is expected to grow. Eight U.S. pregnancies have already resulted in birth defects.
So far, the Zika cases detected in the United States are in people who contracted the virus while traveling or whose sexual partners were infected abroad. Infected people have the potential to pass the virus to others through mosquitoes; infected men also can pass it to their sexual partners.
The Obama administration asked Congress for $1.9 billion in emergency funding to fight Zika four months ago. On Thursday, lawmakers failed again to reach agreement before the House adjourned until July 5. House Republicans approved a $1.1 billion package that received no Democratic support because funding would be partially paid for by cuts to the Affordable Care Act and shifting money from funds set aside to fight Ebola. The legislation also would prevent any Zika funding from being sent to Planned Parenthood.
The White House accused Republicans of putting politics ahead of the health and safety of Americans, particularly pregnant women and their babies.
“This plan from congressional Republicans is four months late and nearly a billion dollars short of what our public health experts have said is necessary to do everything possible to fight the Zika virus, and steals funding from other health priorities,” White House press secretary Josh Earnest said late Wednesday. The plan’s limits on birth control services for women in the United States and Puerto Rico, he said, “is a clear indication that they don’t take seriously the threat from the Zika virus or their responsibility to protect Americans.”
The CDC plans to send rapid-response teams at the states’ request to any community on the mainland or Hawaii where the virus begins to spread locally. The expert teams will help state and local authorities monitor cases, perform lab tests and plan for mosquito control.
But for the most part, mosquito control remains the responsibility of local authorities.
CDC Director Tom Frieden said he was encouraged by the dedication of communities around the country aiming to educate the public and reduce the risk of infection.
"But not having the [federal] funding hinders states, cities and counties and makes it harder to protect pregnant women," he said. "CDC is scraping together funds to meet immediate needs — but this is no way to fight an epidemic."
And while the risk of outbreaks might be low, the consequences could be devastating, Frieden said. “You are now in a situation where you could be sitting on your patio somewhere in the U.S. South and you get a mosquito bite and your life changes,” he said.
Even if federal funding materializes, it may be too late, some public health experts warn.
Without additional resources, the already-depleted health departments in many states and localities aren’t actively looking for infections in humans, said Peter Hotez, a tropical disease expert at Baylor University.
“There may be cases appearing that are not getting diagnosed,” he said. “Right now, if things don’t change, I’m worried we won’t realize we’ve had a Zika epidemic until months from now, when we start seeing microcephaly cases on obstetric wards.”
The CDC has warned that local transmission is most likely to occur in areas that have reported cases of dengue or chikungunya in the past, two viruses related to Zika and spread by the same mosquito — the Aedes aegypti.
In Alabama, one of the states considered at high risk, officials have expanded testing capacity at state labs. Some counties have “exemplary vector control programs,” said Jim McVay, who oversees health promotion and chronic disease for the state public health department. “But particularly in the rural counties, you have almost none.”
That poses practical problems for communities with few public employees.
“Are you going to pick up the garbage on the street three days a week, or have somebody go out and spray tonight? Because you can’t do both,” McVay said.
The state has also tried to recruit citizens to eliminate standing water around their homes, in part by sending out educational “Skeeter Beaters” coloring books to children in third grade and under.
In New Mexico's Dona Ana County, a sprawling farming community across the border from Ciudad Juarez in Mexico, officials also are relying on a Spanish-
English coloring book that features Keeko the "mosquito bandido." More than 12,000 copies have been distributed to grade-school children.
New York City, with far greater resources, developed an extensive plan to fight Zika even though the Aedes aegypti mosquitoes have never been documented there. But the CDC estimates that the mosquito has a potential range north of the city, and Aedes albopictus, the other mosquito that can transmit Zika, is present.
New York established a Zika call center that approves testing requests from health-care providers; selected 21 primary-care clinics and emergency departments as “sentinel” sites to look for locally acquired cases; and used geospatial analysis to identify neighborhoods where pregnant women may be at high risk, because people travel frequently to Zika-affected countries. The city has distributed thousands of Zika testing information cards, and the city subways carry travel warning messages.
The Lee County, Florida, independent mosquito control district has an annual operating budget of more than $16 million. That includes four planes, 11 helicopters and scores of spray trucks. That arsenal is primarily to combat the nuisance mosquitoes that populate the county's salt marshes. But if Zika arrives, officials plan to use every tool at their disposal to eliminate the Aedes aegypti mosquitoes in a one-square-mile radius around where an infection occurs.
“We want to keep it where there is no local transmission; that’s our goal,” said Shelly Redovan, a spokewoman for the county’s mosquito control district.
Aedes aegypti was behind deadly yellow-fever outbreaks during the 19th century in New Orleans, Hampton Roads in Virginia and Memphis. In the early 20th century, fighting the mosquito, primarily throughout the South, became a priority of the federal government.
But as yellow fever was largely eradicated in the United States and the use of air conditioning and window screens became widespread, it became more of a nuisance than a public concern.
"The Aedes aegypti hasn't been an issue for the past century," said Joe Conlon, technical adviser for the American Mosquito Control Association and a former U.S. Navy entomologist.
In recent years, officials in many localities have been far more concerned with Culex mosquitoes that carry West Nile virus.
Controlling the two types of mosquitoes is very different. Aedes aegypti fly no more than 150 yards in their lifetimes and prefer to lay eggs in man-made containers. They require an intense, boots-on-the-ground campaign to eradicate breeding habitats on individual properties. Culex mosquitoes lay eggs in lakes, ditches, gutters and neglected pools and are usually treated with spray trucks and planes over larger areas.
Many communities are facing the unenviable choice of trying to fight the mosquitoes that could cause a Zika outbreak, while also treating for the mosquitoes that spread West Nile, said Dan Markowski, of Vector Disease Control International, a private mosquito control service that contracts with numerous states and localities.
Almost no place has the resources to do both well, he said.
Dallas County, Texas, which had nearly 400 cases of West Nile in 2012, has been on the lookout for Zika, in part because the county has seen periodic cases of dengue and chikungunya. In February, Dallas reported the first sexual transmission of Zika.
“Public enemy number one is still the Culex mosquito for West Nile. That’s still going to be our number one vector-borne disease here,” said Dallas County Health and Human Services Director Zachary Thompson. “But the fact that you have Zika with the potential for local transmission — that raises the bar.”
Thompson said he and his colleagues around the country feel added pressure these days because there are growing demands and almost no new resources.
“We’re all stretched thin,” Thompson added. “There needs to be an infusion of federal dollars focused on vector-borne illnesses. It can’t just be a local fight with local dollars.”